All too often, news spreads about the sudden death of a prominent young actor due to an overdose on prescription or illegal drugs. Most recently, Heath Ledger provides the latest tragic example. However, it's important for HR/benefits pros to remember the same can happen to everyday employees.
At least 4.3 million U.S. adults are regularly taking prescription pain killers in any given week, according to a recent study published in the journal Pain.
The overall death rate from fatal medication errors rose by 360% from 1983 to 2004, according to a study recently published in the Archives of Internal Medicine.
The study attributes this trend partly to the increase in patients taking pain medications at home, rather than in the hospital or the doctor's office.
Alarmingly, the death rate from domestic fatal medication errors combined with alcohol and/or street drugs jumped by 3196% from 1983 to 2004.
To hear about solutions to this problem, Managing Editor Leah Carlson Shepherd interviewed Dr. Brian Solow, vice president and medical director for clinical programs at Prescription Solutions, a Costa Mesa, Calif.-based pharmacy benefit manager.
EBN: What do HR/benefit managers need to know and understand about prescription noncompliance and pain medications?
Solow: The most important thing for them to know would be that noncompliance can lead to higher health costs for their employees and increase absenteeism. Knowledge of which pain medications are appropriate to take at the workplace would be helpful, as well.
EBN: What should employers do to prevent and reduce prescription noncompliance and accidental overdoses?
Solow: Employers can encourage their employees in matters of [disease] prevention and through forums such as providing incentives for exercise programs and sponsoring health fairs.
This would be the time to educate them about taking care of their present diseases, which may include adherence to medications.
Also, there is a chance for the employer to partner with a [pharmacy] benefit that has programs for their employees that will help with adherence and noncompliance issues. These programs look at quantity limits and may be able to help prevent drug interactions that could result in an inappropriate combination. We can catch that.
The pharmacy benefit managers can look at all drug information from their membership and make sure that the combinations are appropriate and that there is not duplicative therapy.
EBN: Why has there been an increase in the number of deaths from accidental overdoses? What are the contributing factors?
Solow: Patients without defined drug benefits tend to go to different pharmacies and physicians, seeking out pain medication.
However, employees enrolled in a health plan have a benefit in that all of their drugs are managed in a central reservoir, so that, even though they may go to different pharmacies, the utilization can monitored and managed.
All potential interactions that could lead to overdose can be reduced. [These programs] address the use of multiple prescribers or multiple pharmacies.
We recognize that we have patients with acute and chronic pain who will need ongoing treatment, and we design programs to keep the doctor at the center of patient care.
We're able to notify physicians for certain classes of analgesics about the current clinical guidelines and policies for the use of these drugs. This way, the doctor has a more complete picture of the potential risk and can act to prevent duplicate therapy; reduce the potential for drug abuse, diversion and/or misuse; and optimize pain management therapy to help patients to improve their quality of life.
EBN: Do you expect to see the trend continue in the future, with more problems with prescription noncompliance and accidental overdoses?
Solow: I believe the trend will actually decrease as technology is able to play a larger role in improving patient adherence with chronic medications and preventing inappropriate drug interactions.
The advent of e-prescribing will improve safe drug utilization, as the physician will have access to more information, including the patient's complete drug history at the time of prescription.
EBN: What are the major take-away messages from the study in the Archives of Internal Medicine?
Solow: As a practicing physician, I know the problem of narcotic prescription abuse has been long-standing.
We need to continue to work on programs and technology that will help increase safe drug utilization for patients.
Having recognized that we have this steep increase [in overdoses], we have the opportunity to develop and implement programs within the use of technology.
Pharmacy benefit managers that are involved in the claims process can help. Quantity limits and member education programs can catch potentially harmful drug interactions.
EBN: On a state or federal level, what are the legislative or policy changes that could help to prevent or reduce prescription noncompliance and accidental overdoses?
Solow: The adoption of e-prescribing, as mandated by the Centers for Medicare and Medicaid Services, will allow for a great tool to help with noncompliance and accidental overdose.
