When I was in pharmacy school, I had my wisdom teeth taken out by an oral surgeon at The Ohio State University Dental College. My friend, who was also in pharmacy school, took me to that appointment and was my ride home. It took me several hours to wake up after surgery and when I was being discharged, the surgeon was going to prescribe Percocet for my pain. My friend discouraged him, stating Percocet was too strong, that I would probably be a zombie if I took it. He listened to her advice and prescribed Vicodin. If you aren’t familiar with Percocet or Vicodin, they are in a class of drugs called opioids. Opioids are used to treat pain and are highly addictive. The surgeon in my story did what many prescribers have done for decades now. He prescribed an opioid for acute pain when it wasn’t necessary.
Opioid abuse continues to be an epidemic in the United States. The crisis can be credited to the prescribing of too many opioids for too many conditions for too long. Drug overdose remains the leading cause of accidental death and the majority of these are due to opioids. The CDC reports 91 Americans die every day from an opioid overdose. So what is being done to combat the epidemic? The CDC published guidelines for Prescribing Opioids for Chronic Pain in March 2016 and states are also making changes to address the epidemic. Many states now encourage or require a prescriber to check their state Prescription Drug Monitoring Program (PDMP) database before prescribing opioids. This provides visibility to opioids and controlled substances a patient has received from other prescribers. The information can help identify patients who may be abusing opioids or other prescribed medications and may be at risk for overdose. Several states have adopted a limit on the days supply that can be prescribed for new prescriptions of opioids and many states have adopted specific guidelines for the prescribing of opioids. States are also putting drug formularies or preferred drug lists in place to further assist in decreasing the prescribing of opioids.
Opioids are a top therapeutic class for drug spend in Workers’ Compensation. PBMs can play a vital role in assisting clients manage claimants on opioids. Edits can be placed in the system to generate alerts if a claimant has been on an opioid for a specified amount of time. Morphine equivalent doses can be calculated to determine those claimants on high dose opioid therapy. Once these claimants are identified, ensure your PBM has a solution to address these medications.
Equian identifies claimants on opioids who are at high risk and offers interventions and Peer Reviews which can lead to a change in treatment plan. If a treating prescriber agrees to a change in treatment plan, Equian recommends oversight services to keep the treating prescriber on track with the agreed upon changes. If a treating prescriber is not cooperative, next steps will be recommended based on the state of jurisdiction.
Medina Lee, R. Ph.
Director of Pharmacy Clinical Services