ANAHEIM, Calif. (December 4, 2018) -- A quarter of chronic opioid users in Idaho were at risk for overdose from unsafe combinations of prescriptions for controlled substances in 2017, according to research presented at the ASHP (American Society for Health-System Pharmacists) 53rd Midyear Clinical Meeting and Exhibition. Forty-four percent of the dangerous overlapping prescriptions were written by more than one prescriber.
"Patients with chronic pain are often under the care of several different physicians to manage their different disease states," said Catherine Oliphant, Pharm.D., a professor of pharmacy practice at Idaho State University and faculty advisor for the study led by student pharmacist James Berain. "This co-management can lead to patients receiving unintentional prescription combinations that put them at higher risk for an opioid overdose."
Given that 56 percent of the dangerous combinations were intentionally written by the same prescriber, the results also suggest that continued education on appropriate opioid prescribing is warranted, Oliphant said.
Researchers from Idaho State University examined all prescriptions of controlled substances for 301,975 patients that were reported to the Idaho Prescription Drug Monitoring Program (PDMP) in 2017. Anyone who dispenses these drugs, including pharmacists as well as some physicians and other clinicians, is required to report the action to a PDMP. PDMPs are now available in every state and the District of Columbia. Physicians and other prescribers can then access the records before writing new prescriptions to ensure patient safety, though review of the PDMP is not required.
In the Idaho study, a third of the patients receiving a controlled substance were identified as chronic users, meaning they have taken the drugs for more than 90 days without a break of at least seven days. Nearly a quarter of those chronic users were also prescribed a benzodiazepine or other central nervous system (CNS) depressants -- combinations the Centers for Disease Control and Prevention warns against because of potential overdose.
Pharmacists are in a prime position to intervene when identifying patients who are placed on both opioids and benzodiazepines or other CNS depressants, Oliphant said. Pharmacists can facilitate communication between prescribers, educate patients and prescribers on the risks of the dangerous drug combinations, and prescribe an opioid-reversal agent such as naloxone.