Prescription Drugs and Potential for Abuse and Misuse

Las Vegas—Providers are usually careful when prescribing opioids and pain medications. The drugs are associated with the potential for misuse and abuse, although there is no single factor to predict whether someone will experience from these issues, according to Yrena Friedman, PharmD, manager at Aetna Pharmacy Management.

Dr. Friedman, who spoke at the PBMI conference, said a variety of factors are at play when a person becomes addicted such as biological changes, the social environment, and a person’s age. The more risk factors lead to a greater chance the person will become addicted.

Citing research from the National Institute on Drug Abuse, Dr. Friedman said 20 million adults in the United States have problems with substance dependence or abuse. Of this population, 60% are employed full time.

The annual workplace cost associated with opioid abuse, dependence, and misuse is $25 billion, according to Dr. Friedman. She added that the average annual healthcare costs for opioid abusers are $16,000 compared with $2000 for nonabusers, according to a 2005 white paper published in the Journal of Managed Care Pharmacy. Of the $16,000, $2000 are for drug costs, $8000 are for hospital inpatient costs, $5000 is for physician’s visits or outpatient costs, and $1000 is for other costs such as emergency department costs.

Dr. Friedman cited a 2011 report that appeared in Pain Medicine saying that the annual cost of prescription drug abuse, misuse, and waste is $55.7 billion, with $25.6 billion in healthcare costs, $25.0 billion in workplace costs, and $5.1 billion in criminal justice costs.

To define the terms commonly used when discussing the prescription drug issue, Dr. Friedman discussed the terms used by the Federation of the State Medical Boards, a nonprofit organization representing 70 medical boards in the United States.

The organization defines addiction as the chronic, compulsive use of drugs, which leads to changes in the brain and affects self-control. People who are dependent on the drugs need them to function properly and experience withdrawal symptoms if they stop using them. When people become tolerant to the drugs, the body adapts and requires increased dosage to have the same affect as before. In addition, patients with pain who receive inadequate pain medication sometimes suffer from pseudo-addiction, which is defined as a relief-seeking syndrome.

Dr. Friedman said Aetna takes precautions when dealing with prescription drugs. Before prescribing the medications, employees manage the use of the drugs. They also perform clinical evaluations of medical and pharmacy data and intervene when necessary.

Aetna uses an integrated case management system, according to Dr. Friedman The company controls access to drugs that have the highest abuse potential by implementing mandatory safety edits for high-cost controlled substances. It also identifies patients with high utilization of the drugs, multiple prescriptions, or providers who engage in suspicious dispensing. Aetna members are able to connect with support services if they are having issues and can enroll in chemical dependency and/or pain management programs. If patients refuse support, Aetna locks them into one provider, installs quantity limits, denies future opioids, recovers claims, or refers the patients to state or federal agencies if necessary.

Through its research, Aetna found members were misusing Suboxone^® (buprenorphine and naloxone), which is used to treat opiate addiction. Dr. Friedman said checks of prescriptions and drug utilization reviews revealed that members who took buprenorphine and naloxone were still receiving opioids. Aetna contacted to prescribers and told them to deny future opioid claims.

From the program initiation in January 2010 until January 2012, the number of opioids dispensed dropped from 42,000 to 36,000. In addition, medication adherence to buprenorphine and naloxone improved from 40.6% to 56.7%.

“We are seeing some positive results,” Dr. Friedman said. “Do not give up. Keep fighting the good fight against prescription drug abuse.”