Study: Many opioid users are taking Rx drugs in potentially harmful combinations; education needed

A majority of opioid users are taking the painkillers concurrently with other prescription drugs, according to a report from Express Scripts that analyzed US opioid trends.

The Express Scripts Lab opioid study findings indicated that 58.5% of patients using prescription opiate painkillers were taking them with other prescription medications, in combinations that posed “potentially serious safety risks.” The combinations included opioids with benzodiazepines (29.2%), muscle relaxants (28.3%) or all 3 medications (8.0%); and 27.5% were taking 2 or more prescription opioids concurrently. Among the patients combining medications, 66.6% obtained prescriptions from two or more physicians, and 39.8% filled their prescriptions at 2 or more pharmacies.

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According to the Express Scripts report, prescription opioids, benzodiazepines and muscle relaxants all have a sedative effect; combining these medications can magnify that effect and slow down the respiratory system, with potentially fatal consequences. Government statistics reveal that opioids were responsible for 75.2% of all pharmaceutical overdose deaths; and in deaths involving multiple prescription drugs, the combination of opioid analgesics and benzodiazepines accounted for 30.7% of deaths.

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To combat substance abuse involving prescription drugs, 49 states-excluding Missouri-have implemented prescription drug monitoring programs (PDMPs) that use electronic databases to track the dispensation of controlled substances. However, PDMPs are not necessarily mandated or enforced in all states; and there are indications that some patients attempt to circumvent these programs by filling prescriptions out of state. An Express Scripts analysis found that “residents from seven neighboring states filled opiate prescriptions in Missouri as much as four times more often than residents in Missouri filled opioid prescriptions out of state.”

Other findings included:

·         Nearly half of all Americans who used opioids for 30 days in the first year of use continued to use them for 3 years or longer.

·         Younger adults demonstrated a propensity to fill the highest number of prescriptions and had the greatest increase in the number of days prescribed per prescription.

·          The most significant clustering of opioid use was found in small cities in the Southeastern region of the United States, with the vast majority of these cities located in 4 states: Kentucky, Alabama, Georgia and Arkansas. 

In response to this research, Novus Medical Detox Center urged stricter controls of prescription medications and implementation of a national prescription drug database.

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For patients currently taking multiple prescriptions, Novus advised a physician consultation to discuss potential interactions and health risks, and enrollment in addiction and detox programs for those looking to overcome a dependency.

“This study should cause concerns that our health industry in some cases appears to be inconsistent in how we are delivering care and this inconsistency places many Americans at risk of addiction and physical harm,” said Kent Runyon, executive director of Novus Medical Detox Center.

“It creates concern that we have a generation of Americans who are starting their adulthood with a dependence or addiction to opioids,” he said.

Runyon offers these 3 take-away points.

1/  There is more education needed to discuss the risks associated with the use of some combinations of prescription medications.

2/. Look at the geographic data associated with this study.  What are the underlying reasons for the clustering of opioid use in some communities in the Southeastern region of the United States?

3/ Continue to educate physicians regarding long-term use of opioids and insure that all Americans who begin taking opioids fully understand the risks of taking them beyond a few days or weeks.