Concerns with Concurrent Therapy

Jul 14, 2015

Injured workers receiving multiple prescriptions from various doctors poses risk for drug interactions, duplication of therapy, harmful side effects and abuse or misuse.

  • Workers' Compensation Insurance
  • Compound Medications
  • Pain

New Pill Bottle

Managing multiple medications is challenging and potentially dangerous – even more so without holistic care coordination.

In workers’ compensation, adjusters may lack a comprehensive view into an injured workers’ prescription history. If injured workers are receiving treatment from various doctors, they could be at risk for drug interactions, duplication of therapy, harmful side effects and abuse or misuse.

In 2014, nearly half of injured workers using an opioid pain medication took a combination of prescription drugs for their work-related injury that carries potentially serious safety risks.

Among patients using opioids:

  • 32.6% had a concurrent prescription for a muscle relaxant,
  • 10.5% had been prescribed a benzodiazepine – a drug class that includes anti-anxiety medications, and
  • 4.3% were also taking all three other types of medications during the same period.

Because opioids, benzodiazepines and muscle relaxants all can slow the respiratory system, taking these medications together can increase the risk of side effects and death from respiratory depression. Although taking three of these types of drugs in combination – sometimes referred to as a “Houston Cocktail” or “Holy Trinity” – may be clinically appropriate if there is a clear clinical indication and functional improvement, the combination must be used with extreme caution. In fact, using benzodiazepines and opioids in combination is the most common cause of overdose deaths involving multiple drugs.

Among patients who in 2014 were taking one of these potentially dangerous combinations of medications, nearly 42% were prescribed the medications by two or more physicians and 19.1% filled their prescriptions at two or more pharmacies.

Concurrent Use of Opioids and Compounds

When a physician prescribes a compounded medication – like a topical cream – to an injured worker, it’s typically for pain management. With this, one might expect oral narcotic use to decrease when injured workers begin using a compound, but Express Scripts research proves this is not the case.

Our data shows that 85% of injured workers taking an oral opioid 30 days before being prescribed a compound continued taking that narcotic 30 days after starting compound use, based on a sample of 1000+ injured workers.

Moreover, 100% of injured workers taking an opioid 60 days prior to using a compound, continued opioid use 60 days post compound use. The same holds true for users taking an opioid 90 days pre- and post-compound use.

Dangerous Impact to Injured Workers, Payers

Not only does concurrent use of an opioid and a compounded medication pose serious safety concerns; it can also lead to unsustainable costs for the payers.

At $487.59 per-user-per-year, opioids are the most expensive class of medications for work-related injuries. Compounded medications have the highest average prescription cost at for this population $1,696.99.

Proactive Solutions

Point-of-sale checks are critical in order to avoid potential abuse or misuse and ensure coordination among multiple prescribers and pharmacies.

Through our Concurrent Drug Utilization Review, Morphine Equivalent Dose (MED) Management program and Compound Management Solution, payers have the ability to proactive manage the pharmacy benefit to ensure safe utilization for injured workers and effectively contain costs.

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