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Transcript
SURPRISING
TRUTHS ABOUT
OPIOID MISUSE
Correlating Laboratory and Pharmacy Data
to Identify and Monitor High-Risk Patients
Richard Stripp, Ph.D.
cordantsolutions.com
A Provider of Toxicology and Case Management Solutions
Abstract
Although nationally an estimated 55–86% of all those reviewed are receiving opioids for chronic pain relief,1 many
physicians receive only limited and fragmented education on how to treat it,2 leading to the over-prescription of
medication.
There are three primary options for identifying potentially high-risk patients:
• Toxicology drug testing
• State-run prescription databases
• Physicians’ clinical judgment
Cordant conducted a study to determine the efficacy of combining pharmacy and laboratory data to identify high-risk
opioid users.
In April through June 2014, Cordant conducted 257 toxicology screens on 237 injured subjects across 48 states.
Test subjects were selected from the pool of patients meeting key risk identifiers from prescription data.
70.9% of those tested in the study produced results inconsistent with the prescribed
medication regimen. Of those tested, 45.6% were deemed high-risk. Only 36% of pain patients
tested at random, without using prescription data, showed inconsistent results.
High-risk patients exhibited one or more of the following inconsistent outcomes:
• Prescribed medication not detected
• Illicit drugs or alcohol detected
• Non-reported prescription medication detected
• An invalid or diluted specimen
The study concluded that combining pharmacy and laboratory data to predict risk is highly effective and mitigates the
common problem of overtesting.
Of patients who had initial inconsistent tests and were tested more than once,
33.3% improved with the second test. This suggests drug testing can help enforce
proper medication adherence.
For more information, visit www.cordantsolutions.com,
email [email protected], or call 1-844-835-5870
©2015 Cordant Health Solutions™. All Rights Reserved. Do not duplicate
or distribute without written permission from Cordant Health Solutions.
The Problem: Isolated Pharmacy and Laboratory Databases
Tens of millions of urine drug tests are performed annually in the United States,3 but when and if drug tests are
performed often depends on whether a physician believes a patient needs testing. However, most healthcare
providers are not skilled at identifying high-risk patients on their own.4 Consequently, physicians sometimes test
every patient at every visit, even when initial test results have been consistent with the prescribed drug regimen.
This is medically unnecessary and wastes millions of dollars due to needless testing.
Pilot programs that involve integration of siloed data have shown much promise. For instance, a study of medical
providers in Ohio emergency departments found that 41% of those given data from the state’s prescription
drug monitoring program (PDMP) altered their prescribing for those receiving multiple simultaneous narcotics
prescriptions. Of these providers, 61% prescribed no narcotics or fewer narcotics than originally planned.
PDMP databases allow prescribers and pharmacists to access prescription data in order to prevent doctor shopping
and abuse, and they are the definitive source of information for controlled substances that are filled through
insurance or paid in cash outside of insurance. Unfortunately, payers such as health plans, pharmacy benefit
managers, and workers’ compensation carriers often have difficulty accessing this data.
Using lab and pharmacy data together is key—evaluating each data set individually does
not provide a complete picture. Pharmacy data indicates what drugs are dispensed but
not necessarily taken as prescribed, and reveals nothing about illicit drug use. Although
some states and literature provide testing frequency recommendations, there are no
uniform laboratory guidelines for appropriate testing, which leads to unnecessary testing.
A Solution for Determining Risk Levels
Cordant recently completed a study determining the efficacy of combining pharmacy and laboratory data to identify
high-risk opioid users.
Scope
In April through June 2014, Cordant conducted 257 toxicology screens on 237 patients across 48 states.
Test subjects were selected from the pool of those meeting key risk identifiers.
Process
Cordant applied the following parameters to the study group using the payers’ prescription data to identify
potential risk:
• Prescribed a high-medication dosage
• Filled one or more initial opioid prescriptions
• On the prescribed opioid for more than two months
Once patients were identified as potentially high-risk, samples were collected at the doctor’s office during their
next visit and sent to one of Cordant’s five laboratories for evaluation. Results were reported to the payer and the
physician.
For more information, visit www.cordantsolutions.com,
email [email protected], or call 1-844-835-5870
©2015 Cordant Health Solutions™. All Rights Reserved. Do not duplicate
or distribute without written permission from Cordant Health Solutions.
Results
70.9% of patients tested in the study produced inconsistent results.
An inconsistent result is due to either of these circumstances:
• The prescribed drug is not detected. This often signals that the patient is not taking the medication as
prescribed, and necessitates a conversation between the prescribing physician and the patient to understand if
the patient is taking the medication on an as-needed basis, whether there is a metabolic issue, or if there is a
potential diversion concern.
• Non-disclosed medications or other drugs are detected in the sample. This could mean the patient is ingesting
illicit substances or non-prescribed medications, or receiving controlled substances from another provider.
INCONSISTENT RESULTS
CONSISTENT
29.2%
INCONSISTENT
70.8%
NON-REPORTED
PRESCRIPTION MED
DETECTED 32.4%
REPORTED
PRESCRIPTION
MED NOT
DETECTED
41.75%
ILLICIT DRUGS 7.4%
ALCOHOL 13.9%
INVALID SAMPLE 4.6%
Of patients tested, 45.6% were deemed high-risk due to meeting one or
more of the following criteria:
• Not taking their prescribed medication
PERCENTAGE OF PATIENTS
IN EACH RISK CATEGORY
• Mixing their medication with an illicit drug or alcohol
• Exhibiting other aberrant results or behavior
Patients were deemed medium-risk if non-reported prescription
medications were detected, and low-risk if tests showed the expected
results.
LOW
RISK
29.1%
Toxicology testing revealed high degrees of inconsistent test results among
the tested patients who fit the parameters outlined above:
• Prescribed a high-medication dosage: 70.9% inconsistent test results.
• Filled the initial opioid prescription: 100% inconsistent test results.
• On the prescribed opioid for more than two months: 73.8%
inconsistent test results. (Patients in this group were often prescribed
higher doses and for a longer duration than patients in other groups.)
For more information, visit www.cordantsolutions.com,
email [email protected], or call 1-844-835-5870
©2015 Cordant Health Solutions™. All Rights Reserved. Do not duplicate
or distribute without written permission from Cordant Health Solutions.
MEDIUM
RISK
25.3%
HIGH
RISK
45.6%
Conclusion
Combining pharmacy and laboratory data is extremely effective in identifying high-risk opioid users. Getting the
right medication to the patient at the right time, in the right dose, and with the right monitoring requires a
combination of care coordination, lab and prescription data integration, and clinical expertise. An effective solution,
like the one offered by Cordant, is based on several key concepts:
• Integrating data and clinical algorithms to identify at-risk patients and help providers determine the correct
care plan
• Providing physician education on effective opioid-monitoring protocols
• Helping physicians understand the patient’s risk of abuse and diversion
• Using targeted testing to reduce overutilization and increase efficiency of drug testing
• Providing lab reports with insights and evidence-based guidelines, not just data
Cordant is a national toxicology network offering comprehensive medication monitoring
solutions focused on improving patients’ safety and compliance with their prescription
treatment plan to improve outcomes and reduce fraud, abuse and waste.
For more information, visit www.cordantsolutions.com,
email [email protected], or call 1-844-835-5870
©2015 Cordant Health Solutions™. All Rights Reserved. Do not duplicate
or distribute without written permission from Cordant Health Solutions.
About Dr. Richard Stripp
Dr. Richard Stripp currently serves as the chief scientific
and technical officer at Cordant Health Solutions™, providing
leadership to Cordant’s five toxicology laboratories across
the country. He is also a professor of forensic and clinical
toxicology at the City University of New York. Dr. Stripp is
a member of many toxicology organizations, including the
American Academy of Clinical Toxicology, and is a certified
forensic consultant for the American Board of Forensic
Examiners.
Prior to joining Cordant in 2012, Dr. Stripp served as the
CEO and laboratory director of American Forensic Toxicology
Services (AFTS) in Long Island, NY. He earned his Ph.D. in
pharmacology and toxicology from St. John’s University’s
College of Pharmacy and Allied Health Professions.
For more information, visit www.cordantsolutions.com,
email [email protected], or call 1-844-835-5870
©2015 Cordant Health Solutions™. All Rights Reserved. Do not duplicate
or distribute without written permission from Cordant Health Solutions.
Endnotes
1Rosenblum, KE. (2012). “Opioids Wreak Havoc on Workers’ Compensation Costs.” Lockton Companies.
http://www.lockton.com/Resource_/PageResource/MKT/wc-pbm10-9-2012.pdf.
2Mezei, L., BB Murinson, and Johns Hopkins Pain Curriculum Development Team (2011).
“Pain Education in North American Medical Schools,” J Pain 12, vol. 12 (Dec.): 1199–1208. doi: 10.1016/j.
jpain.2011.06.006. Epub Sept. 25, 2011.
3Lum, G. and B. Mushlin. (2004). “Urine Drug Testing: Approaches to Confirmation Screening and Urine Drug Testing.”
Laboratory Medicine 6, vol. 35 (June). DOI: 10.1309/QHJCKA4235EGPEGF.
4Jung B. and MM Reidenberg. (2007). “Physicians Being Deceived.” Pain Med. 8, no. 5 (July–August): 433-7.
For more information, visit www.cordantsolutions.com,
email [email protected], or call 1-844-835-5870
©2015 Cordant Health Solutions™. All Rights Reserved. Do not duplicate
or distribute without written permission from Cordant Health Solutions.