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State Study Shows Chronic Opioid Users Often Receive Dangerous Combinations

December 12, 2018
An Idaho report points to the continued need for prescriber-pharmacist communication especially when multiple prescribers are involved.

A state-wide study of patients on opioids confirmed other recent reports that chronic opioid users may receive dangerous prescription combinations, even when prescribers have access to drug monitoring databases that could prevent duplicate prescriptions. Many of the prescriptions involve multiple prescribers. The study, based in Idaho, was released at the December 2018 meeting of ASHP, a professional organization of 45,000 pharmacists.

PPM spoke to Michael Ganio, PharmD, BCPS, FASHP, ASHP’s Director of Pharmacy Practice and Quality for more insight.

Specifically, researchers at Idaho State University examined the controlled substance prescriptions for just over 300,000 patients reported to the Idaho Prescription Drug Monitoring Program (PDMP) in 2017. One third of the patients receiving a controlled substance were identified as chronic users (ie, they had taken the medications for more than 90 days without a break of at least 7 days). Nearly a quarter of those chronic users had also been prescribed a benzodiazepine or other central nervous system (CNS) depressants. The CDC has warned against such combinations due to a potential overdose.

PPM: How does this data, from 2017, impact ongoing national and state efforts to curb the opioid epidemic? Does ASHP anticipate that the reported trends noted in the study lessened in 2018?

Dr. Ganio: The 2016 CDC Guideline on Prescribing Opioids for Chronic Pain recommends that clinicians periodically evaluate the following factors for risk of overdose before continuing opioids in patients: a history of overdose, history of substance use disorder, high opioid doses, or concurrent benzodiazepine use. While the data from this research project demonstrated that one quarter of chronic opioid users in Idaho are at increased risk of overdose due to co-prescribing of a benzodiazepine or CNS depressant, the data did not inform us whether clinicians have evaluated the risk of overdose before deciding to continue both prescriptions at the same time. 

Because the data are only for one year, we cannot determine whether the number of chronic opioid users also receiving CNS depressants is increasing or decreasing. The CDC’s 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes shows a continued decrease in opioid prescribing in the United States, so it’s reasonable to expect that the number of patients at higher risk for overdose due to co-prescribing will decrease in 2018, but this analysis will have to be repeated to confirm a trend.

Source: 123RF

PPM: From a practical standpoint, in what ways does ASHP recommend pharmacists and prescribers better work together with regard to drug monitoring?

Dr. Ganio: What we do know from the data is that there is an opportunity for pharmacists and other clinicians to work together to reduce the risk of overdose. Since 44% of these chronic opioid users also receiving benzodiazepines were cared for by multiple prescribers, it’s possible that they are unaware of the patient’s current medication list and the patient’s increased risk of overdose.

Pharmacists can ensure all prescribers are aware of the patient’s current medication list and confirm that all prescribers have evaluated therapy for appropriateness. Pharmacists can also discuss the role of naloxone with prescribers and patients when these higher-risk combinations are considered appropriate.

Read more about pharmacists and prescribers working together in PPM's “Our Clinical Neighborhood.”


Last updated on: December 13, 2018
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