{"id":172137,"date":"2017-04-27T11:31:45","date_gmt":"2017-04-27T11:31:45","guid":{"rendered":"http:\/\/healthmedicinet.com\/i\/opioid-abuse-drops-when-doctors-check-patients-drug-history\/"},"modified":"2017-04-27T11:31:45","modified_gmt":"2017-04-27T11:31:45","slug":"opioid-abuse-drops-when-doctors-check-patients-drug-history","status":"publish","type":"post","link":"http:\/\/healthmedicinet.com\/i\/opioid-abuse-drops-when-doctors-check-patients-drug-history\/","title":{"rendered":"Opioid abuse drops when doctors check patients’ drug history"},"content":{"rendered":"
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\n Credit: Petr Kratochvil\/public domain
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There’s a simple way to reduce the opioid epidemic gripping the country, according to new Cornell research: Make doctors check their patients’ previous prescriptions.\n <\/p>\n

The most significant response to the opioid<\/a> epidemic has come from state governments. Nearly every state now has a database that tracks every prescription for opioids like OxyContin, Percocet and Vicodin. Using these databases, doctors and pharmacists can retrieve a patient’s history to decide whether they are an opioid abuser before prescribing them drugs.<\/p>\n

These databases reduce opioid abuse among Medicare recipients \u2013 but only when laws require doctors to consult them, according to a Cornell health care economist and her colleague. Their study refutes previous research suggesting the databases have no effect on opioid abuse.<\/p>\n

The paper is forthcoming in the American Economic Journal: Economic Policy<\/i>.<\/p>\n

“The main issue is getting providers to change their prescribing behavior. The majority of opioids that people abuse start in the medical system as a legitimate prescription,” said co-author Colleen Carey, assistant professor of policy analysis and management in the College of Human Ecology. Her co-author is Thomas Buchmueller of the University of Michigan.<\/p>\n

The team crunched numbers from 10 states that mandated doctors access the databases under certain circumstances prior to prescribing. States that implemented a “must access” database saw a decline in the number of Medicare recipients who got more than a seven-months’ supply in a six-month period. And there was a decrease in those who filled a prescription before the previous prescription’s supply had been used.<\/p>\n

“Doctor shopping” also dropped. Medicare opioid users who got prescriptions<\/a> from five or more doctors \u2013 a common marker for “doctor shopping” \u2013 fell by 8 percent; the number of those who got opioids from five or more pharmacies declined by more than 15 percent.<\/p>\n

On the flip side, Medicare patients appeared to evade the new regulations by traveling to a less-regulated state; residents of states that passed a “must access” provision began to obtain more opioid prescriptions from out-of-state prescribers, the study said.<\/p>\n

The researchers also looked at whether a Medicare beneficiary had an unusually high number of “new patient” procedure codes, which suggests the person is shopping around for doctors willing to provide new prescriptions. The study showed a “must access” database reduces by 15 percent the number of people with four or more new patient visits in a half-year. “Given Medicare outlays for these visits, a ‘must access’ database in every state would avert $174 million in expenditures each half-year,” the authors wrote.<\/p>\n

Although the study looked only at Medicare recipients, the findings are likely to translate to the general population, the researchers said.<\/p>\n

The effects were especially large for low-income disabled users and for those who obtain opioid prescriptions from a high number of doctors; both groups have the highest rates of misuse and abuse, Carey said.<\/p>\n

The researchers also analyzed data from 17 states that implemented databases between 2007 and 2013 but did not require providers to access them. In these states, only a small share of providers registered with or queried the database<\/a>, and there was no effect on patterns of opioid abuse<\/a> in Medicare.<\/p>\n

The strongest effects were in states with the strictest laws, which require doctors<\/a> to check the opioid history of “every patient, every time.” But even states with laws requiring access only under certain circumstances reduced doctor shopping.<\/p>\n

Until recently Medicare has had very few legislative tools to curtail the epidemic.<\/p>\n

And insurance companies have little incentive, because opioids are relatively cheap, costing about $1.60 per day in the study’s sample. And opioids don’t hit Medicare insurers in the bottom line, making up only 3 percent of their total drug costs, Carey said.<\/p>\n

“If people had been abusing hepatitis C drugs that cost $84,000 for a course of treatment,” she said, “there would have been some action.”\n <\/p>\n

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\n Health policy researcher finds drug monitoring reduces opioid prescriptions, medicaid costs<\/a>\n <\/p>\n