Managing the Growing Risk of Opioid Addictions – Patient, Employer and Insurer

This guest blog post was written by health plan consultant, Suzanne Lepage in response to a recent article that appeared in La Presse by Katia Gagnon. In the article, Katia outlines how getting multiple prescriptions for painkillers – or opioids – has become dangerously easy. As this misuse of drugs grows, Suzanne explains how health technology can help track prescriptions to protect patients, employers and insurers.

 Canada’s prescription drug abuse crisis

There is a perception of safety associated with painkillers in the opioids family (morphine, codeine, oxycodone, hydromorphone, meperidine) simply because a physician prescribes them. But while these drugs have therapeutic purposes, they also have a high tendency for misuse because of their psychoactive properties and associated risk for psychological and physical dependence.

In fact, non-medical use of prescribed opioids is now the fourth most prevalent form of substance abuse in Canada (behind alcohol, tobacco, and cannabis) – an increase of 203 per cent between 2000 and 2010, which is a steeper increase than in the U.S. according to The International Narcotics Control Board.  The same report estimates the annual cost of the non-medical use of prescription opioids to be more than $50 billion, with lost productivity accounting for 61 per cent of this amount. The human price, in addition to the impact to insurers and companies who sponsor benefits plans, is high.

Knowledge is power

While there is no denying the potential for misusing opioids, there are several protocols that can be implemented to proactively monitor prescription services and prevent abuse by patients. In Quebec for example, Santé Quebec has a simple, straightforward process that enables pharmacists province-wide to view a patient’s prescription history with just a few clicks of the mouse. However, as a recent experiment by a La Presse journalist in Quebec demonstrated, although the process exists, healthcare providers are not using it systematically.

An innovative approach by TELUS Health manages overall narcotic consumption from the insurer or private drug plan perspective, basing a patient’s use on morphine equivalent dosing (MED).

MED is an innovative prescription drug-monitoring tool that can act as a starting point in mitigating the risks of opioid addiction. The MED process converts doses of various narcotic analgesics to a morphine equivalent. Simon Lee, a manager in Pharmacy Services at TELUS explains: “Just as most foreign currencies are referenced to the American dollar to simplify exchange, the MED process references narcotics against a 30mg morphine equivalent to allow for accurate comparison.”  This approach can act as an “early warning system” to help identify plan members who may be on the path to addiction before the addictive behaviours have a serious impact on their health, and in the workplace.

Through MED, TELUS Health allows insurers to more accurately track medications regardless of the number of doctors who prescribe, or how many pharmacies the plan member uses. Plans can implement limits at the point-of-sale based on the MED value, which is better aligned with clinical experience than a dollar or quantity limit.

Managing Canada’s prescription drug abuse crisis using healthcare technology will require collaboration from all stakeholders: patients, insurers, plan sponsors, as well as all healthcare providers. And according to reports, it will be a critical focus for the future safety of all Canadians.