Healthcare information technology has opened new doors to understanding opioid addiction, but there still are areas where data and innovation can help medical professionals better handle this crisis, contends Reema Hammoud, PharmD, assistant vice president of clinical pharmacy at Sedgwick, a vendor of technology- enabled risk, benefits and integrated business systems.
The COVID-19 pandemic is a major health crisis that has taken center stage, but the still-rising opioid crisis is a large-scale epidemic that cannot be overlooked. It is a crisis in desperate need of innovative solutions, and certainly technology can be one sector that provides them.
Healthcare IT News interviewed Hammoud to discuss the opioid crisis and IT, specifically, metrics to track potential abuse and abuse mitigation strategies providers can pursue, and the best ways to proceed and how health IT can help when there is no one-size-fits-all approach for pain management or addressing substance use disorder.
Q. You say there are metrics healthcare professionals can use to track potential abuse. What are they, where can they be obtained and what role can health IT play here?
A It’s no surprise that drug abuse in the US has skyrocketed in recent years. In fact, the CDC recently released a report that found overdoses involving fentanyl and other synthetic opioids surpassed 71,000, which is up 23% from the previous year, as well as a 23% increase in deaths involving cocaine and a 34% increase in deaths involving methamphetamines and other stimulants.
Additionally, according to a 2021 Quest Diagnostics study, the use of amphetamines, including prescription medications such as Adderall, has more than doubled in the past 10 years. Further, more than 50% of respondents reported using a prescription stimulant when not prescribed for them, according to a recent study from The American Professional Society of ADHD and Related Disorders.
These statistics mainly account for prescription drugs only, but many of these medications can be very dangerous when mixed with other substances, including alcohol and cannabis. As drugs continue to circulate the streets, there are several means for healthcare professionals to track abuse and safely provide help to patients.
The first and most important is understanding your patient’s health and history of prescription and recreational drugs. Electronic medical records, coupled with a detailed verbal history from patients, have helped healthcare professionals better analyze medical records and make more informed decisions when prescribing medication.
These records will detail what medication a patient is receiving, where they are getting it from, how often they fill it, and so on. While looking at these records, random drug testing also can help paint a clear picture to monitor for potential drug abuse.
This allows prescribers to look at medications from both a qualitative and quantitative perspective. For example, if a patient says they are taking two oxycodone pills during the day, but they only took it once and used cannabis instead, prescribers will be able to track potential abuse and alter prescription medications swiftly and accordingly.
Another very helpful tool is Prescription Drug Monitoring Programs (PDMPs), which assist physicians and pharmacists when they are prescribing and dispensing scheduled medicines. These electronic records, which are available in most states, track and flag controlled substance prescriptions.
For example, if a patient received oxycodone from a pain specialist and alprazolam from a psychiatrist, the PDMP would alert the prescriber to discuss medication usage with patients to gauge whether they are using these controlled substances in a safe way.
Additionally, states typically share data with one another so individuals who live close to another state cannot double up on prescriptions or take potentially harmful combinations of drugs without the counsel of a professional. While these tracking systems are incredibly helpful, a large problem is that many physicians and pharmacists do not fully use them.
Should these technologies be widely adopted and implemented, medical professionals have a better chance of tracking potential abuses.
Q. There are abuse-mitigation strategies healthcare providers can pursue. What are some of them, and how can health IT support them?
A Counseling needs to be top of mind for healthcare professionals. Discussing drug side effects, potential abuse factors, bad interactions and other dangers is a critical mitigation strategy and ultimately can impact patient safety. This should be the case for all situations whether prescribing a medication for the first time or an individual is actively using a drug or in recovery.
Another mitigation strategy is pill counting, though it is time-consuming. For example, if a patient was prescribed Oxycontin two weeks ago and the doctor asks them to bring in the bottle, there should be 15 pills left for a 30-day fill. If there are fewer, it’s likely the patient is either abusing the drug or selling it.
Because this manual process often can be tedious, technology helps expedite the numbers. This was recently seen where a patient was prescribed 150 tablets of Oxycontin for a 30-day supply; however, the patient kept filling the prescription 10-15 days early every month. This patient’s behavior was identified through PDMP, and utilization trends were identified through electronic medical records.
In less than 18 months, the patient received 1,237 extra tablets of Oxycontin, and there was no clear explanation on how those extra tablets were utilized. Situations like this one are often very dangerous without technology and proper monitoring.
Drug Utilization Reviews [DURs] at pharmacies also are very helpful when mitigating drug abuse. These programs alert pharmacists if a patient is getting medications that are dangerous when combined. This feature oftentimes is used to identify drug abuse or risk, but due to the chaotic nature of retail business, pharmacists often override these warnings.
Whether pharmacies are chain, family owned, private or public, all DUR programs are processed through insurance, reducing the risk of individuals filling multiple prescriptions within a dangerous time frame. When combined with drug screenings, a patient’s entire prescription history can be on hand for prescribers, detailing possible combinations that could lead to devastating circumstances.
Q. You suggest there is no one-size-fits-all approach for pain management or addressing substance use disorder. What’s the best way for providers to proceed, and how can health IT support them in this process?
A Individualizing patient care and involving them in decision-making not only ensures better treatment, but yields successful outcomes. Understanding a patient’s approach to their health, knowing their personal medications, prescription and over-the-counter, and any workers’ compensation medications could provide a good baseline status.
For example, if someone is receiving Norco under a workers’ compensation program but also prescribed Fioricet for headaches by a primary care physician and taking Tylenol PM over the counter, the patient might think of them as different medications, but in reality, they all have a common ingredient, acetaminophen.
This combination can be very dangerous and could lead to unintentional overdose. It’s also critical to understand the medicine when prescribing it to a patient as some drugs at a certain dose might not be recommended for female patients over the age of 65. Therefore, individualizing medication doses based on their demographics is important.
To curb the opioid epidemic, to help patients successfully wean off the opioids, and cope with pain, individualizing care is crucial. It’s never recommended to abruptly discontinue medication, but it’s the onus of the medical professionals to safely wean patients off.
There is data throughout the healthcare industry to help better understand doses, and incorporating personalized care, alongside counseling, can help former abusers avoid falling into old habits.
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