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By Richard Asinof
WOONSOCKET – In a “perspective” piece published online in the Aug. 21 edition of the New England Journal of Medicine entitled “Abusive Prescribing of Controlled Substances – A Pharmacy View,” CVS Caremark detailed how it was mining data from its database to identify “outliers” and halt inappropriate prescription of high-risk drugs such as opioid painkillers.
The article, written by Dr. Troyen Brennan, executive vice president and chief medical officer at CVS, and Mitch Betses senior vice president of Retail Pharmacy Services, at CVS, Pharmacy Services, detailed how the national pharmacy chain put a program in place to identify problem prescribers by studying their volume and share of high-risk drugs versus other providers in the same specialty and geographic region, also comparing the ages of payments and their payment methods.
As a result, the authors said, 42 outlying prescribers were identified from the CVS’s database of nearly 1 million prescribers, who were then asked to provide additional information. Only six of those had legitimate reasons for their unusual prescribing practices, according to the article.
“Our program is certainly not a comprehensive solution, but it provides some sense of the kind of inappropriate prescribing that is going on in our health care system,” the authors wrote, noting that patients who are abusing painkillers are often generally younger than the average patient with chronic disease. A more comprehensive solution, they continued, “would involve the use of a national prescription-drug-monitoring database that would be used by clinicians at the point of prescribing and by all pharmacies at the point of dispensing.”
Traci C. Green, an assistant professor of Medicine in research at Brown University focused on drug abuse and addiction, agreed that a more comprehensive system, one that was integrated with all pharmacies on a statewide or regional basis, would be a preventive measure to stop “doctor shoppers” – patients who go to numerous doctors to refill prescriptions for painkillers.
Green’s 2011 research and analysis of medical examiner reporters on the prevalence of overdose deaths linked to prescription drugs in Rhode Island led Dr. Michael Fine, the director of the R.I. Department of Health to change the state’s health priorities to address the issue.
Green also pointed the pilot program undertaken by Walgreens pharmacies in Rhode Island to dispense Narcan (Naloxone), an emergency antidote that can be used to reverse the effects of opioid overdoses, as an example of what pharmacies can do working collaboratively with state health officials to combat overdoses.