The misuse and abuse of prescription pain medications is an epidemic, and the statistics are staggering:
Every day, more than 1,000 people are treated in emergency rooms as a result of prescription opioid misuse.
In 2015, more than 12.5 million people misused prescription opioids.
Drug overdose is now the leading cause of death in the U.S. among Americans under 50.
In addition to treating those already impacted by opioid addiction, one way to help stem this public health epidemic is to identify and stop inappropriate prescribing and misuse of opioids. In fact, research from the CVS Health Research Institute and Johns Hopkins University provides evidence that automated algorithms – or complex calculations – in electronic medical and pharmacy claims data may be useful in screening large populations for non-medical opioid use as well as identifying those providers who may be writing fraudulent prescriptions.
The systematic review, published in the Journal of American Medical Informatics Association, evaluated 15 algorithms that used electronic prescription and/or medical claims to identify and track habits associated with opioid misuse such as pharmacy or doctor shopping, or those who visit multiple doctors or pharmacies seeking prescriptions that are not medically necessary. The authors conclude that algorithmic approaches, such as the ones studied, can help identify patients and providers in need of more intensive screening or intervention, such as pharmacy-based outreach, for further evaluation of opioid misuse.
“With the exponential rise in non-medical opioid use, this research shows the utility of automated algorithms to detect potential misuse,” said Dr. Troyen A. Brennan, MD, Chief Medical Officer, CVS Health and study co-author. “As health care payors seek to both improve patients’ health and minimize fraud and waste, these data-driven approaches are applicable and beneficial to real-world, population-level surveillance and critical to targeting patient outreach and intervention as well as minimizing provider fraud.”
Steps Toward a Solution
We have a number of efforts underway to address opioid misuse and abuse. Our pharmacy benefits manager, CVS Caremark, has an extensive safety and monitoring program. This includes regular retrospective analyses and screening of pharmacy claims to uncover patterns of behavior that could signal non-medical opioid use. This process relies on a number of common predictors of opioid misuse that were studied in the research. In addition, we conduct regular drug utilization reviews and when appropriate, employ quantity limits, criteria, for example, that sets maximum daily dose per labeling.
In addition, in states with prescription drug monitoring programs, our CVS pharmacists have access to real-time information on what drugs a patient is taking as well as when and where these prescriptions were filled, which can help detect doctor and pharmacy shopping. We are also working to expand access to the opioid antidote naloxone; working to prevent teen drug abuse through our student education program Pharmacists Teach; and providing access to safe disposal of unused or unwanted prescription drugs with Medication Disposal for Safer Communities.
Together, these things help ensure greater awareness of the risk of prescription drug abuse as well as the clinically appropriate use of these controlled substances when prescribed.
For more information about our efforts in the fight against opioid abuse, visit our Prescription Drug Abuse information center. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.
This article was originally published on July 18, 2017, and was updated to reflect current data on September 21, 2017.