As the country works through finding medically responsible solutions to eradicate the opioid epidemic, a blame game has ensued and is making the crux of the issue cloudy. The opioid crisis is the result of unchecked, inappropriate prescribing habits.

Carlos Luna

Are opioids the only inappropriately prescribed drugs?

This year’s National Rx Drug Abuse and Heroin Summit hosted a panel discussing “Problematic Patterns: Overlapping Opioid/Benzodiazepine Prescriptions.” Panelist Gery Guy, senior health economist for the Centers for Disease Control and Prevention, shared findings from a study on overlapping prescriptions in nine states.

Contrary to clinical practice guidelines that recommend avoiding the prescription of opioid pain medication and benzodiazepines concurrently whenever possible, the study found that opioids and benzodiazepines are actually being prescribed together more frequently.

In California, Delaware, Florida, Idaho, Kentucky, Maine, Ohio, Virginia and West Virginia, overlapping prescriptions occurred as much as 29.7% of the time in patients (22.4% on average). This means that in the more problematic areas, nearly one out of every three patients received overlapping prescriptions against clinical practice guidelines.

Guy's presentation download is available here with an Rx Drug Summit-issued password.

The practice of overlapping prescriptions is a dangerous affair. A 2017 study from The BMJ concluded that concurrent benzodiazepine/opioid use has sharply increased in a large sample of privately insured patients in the U.S. The notable increase has significantly contributed to the overall population risk of opioid overdose.

To paraphrase recent commentary from Rep. Bobby Scott, D-Virginia, ranking member in the House Committee on Education and the Workforce, how does a prescription get filled without someone along the line certifying that the drug being prescribed is actually medically necessary?

Excellent question.

Are narrow legislative bills enough to keep patients safe?

The State of Massachusetts recently passed a modified version of Gov. Charlie Baker’s House Bill 4033 requiring the Department of Industrial Accidents to create a drug formulary for workers’ compensation.

The latest version of the text, included in House Bill 4470, narrows the focus of the drug formulary to opioid prescriptions only. Judging by stakeholder commentary, a compromise on Baker's original bill was the only path for some form of the legislation to be passed.

Earlier this year, both chambers in the State of Pennsylvania’s legislature, the House and Senate, struggled to get Senate Bill 936, requiring the adoption of an evidence-based drug formulary, to Gov. Tom Wolf's desk for consideration. Wolf vetoed the bill providing what many in Pennsylvania considered to be a hollow commitment to enact standards to curb the inappropriate prescription of these dangerous drugs.

Considering the fate of Pennsylvania’s SB 936, the compromise in Massachusetts may prove to be a great first step. Still, one has to wonder if the passage of such a narrow bill will be effective in keeping injured workers safe, with prescribers having little prescribing standards to consider.

Is Massachusetts swapping one pharmacy problem for another? Only time and the measurement of health outcomes will tell.

For now, the crux of the opioid epidemic continues to elude some influencers in the legal and medical communities across the country. Lacking comprehensive evidence-based prescribing standards, today's opioid issue has the potential to evolve into another prescription drug crisis.

Carlos Luna is vice president of marketing and business development at Risico Total Managed Care. This column is republished with his permission from his Carlos Luna News blog.