Electronic databases can help fight prescription painkiller abuse

Annual prescription painkiller rates are stabilizing after increasing fivefold in a 10-year period, researchers at Columbia University's Mailman School of Public Health found, and prescription drug monitoring programs (PDMP) contribute to plateauing utilization. 

The study analyzed data from the U.S. Drug Enforcement Administration on the seven most commonly distributed opioid analgesics: Fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine and oxycodone. Researchers found PDMPs could be even more helpful in abuse control by increasing interstate data sharing and making prescription drug dispensing information available to providers in real time.

Many states use PDMP reports to see if patients are doctor shopping or getting prescriptions from multiple providers to satisfy drug addictions. As of 2012, 43 states use databases to track opioid prescriptions, CBS News reported. But chronic pain sufferers said in a recent poll by the National Pain Foundation that they were humiliated and treated like addicts by pharmacists, the article noted.        

Painkiller overdoses killed 15,000 people nationwide in 2008. Data from the Centers for Disease Control and Prevention show prescription drug misuse causes more annual deaths than cocaine and heroin combined, CBS reported.

Nevertheless, many insurers haven't measured the risks prescription opioid abuse, diversion and addiction present to members and profit margins, according to an article in the American Journal of Managed Care. The article lists eight government-recommended steps payers can take against fraud:  

  1. Implement data sharing to spot fraudulent enrollments and claims.
  2. Check prescribers and pharmacies against the federal exclusions list.
  3. Perform drug utilization reviews.
  4. Precertify abuse-prone medications.
  5. Increase use of state PDMPs.
  6. Check vital records to prevent inappropriate payment for deceased members. 
  7. Increase use of the restricted participant program.
  8. Aggressively investigate and prosecute those involved in prescription painkiller fraud.  

Finally, here's another analytics-related tactic to consider: Humana partnered with Pfizer to create a predictive model that flags members at risk for opioid abuse, as FierceHealthPayer reported.  

For more:
- here's the study announcement
- see the CBS News article
- read the American Journal of Managed Care article