Risks of Prescription Drug Abuse

Las Vegas—Patients with commercial insurance who are taking prescription drugs are at risk of abusing the medications and burdening the healthcare system with significant costs, according to pharmaceutical and medical claims data. The authors cited data that found an estimated 7 million people in the United States abuse prescription psychotherapeutic medications, while prescription drug abuse contributes to $25 billion in excess healthcare costs.

These results were presented during a poster session at the PBMI conference. The poster was titled Medical and Pharmaceutical Claims-Based Identification of Potential Prescription Drug Abuse.

In 2004, an article identified 10 predictors of controlled substance patterns of utilization requiring evaluation that could identify people who may abuse or mismanage substances. The list included:

(1)  Multiple prescribers (≥6 prescribers for the same drug)

(2)  Multiple pharmacies (≥4 pharmacies for the same drug)

(3)  Chronic use of carisoprodol (≥4 prescriptions in 6 months)

(4)  Continuous overlap of ≥2 different benzodiazepines for ≥30 days when 1 is for alprazolam

(5)  Estimated ≥4 grams of acetaminophen, 2 prescriptions for meperidine hydrochloride with more than a 2-day supply

(6)  Chronic use of butorphanol (≥4 prescriptions in 6 months)

(7)  Continuous overlap of ≥2 different benzodiazepines for ≥90 days when 1 is clonazepam

(8)  Continuous overlap of ≥2 different benzodiazepines for ≥90 days when 1 is diazepam

(9)  Overlap of ≥2 different sustained-release or long-acting opioids for ≥90 consecutive days

(10) Suboxone use without history of opioid abuse

The authors noted that in the 10 years since that article was published, prescription drug abuse has changed, due in part to the increasing use of buprenorphine and naloxone. The FDA approved buprenorphine and naloxone in 2002. There were nearly 8 million prescriptions for buprenorphine and naloxone in 2012, nearly 4 times more than 5 years earlier.

In this analysis, the authors examined data from a geographically diverse cohort of trusts that included 264,964 people <65 years of age who had pharmaceutical and medical claims from July 2012 to June 2013.

The authors found that prevalence of the predictors in their analysis differed from the ones published in 2004. They noted that the prevalence of the multiple prescriber predictor significantly decreased, while the prevalence of the multiple pharmacy predictor significantly increased. They added that the lower prevalence of the multiple prescriber predictor may be associated with the increased monitoring of “doctor shopping,” with the number of states monitoring “doctor shopping” increasing from 16 in 2002 to 46 in 2012.

Of the study’s participants, 1390 (5.25 per 1000) met the criteria for at least 1 of the predictors: 83% had 1 predictor, 15.1% had 2 predictors, and 1.9% had ≥3 predictors. The participants had the following characteristics: average age of 45.4 years, 49.7% were female, 47.4% were employees, the total cost per member was $17,381, the medical cost per member was $13,103, and the prescription cost per member was $4278. In addition, the controlled substance cost per member was $2379, while the controlled substance prescriptions per member was 24.7.

The people who met the criteria for at least 1 predictor had higher financial costs than typical members, including approximately $200 per month spent on controlled substances. Furthermore, 37.1% of people who took buprenorphine and naloxone had no evidence of opioid addiction in the 12 prior months of medical claims. Of the people prescribed buprenorphine and naloxone, patients who had a diagnosis of opioid addiction had significantly higher medical costs and were approximately 5.5 years younger than patients without a diagnosed opioid addiction.