Congress told more prescription drug monitoring programs are needed

Physicians point to fragmented care and patients receiving multiple prescriptions from different doctors as enabling abuse of some medicines.

By Charles Fiegl amednews staff — Posted March 29, 2012

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More monitoring programs are needed to counter the abuse of prescription drugs in Medicaid and Medicare programs, physicians told lawmakers during a March 22 Senate hearing.

An epidemic of prescription drug use for nonmedical purposes has hurt families and communities across the country, said Sen. Jay Rockefeller (D, W.Va.), chair of the Senate Finance health subcommittee. He called for the hearing after concerns about abuse of medications in his home state. Problems such as misunderstanding the strength of addictive painkillers also can lead to unintentional misuse by elderly patients and tragic overdoses.

“Patients need better education so they are sure how to use powerful prescription drugs correctly,” Rockefeller said.

Taking multiple prescriptions is not uncommon for seniors, said internist and geriatrician Timothy C. Schwab, MD. He’s the chief medical officer of SCAN Health Plan, a private Medicare plan in Long Beach, Calif. Different medications, prescribed by different doctors and filled at separate pharmacies, can be extremely dangerous for patients when taken together.

“What is needed are ongoing drug utilization reviews which monitor appropriateness of prescriptions and alert members and physicians of potential risks,” Dr. Schwab said.

SCAN Health Plan confronts the problem of drug abuse by analyzing pharmacy data, using real-time system edits, and notifying physicians of duplicate prescriptions or medications that are inappropriate for seniors.

Dr. Schwab called for support of programs that identify potential problem pharmacies as well as patients with unusual or excessive utilization patterns. For example, his company tracks early refills, which can be an indicator of personal misuse, the diversion of drugs or a stolen prescription.

Jeffrey Coben, MD, director of the Injury Control Research Center at West Virginia University, had worked at an emergency department the day before the hearing. He encountered a half-dozen patients struggling with pain and medication issues during his eight-hour shift, he said. “Part of the problem is the fragmented primary care system. Patients seek out relief wherever they can obtain care.”

Dr. Coben advocated for the patient-centered medical home model for delivering health care, which could help eliminate prescription drug abuse through coordinating care. Prescribers often do not have a complete record showing all the medicines that a patient is taking.

The sickest patients often will receive opioids, said Alex Cahana, MD, chief of anesthesiology and pain medicine at the University of Washington, Seattle. He offered other solutions for combating prescription drug abuse, such as using an assessment tool to measure pain and seeking second opinions for those patients receiving high doses of opioids.

Roughly 2.5 million people used prescription drugs for nonmedical purposes for the first time in 2010, said Sen. Charles Grassley (R, Iowa), citing a recent Dept. of Health and Human Services study. His office has investigated the overprescribing of painkillers and has called on federal health programs to do a better job to reduce drug abuse.

For instance, Grassley has reviewed high-volume prescribers in Medicaid and has asked states to investigate possible abuses further. As a result, South Carolina has recovered $1.9 million from 30 prescribers who billed the state’s Medicaid program inappropriately.

“Not only should we put an end to the lives lost over prescription drug abuse in the Medicare and Medicaid system, we should be working collaboratively to find meaningful solutions,” he said. “The cost of doing nothing is too high already.”

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