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Flagging opioid abusers
January 12th, 2015
Should we flag patients who misuse and/or overdose on opioids? Should these patients be closely monitored? With nearly one-fourth of 3.5 million opioid users in the United States exhibiting a least one indicator of misuse, it’s becoming a major health issue that needs to be addressed.1
The statistics are staggering. In 2010, nearly 40,000 Americans died from a drug overdose, and another 1.2 million landed in the emergency room due to prescription drug abuse. In 2009, opioid analgesics, either alone or in combination with other drugs, accounted for nearly half of the drug overdose deaths in the United States and almost 75% of prescription drug-related emergency room visits.1
So, researches set out to study the indicators for risk of misuse among a study population.1 They found that having more than one opioid prescription, overlapping or refilling prescriptions early, dose escalation, and having several days’ worth of opioids as indicators of misuse. According to the study authors, patients should have no more than a 7-day supply of opioids for acute pain.
Other study findings showed among those patients who were prescribed opioids, twice as many received prescriptions for acute pain as for chronic pain, and about 15% had high daily doses. Women were more likely than men to indicate an overlap of opioid prescription use with other drugs, like benzodiazepine, which is used to treat anxiety.
“In this study, 22.8% of opioid prescriptions for acute pain were for 10 or more days, and 9.5% were for 30 or more days,” the study authors wrote. “The American College of Occupational and Environmental Medicine practice guidelines only recommend opioids on a limited basis for treatment of severe, acute low back pain, with treatment to last no more than 2 weeks. In this study, 42.3% of opioid prescriptions for back pain were for 30 days or more, clearly much more than recommended.”
While certainly not every patient is at risk for misuse, the authors suggest more review programs be implemented to flag patients who might need to be closely monitored. “A number of tools and approaches clinicians should use to safely prescribe opioids,” the study authors say. “These include checking prescription drug monitoring programs, which track information on controlled substance prescriptions filled in a state, taking a careful history of substance abuse and other mental health problems, conducting routine urine drug screens in concert with pain management agreements, and making use of pain medicine consultants when problems arise.”
Reference 1. http://www.ajmc.com/publications/issue/2013/2013-1-vol19-n8/Potential-Misuse-and-Inappropriate-Prescription-Practices-Involving-Opioid-Analgesics