Narcotics Usage: Too Much or too Little?

Tuesday, August 10, 2010 | 0

By Joe Paduda
Health Strategy Associates

Just in case you thought the problems with abuse of powerful prescription drugs have been overstated, here's a wake-up call.

The CDC's Director is taking this very seriously, saying: "Overdose with prescription drugs is one of the most serious and fastest-growing problems in this country."

The problem is showing up in a doubling of Emergency Room admissions due to prescription drug abuse, driven primarily by oxycodone, methadone, and hydrocodone.

Narcotic use is rampant in workers' compensation as well. Studies by the National Council on Compensation Insurance and the California Workers' Compensation Institute point to the frequent use of narcotic opioids for workers' comp claimants, with the explosive growth in California particularly troubling.

One of the issues in comp is that unlike group, most Medicare Part D plans, and to a lesser extent Medicaid, claimant copays are nonexistent. There's no financial skin in the game, as medications are free.

Another potential contributor is the potential street value of these drugs; while there isn't conclusive documentation of the percentage of scripts that are diverted, the 'sense of the industry' is that diversion is not uncommon. Add to that the desire on the part of some states to reduce the work comp drug fee schedule to match Medicaid, and there's no surprise use is exploding (if pharmacy benefit managers can't afford to manage utilization, utilization isn't managed).

Here's what some of these drugs are reportedly worth on the street.

The estimated street value of one 40-milligram Oxycontin pill is about $40; another report indicates an 80 mg dose is going for $30 in the Northeast.

Actiq runs about $25 a dose.

Duragesic patches range from $20 to $75 depending on brand, location, and dosage.

So, narcotics are ripe for abuse, there's a big and very profitable secondary market for them, and use is growing. That's one side of the story.

The other is the inability of many legitimate pain sufferers to get adequate treatment.

Research published by Oregon State University indicates "at least 30 percent of patients with moderate chronic pain and over 50% of those with severe chronic pain fail to achieve adequate pain relief."

Some think the inability of those with chronic pain to get treatment through standard channels is a big component of the overall narcotic diversion issue.

What does this mean for you?

Like so much else in health care, there are no clear problems or easy solutions. This is more evidence of the complexity of one small part of the challenge.

<i>Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers, and president of Health Strategy Associates, a Connecticut employer consulting firm. This column was reprinted with his permission from his blog, http://www.managedcarematters.com</i>