The number of deaths resulting from prescription drug overdoses is staggering — over 38,000 in 2010 according to published reports by the CDC — and the number is escalating. Opioids were a factor in 15,000 deadly overdoses stemming from combinations of prescription drugs and alcohol in 2010. When considering the prevalent use of opioids to treat work related injuries, the implications for workers’ compensation payers can be serious.
The risk of a lethal outcome becomes even higher when opioids are used in combination with certain other prescription drugs. Most notably, clinical experts agree that opioids, muscle relaxants and benzodiazepines should never be prescribed or used together. When taken concurrently the result can be lethal. The frequency of overdose deaths resulting from the combination of these drugs continues to rise and they have also been involved in several widely reportedly celebrity deaths:
- Actor Heath Ledger, 28
- Actress Dana Plato, 34
- Professional hockey player Derek Boogaard, 28
- Professional wrestler Umaga (Edward Fatu), 36
Monitor for combinations of these drug classes and respective drugs
- Opioids: Vicodin®, Lortab®, Opana®
- Muscle Relaxants: Carisoprodol, Soma®
- Benzodiazepines: Xanax®, Valium® and Klonopin®
Though the number of cases may be small where an injured worker acquires combinations of these drugs with the intention of abuse, the risks to payers can be serious.
According to Silvia Sacalis, PharmD, vice president of Clinical Services at Healthesystems, “It’s important to maintain a comprehensive opioid management strategy to address all treatment regimens involving opioids. However, it’s critical to aggressively address drug treatments for concurrent presence of opioids, muscle relaxants and benzodiazepines. This potentially lethal combination is not clinically appropriate and there are serious risks involved. These risks extend well beyond the need and cost of additional treatment modalities such as detoxification and rehabilitation, and involve the ultimate risk – the potential loss of a human life.”
The current issue of the RxInformer clinical journal published by Healthesystems, a workers’ compensation PBM, takes a comprehensive look at the various deadly drug combinations and provides strategies to identify and address them. To download the article, titled “Deadly Drug Combinations Escaping Notice” and request the full issue of RxInformer, visit: www.healthesystems.com/rxinformer
Opportunities for diversion
When used in combination, opioids, muscle relaxants and benzodiazepines can produce a feeling of euphoria. Drug abusers have created names for some of these combinations such as “The Holy Trinity” and “Las Vegas Cocktail”. There is a ready street market for these drugs, making them ripe for diversion. Detection of this type of illicit behavior must look beyond cost since these drugs frequently have a relatively low average wholesale price.
Indicators of misuse and abuse may include patient behaviors such as:
- Visiting multiple prescribers at different practices
- Using multiple pharmacies
- Refilling prescriptions early
Identifying these types of activities requires comprehensive pharmacy benefit management prescription monitoring and advanced analytics capabilities in addition to aggressive intervention strategies to avert potentially tragic or costly outcomes.
Silvia Sacalis, PharmD, is a clinical pharmacist and vice president of Clinical Services at Healthesystems, a leading PBM and ancillary medical benefits manager serving workers’ compensation payers. Dr. Sacalis is a nationally recognized thought leader with extensive experience developing technology-enabled clinical solutions that achieve reductions in pharmacy spend and promote improved patient outcomes for payers, employers, TPAs, PBMs and health systems.
For additional insights on fraud, waste and abuse, read “Red Flags in Opioid Therapy,” in RxInformer.