4 ways to manage prescription drug misuse

While there are signs of progress in the epidemic of prescription drug misuse, everyone is at risk of misuse, according to a new study.

The Quest Diagnostics Health Trends study (Prescription Drug Misuse in America: Diagnostic Insights into Managing the Drug Epidemic) found that 55% of Americans potentially put their health at risk by misusing drugs including pain prescription medications in 2013, a decrease of 8 percentage points compared to misuse rates of 63% in 2011.

The analysis assessed inconsistency rate by age, gender, health plan payer group; patterns of misuse; the use of different drugs-illegal or controlled-other than those prescribed; the use of additional, non-prescribed-illegal or controlled -medications; the failure to use or detect prescribed drugs; the frequency of morphine negativity among patients who tested positive for heroin metabolite, 6-monoacetylmorphine; and the scope and pattern of abnormal test reports with specimen validity testing.

“The declining trend in prescription drug misuse suggests better provision of information of prescribed drugs, less misuse of additional drugs other than those prescribed, better compliance with prescriptions, or a combination of these factors,” said F. Leland McClure, PhD, a study investigator and director, pain management, mass spectrometry operations, Quest Diagnostics.

The analysis of more than 1.4 million drug test results between 2011 and 2013 also suggested that Americans are misusing drugs in different ways than previous years. Patients are increasingly supplementing their prescribed medications with increasing amounts of nonprescribed drugs, and decreasingly substituting different drugs for those prescribed and not taking their prescribed medications.

The high rate of prescription medication misuse was observed across all age groups, both genders, and across different health plans. Adolescents experienced the greatest gain in appropriate prescription drug use, with inconsistency rates for patients aged 10 to 17 years decreasing from 70% in 2011 to 57% in 2013. Seniors (aged 65+ years) showed the greatest rate with medication compliance, with a 44% inconsistency rate.

“Healthcare professionals should discard ‘traditional wisdom’ suggesting that patients with high potential for misuse could be pre-identified based on assumptions about age, gender or socio-economic status, as the report’s findings suggest that these assumptions may be misguided or out of date,” McClure said.

“The analysis also found significant decreases in certain states with comprehensive prescription drug abuse programs, suggesting that broad, collaborative measures that include prescription drug databases and physician and patient education may be effective at curbing the nation’s epidemic of prescription drug abuse,” McClure added.

Florida, Georgia, Kentucky, New York and Tennessee showed the highest rates of decline in misuse rates over the last 3 years. The average decline for these states was 10.7%, nearly 2.5 times higher than the average decline of 4.4% for all other states combined. These states share common characteristics, including the use of prescription drug monitoring programs (PDMPs), broadly implemented physician education programs and public awareness campaigns. 

Formulary managers can manage prescription drug misuse by doing the following:

1.Be vigilant. The analysis shows that while prescription drug misuse has decreased, the majority of Americans still misuse their medication medications. Formulary managers can play a key role as “auditor” through the use of data analytics to identify outliers and suspicious patterns of prescribing or overutilization.

2.Don’t rush to judgment on formulary restrictions.  While the high rate of misuse of prescription drugs (and especially highly addictive opiates) is often attributed to increased prescribing over the last decade, our findings indicate that issues of misuse are complex and multi-faceted. Healthcare practitioners, including formulary managers who are involved in updating lists of approved medications, must remain sensitive to the need for balance between the very real needs of chronic pain patients with the need to ensure prescription adherence.

3.Contribute to the information exchange. Our report suggests that physician education has been a key contributor to the decrease in misuse rates. Proactive efforts to reach physicians who exhibit suspicious prescribing patterns can lead to an informed dialogue about patient treatment options.

4.Advocate for the availability of PDMP data to “end users” such as formulary managers. Our analysis showed marked improvements in states with comprehensive drug abuse prevention programs, including PDMPs. All states should allow access to PDMP data to private health insurers or other end users in order to improve monitoring of prescription drug misuse via patterns suggestive of substance abuse and diversion.