How patient engagement and data may curb prescription painkiller abuse.

Frank Lee leefh9@gmail.com

Abstract

Prescription painkiller abuse is an epidemic and a serious public health problem in the United States.  In 2013, 16,235 drug overdose deaths were related to opioid analgesics (1).  For every drug abuse death, there were 10 treatment admissions for abuse, 32 emergency department visits, and 130 patients who abuse or are dependent on prescription medications (2,3,4).  The estimated cost of prescription opioid abuse in the United States in 2007 was $55.7 billion, of which 46% was attributed to workplace costs, 45% to healthcare costs, and 9% to criminal justice costs (5). 

Despite new laws and guidelines to curve abuse, the continued growth of painkiller overdose in part reflects the lucrative business of painkillers for the healthcare industry.  According to IMS Health, in 2011, U.S. sales of prescription painkillers amounted to $9 billion.  In one “pill-mill” in Florida, a physician had the potential to earn roughly $37,500 a week, or $1.95 million a year by prescribing such painkillers indiscriminately (6).  Between the pharmaceutical industry, the opium fields in India and Turkey, and the thousands of pharmacies and doctors offices, there is plenty of profit to be shared.  United States holds 5% of the world population, yet it consumes 80% of painkillers in the world.

Physicians are the current gatekeepers of painkiller prescriptions.  Due to increasing abuse and pressure by the Drug Enforcement Administration, a recent survey showed that nearly half of the primary care physicians were less likely to prescribe painkillers today compared to a year ago (7).  Unfortunately, the major casualty of war against painkiller abuse is the good patient with pain who can be difficult to discriminate from a painkiller abuser.

Despite the massive amount of patient data that is created each time a patient is prescribed a painkiller, from the physician note that documents the need for pain medication, the urine toxicology report to monitor patient’s compliance, the prescription that describes the medication, the insurance claim to fill the prescription, the pharmacist’s documentation, and the state sponsored narcotic registries, such data has not been effective in curving painkiller abuse. Furthermore, data produced by such systems is often fragmented and has little value to the providers.  In short, even if you are a good patient with pain, a physician may refuse to prescribe painkillers, a pharmacist may decline to fill the prescription, and the insurance company may refuse to pay for the medication, all because you maybe suspected of abusing painkillers since there is no way of proving otherwise.

We need a revolution in how we use prescription painkillers data to help good patients with pain have easier access to opioid analgesics and differentiate them from patients who abuse them.  All of the regulatory efforts and gatekeeping cannot be left to the healthcare industry and its providers.  We need a system that organizes patient data into a meaningful tool for healthcare providers and also empower good patients to differentiate themselves from abusers.  

There are many stakeholders in the world of pain management including the pharmaceutical industry, insurance industry, physicians, and pharmacists.  But the most important stakeholder, the patient, arguably has the least influence in how painkillers are prescribed to them.

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