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July 22, 2015
Opioid Users Visiting Multiple Pharmacies Have Higher Overdose Risk
Davis, CA—Pharmacy shopping for opioid prescriptions is a key indicator that abuse or misuse of the painkillers might be occurring, according to a new study. A study published recently in The Journal of Pain notes that using multiple pharmacies to fill prescriptions is linked with opioid overdoses. Researchers from the CDC, many of whom were at the University of California Davis during the study, and colleagues also found that nearly half of deaths attributed to prescription opioids were Medicaid recipients. In fact, according to background information in the article, Medicaid programs in many states monitor the number of pharmacies visited to determine risk for misuse or abuse of opioid medications. Yet no consensus exists on the threshold number of pharmacies or specified length of time that can define pharmacy-shopping behavior. The risk also exists that patients who legitimately use multiple pharmacies—because of insurance coverage changes, moving, traveling or vacations—could be misidentified as potential opioid misusers, study authors point out. For the study, researchers examined records from 2008 through 2010 of more than 90,000 Medicaid enrollees in Washington State who used three or more opioid prescriptions, focusing on adults who were long-term opioid users. Visiting four pharmacies over a 90-day period had the highest diagnostic odds ratios for opioid overdose events, according to the results, and might be considered as an indicator for pharmacy shopping. A subgroup with overlapping prescriptions had an even higher overdose rate—18.5 per 1,000 person-years [PYs]) compared to 10.7 per 1,000 PYs for those with pharmacy shopping as the only indicator. Among the subgroup with both conditions, meanwhile, the overdose rate was 26.3 per 1,000 PYs, compared with 4.3 per 1,000 PYs for those with neither condition. The study found that overlapping opioid prescriptions and pharmacy shopping measures had adjusted hazard ratios of 3.0 and 1.8, respectively, for opioid overdose. For patients whose use of overlapping prescriptions and multiple pharmacies cannot be medically justified, study authors suggest that patient review and restriction programs (PRRs) could restrict reimbursement for controlled prescription drugs to a single designated physician and one pharmacy. “Long-term prescription opioid use may lead to adverse events, including overdose. Both pharmacy shopping and overlapping opioid prescriptions are associated with adverse outcomes,” the report concludes. “This study demonstrates that using both indicators will better identify those at high risk of overdose.”
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