During this current epidemic of overdose deaths from pain prescription medications, it’s important for clinicians to understand prescribing patterns and treatment guidelines. The Centers for Disease Control and Prevention (CDC) and other experts point out that an increase in prescriptions for painkillers is a key driver of the increase in prescription opioid overdoses.
The CDC reports that:
- The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices quadrupled from 1999 to 2010.
- There are twice as many painkiller prescriptions per person in the U.S. as in Canada.
- In the U.S., the Northeast had the most prescriptions per person for long-acting and high dose painkillers in 2012.
The rise in fatalities closely relates to the prescribing behavior of these types of drugs over the past decade. The CDC recommends that when prescribing painkillers, health providers:
- Recognize that while men are still more likely to die of prescription painkiller overdoses, it is a serious and growing problem among women — more than 5 times as many women died from prescription painkiller overdoses in the U.S. in 2010 as in 1999. Because women are more likely to be affected by chronic pain than men are, they are often prescribed opioids at higher doses and use them for longer periods of time than men. Additionally, women may become dependent on pain medications more quickly than men do and may be more likely to engage in “doctor shopping” to obtain multiple opioid prescriptions.
- Follow guidelines for responsible prescribing, including screening and monitoring for substance abuse and mental health problems. Screening at the primary care level provides an important opportunity for early intervention and better overall health maintenance and improvement. Please refer to the clinical guidelines on Harvard Pilgrim’s provider website.
- Use prescription drug monitoring programs to identify who may be improperly obtaining or using prescription painkillers and other drugs. Individual states offer database programs for providers to track painkiller prescriptions and identify overprescribing.
- Talk with patients about safely storing, using, and disposing of prescription pain medications.
For more information on painkiller prescribing trends and overdoses in the U.S., please see the CDC’s Vital Signs reports.
Additionally, the April 2010 issue of Anesthesiology included practice guidelines for chronic pain management to aid physicians in optimizing pain control, improving function, and enhancing quality of life, while minimizing adverse outcomes.
How Optum/UBH can help your patients. For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at
800-292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum at 888-777-4742.