Nearly 6 in 10 Opioid Users Prescribed Dangerous Drug Combinations

The number of Americans taking opioids long-term remained stable between 2009 and 2013, steadying a decades-long upward trend. But according to a new report from Express Scripts, both the number of opioid prescriptions filled by those patients and the number of days of medicine per prescription increased significantly—more than 8%—over the past 5 years. The report, “A Nation in Pain,” details the use of prescription opioids in the United States between 2009 and 2013.

Among its most alarming findings, almost 60% of patients prescribed opioids long-term received subsequent prescriptions for potentially dangerous combinations of medications. Two-thirds of them involved prescriptions from >1 physician, and approximately 40% of patients filled those prescriptions at multiple pharmacies.

Specifically, nearly one-third of those patients took an opiate and a benzodiazepine—a combination that, according to the report, is the most common cause of overdose deaths involving multiple drugs. Approximately 28% took an opioid and a muscle relaxant. Meanwhile, 8% combined an opioid, a muscle relaxant, and a benzodiazepine.

"There could be instances when prescribing these combinations of drugs is appropriate, but not at this scale,” said Lynne Nowak, MD, medical director, Express Scripts, former hospice care physician. “The fact that the majority of these patients are being treated by multiple physicians and pharmacies signals a communication breakdown that leads to dangerous use."

Another 27% took multiple opiate pain medicines simultaneously. Two-thirds of patients prescribed the dangerous medication combinations were women.

"Government- and insurer-run drug monitoring programs can help prevent these possibly life-threatening scenarios, but unfortunately they are underused and vary by state,” Dr. Nowak said. “As more people gain access to health coverage, this problem will worsen if the country does not use every tool at its disposal to ensure the safe use of these medications."—Jolynn Tumolo

References

Express Scripts. A nation in pain: focusing on U.S. opioid trends for treatment of short-term and longer-term pain. December 9, 2014.

Many Americans on long-term painkillers take potentially fatal drug combinations [press release]. PRNewswire: New York City; December 9, 2014.