Screening for potential prescription opioid misuse in a michigan medicaid population.

BACKGROUND AND OBJECTIVES The study's objective was to identify patients at risk for ineffective pain management using patient-specific opioid prescription data. METHODS We conducted a retrospective review of payer opioid prescription data and patient charts from a rural family medicine group with a residency program. Sixty-one patients were identified who had received three or more prescriptions from two or more providers over a 6-month period. We noted the number of prescriptions and providers, type of medication prescribed, evidence of a medication management agreement (MMA), early refills, increasing doses, frequent telephone calls, reports of lost or stolen medication, history of drug abuse, and proper chart documentation. RESULTS Seventy percent of the patients were female, 35% had a history of drug abuse, 15% had MMAs, and only 55% had accurate office chart documentation. The number of prescriptions in a 6-month period averaged 8.4 (SD=5.5, range 3 to 28). The average number of prescribers was 3.7 (SD=1.8, range 2 to 10). Patients using non-opioid analgesics had 3.2 fewer prescriptions per 6 months and were less likely to have six or more prescriptions (OR=0.24, 95% CI=0.08--0.73) than those on opioids alone. Concurrent use of non-opioid analgesics, escalating opioid dosage, and number of providers best predicted the number of opioid prescriptions. CONCLUSIONS Payer data was useful in identifying patients who receive larger-than-expected numbers of opioid prescriptions and factors associated with those larger prescription numbers.