TRC Conversation: Safe and Effective Pain Treatment

Oct 14, 2014
Interventions from specialist pharmacists in the Neuroscience Therapeutic Resource Center® help patients gain a better understanding of their treatment regimen.
  • Pain

What Happened?

A 57-year-old woman with back pain was prescribed multiple long-acting pain medications: OxyContin® (oxycodone) and methadone.

Clinical Gap in Care

Methadone has a black box warning because deaths have occurred from improper use. Chronic dosing causes methadone to accumulate, leading to adverse effects.

Pain guidelines typically recommend treating chronic pain with one long-acting opiate and adding a short-acting opiate, such as Percocet® (acetaminophen and oxycodone), for breakthrough symptoms. Taking multiple long-acting opiates, such as OxyContin, with methadone increases the risk of adverse effects, including respiratory depression.

Specialist Pharmacist Intervention

A specialist pharmacist in the Neuroscience Therapeutic Resource Center® intervened to prevent the risk of a fatal overdose, while offering a solution for the member’s pain treatment.

Express Scripts specialist pharmacists perform concurrent drug utilization reviews (CDUR) on prescriptions to ensure safe and appropriate use of medications for chronic and complex conditions.

Our pharmacist contacted the prescriber to clarify the diagnosis and pain treatment plan as well as to discuss the increased risks associated with using multiple long-acting opiates.

The doctor consolidated the pain medications and discontinued the OxyContin. The dose of the methadone was increased to provide better pain control.

Why It Matters

Specialist pharmacists develop adherence, omission and safety alerts specific to a drug therapy, as well as recommend drug-therapy education materials.

A strong roster of specialist pharmacists focusing on patients with needs in a specific area, like neuroscience, is one of the unique ways Express Scripts helps patients stay on the right treatment and avoid unnecessary, harmful, adverse events. We call it Health Decision Science: the application of clinical specialization and behavioral sciences combined with actionable data to enable better decisions and healthier outcomes.

Click here to download an overview of this conversation.

Author Bio

Lab Staff
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