Earlier this week, the LA Times had a good article on a study that traced where people who overdosed on prescription drug opiods got their pills:
The study, published Monday by the Journal of the American Medical Assn., echoes a 2012 Times investigation that found drugs prescribed by doctors caused or contributed to nearly half of the prescription overdose deaths in Southern California in recent years. The Times also revealed that authorities were failing to mine a rich database of prescribing records to identify and stop reckless prescribers…
Prescription drugs — mostly narcotic painkillers, such as OxyContin and Vicodin — contribute to more than 16,000 fatal overdoses annually and are the main reason drugs have surpassed traffic accidents as a cause of death in the U.S.
If drugs are being prescribed, this implies a good proportion of the drugs are being paid for by some insurance program. The question is what can insurance companies and state/federal insurance programs do to minimize overprescription of opiod pain mdiciation?
There are two classes of actions that can be taken. Medicaid has a system in place to identify patients who doctor shop for extra pills. Doctor shopping means they frequently go to different providers for the same diagnosis, or show up to the emergency room with a pain complaint that can not be otherwise specified. Medicaid or managed care organizations managing Medicaid patients perform statistic analysis for outliers, and then have a system that locks a patient to a single primary care provider at a signle location who can prescribe to only a single pharmacy. This type of care-lock can last for several years. It has been shown to reduce diversion and overdoses by making several classes of drugs far less available.
Commercial programs have this as an option. However, since they are in the member satisfaction as well as the health provision/maitenance business, restricting member options even when it is for their own long term good is not popular. I think there is an opportunity on the provider side of changing the opiod prescribing culture which would be far more effective in limiting diversion.