Patients with chronic pain may face a medication double jeopardy

We as a society either take too much or too little prescription medication — and, interestingly, sometimes both too much and too little in the same patient.

In a recent article, “America’s fatal addiction to prescription drugs”, the author (Dr David Kloth) describes rather poignantly this plight with prescription medications:

Misuse of legal medications kills more US citizens than die in car crashes. The cost in dollars, let alone lives, compels action

Dr Kloth is the founder, medical director and president of Connecticut Pain Care. He has been practising in pain management medicine for almost 10 years. In 1999, David was elected to the board of directors of the American Society of Intervention Pain Physicians (ASIPP), and served as president in 2005; he remains the organisation’s immediate past president.

Dr Kloth was specifically referring to the overuse of opioid medications, and cites a study, “Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective” which concluded:

Americans, constituting only 4.6% of the world’s population, have been consuming 80% of the global opioid supply, and 99% of the global hydrocodone supply

Opioids are typically used to treat severe or chronic pain. However, what some might deride as “dependence” and “overuse” of opioids is in a sense just touching on half of the whole story (no slight at all intended towards Dr Kloth), because its use is associated with some underlying condition.

In a recent study published in The American Journal of Managed Care, researchers found that “chronic opioid users had elevated healthcare resource use and incurred substantially greater healthcare costs than nonusers.”

More specifically, in analyzing the claims of more than 18 million patients, they found that patients on chronic opioid therapy who were likely non-adherent, as determined by urine drug testing results, had 14 percent higher health care costs and 35 percent more hospital days. In dollars and cents, this translated into a more than $3,000 annually in terms of healthcare spending:

  • For chronic opioid patients over $23,000 per year (2008 dollars)
  • For non-adherent chronic opioid patients $26,433
In short, these patients suffering from chronic pain taking opioids suffer from medication double jeopardy — the opioids may be taken in excess and other medication may not be taken enough.

Is this a situation that can be controlled by a patient adherence/compliance program? These researchers recommend such an approach — “Our findings suggest that appropriate use of an opioid regimen moderates excess costs.”

What do you think?

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