Quantitative drug testing and monitoring can reduce utilization of high-risk medications in injured workers on chronic opioid therapy, according to a study presented at the Academy of Managed Care Pharmacy 26th Annual Meeting and Expo (April 1-4; Tampa, Fla.). Laboratories can play an important role in addressing the national opioid abuse epidemic, as increased utilization of drug monitoring is proving it can improve outcomes both for patients and payers. Existing guidelines do call for periodic monitoring for prescription compliance, but noncompliance remains a substantial burden with fraud, addiction, and cost implications for both patients and payers. The current study evaluated clinical benefits for 100 injured workers enrolled in workers’ compensation service provider Progressive Medical/PMSI’s Drug Testing and Monitoring (DTM; March to April 2013) program. Enrollment was due to urine drug test results inconsistent with the drug regimen reported by the prescribing provider. Prescription transaction history and urine samples were evaluated during the 90-day period prior to enrollment in the DTM service, 90-days after enrollment, and six months post enrollment. Lab testing was performed by Millennium Laboratories (San Diego), which specializes in medication monitoring and pharmacogenomics testing. Liquid chromatography tandem mass-spectrometry, which is becoming the gold standard for drug screening given […]
Quantitative drug testing and monitoring can reduce utilization of high-risk medications in injured workers on chronic opioid therapy, according to a study presented at the Academy of Managed Care Pharmacy 26th Annual Meeting and Expo (April 1-4; Tampa, Fla.). Laboratories can play an important role in addressing the national opioid abuse epidemic, as increased utilization of drug monitoring is proving it can improve outcomes both for patients and payers.
Existing guidelines do call for periodic monitoring for prescription compliance, but noncompliance remains a substantial burden with fraud, addiction, and cost implications for both patients and payers. The current study evaluated clinical benefits for 100 injured workers enrolled in workers’ compensation service provider Progressive Medical/PMSI’s Drug Testing and Monitoring (DTM; March to April 2013) program. Enrollment was due to urine drug test results inconsistent with the drug regimen reported by the prescribing provider. Prescription transaction history and urine samples were evaluated during the 90-day period prior to enrollment in the DTM service, 90-days after enrollment, and six months post enrollment.
Lab testing was performed by Millennium Laboratories (San Diego), which specializes in medication monitoring and pharmacogenomics testing. Liquid chromatography tandem mass-spectrometry, which is becoming the gold standard for drug screening given its increased specificity over immunoassays and lower levels of detection, was used in the study to test for a broad array of drugs.
With monitoring, a decrease in all measures of drug utilization, including high-risk medication, was seen. This decline was driven primarily by opioids (a 32 percent decrease) and benzodiazepines (a 51 percent decrease), as well as a 26 percent reduction in total utilization of all medications, regardless of drug class. There was a reduction in the average morphine equivalent dose (MED), from 123.3 mg to 83.3 mg, after six months. The total percentage of claimants with a daily MED less than 120 mg increased from 65 percent to 77.7 percent.
“It is a win-win demonstrating both cost savings and enhanced safety,” says Steve Passik, Ph.D., director of clinical addiction research and education at Millennium.
Passik tells DTET that generally about 60 percent of urine test results are consistent with the doctor’s prescribed regimen. Roughly one-third of missing results can be explained by “more innocent explanations” such as clerical errors, including a prescription being inadvertently left off the requisition. However, a substantial number of patients are not taking their medications or are “diverting” them by only taking part of the pill and sharing or selling the other part. However, in some cases where the patient is reporting proper drug usage, yet the metabolite is not consistently showing up, pharmacogenomic testing may be ordered.
With the benefits of monitoring becoming apparent, Brooke Mueller, Pharm.D., a senior clinical pharmacist at Progressive Medical/PMSI (Tampa, Fla.)., says she expects to see a trend toward higher volumes of patients referred as continued monitoring becomes the standard of care. Yet, she tells DTET that open questions remain regarding just how broad monitoring should be. Not only are other often-prescribed medications potentially high-risk with opioids (i.e., antidepressants, anti-convulsants, muscle relaxants), but there are perpetually new drugs of choice emerging for abuse. Both Millennium and Progressive Medical/PMSI have ongoing studies to further demonstrate the economic impact of systematic drug monitoring, as well as which patients and at what point they should be referred for pharmacogenomic testing. Additionally, the necessary frequency of monitoring needs to be settled.
“To realize the benefit, the frequency has to be frequent enough to be systematic,” says Passik. “Once a year is not enough and three times a week is too much. The truth will lie in the middle somewhere.”
Passik says that in the future, throughout medicine, he believes there will be increased testing for medication adherence, even outside of opioids. “Labs will be in a better position to help with adherence—to get information to doctors and to package it in a way that they can understand,” says Passik. “With more testing, overall patients will be more adherent, and pain patients, in particular, will be safer, if taking their medications as prescribed and avoiding illicit drugs.”
Takeaway: Continuing drug monitoring in those prescribed chronic opioid therapy will likely increase in the coming years as part of a trend toward greater emphasis on adherence in clinical care. Data obtained from this systematic monitoring both saves payers money and enhances medication safety for patients.
