Pharmacy Shopping and Overlapping Prescriptions Linked To Opioid Overdose

Dr. Zhou Yang Office of the Associate Director for Policy Centers for Disease Control and Prevention, Atlanta, Interview with:
Dr. Zhou Yang
Office of the Associate Director for Policy
Centers for Disease Control and Prevention, Atlanta, GA

Medical Research: What is the background for this study?

Response: Prescription drug misuse and abuse, largely those involving opioid painkillers, have been characterized as an epidemic. According to a CDC report, drug-related overdose has surpassed traffic crashes to become the leading cause of injury death in the U.S. in 2009. Medicaid programs in most states implement Patient Review and Restriction (PRR) programs, also called ‘lock-in’ program. The PRR programs use a set of behavioral indicators to identify patients at higher risk of opioid drug misuse and abuse, and ‘locks’ them in to a designated provider, pharmacy, or both. Pharmacy shopping is one of the key indicators employed by the PRR program. However, definition of pharmacy shopper varies widely across states. In addition, the PRR programs have not paid attention to the indicators of prescribing overlapped drugs, which we see as a missed opportunity to help the PRR program to better target users at high risk of overdose.

Medical Research: What are the main findings?

Response: Among a number of currently used definitions of pharmacy shopping, we found that the definition of ‘four or more pharmacies visited within any 90-day period’ is the most effective one. We also found that having overlapping opioid prescriptions is associated with an elevated risk of overdose. In fact, patients who exhibited both pharmacy shopping and having overlapping prescription had more than twice the risk of overdose than those who only exhibited pharmacy shopping.

Medical Research: What should clinicians and patients take away from your report?

Response: The main target audience of this study is the Medicaid policy makers at state level. How to better define pharmacy shopping behavior and how to better identify high risk opioid users are both relevant questions to ask. Based on our study, we recommend defining pharmacy shopping as visiting four or more different pharmacies in any 90 days. We also suggest that the PRR program should use patient’s prescription records to identify overlapped prescriptions.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Medicaid populations have a much higher risk of opioid overdose-related death than non-Medicaid populations; therefore more research on possible ways to prevent opioid prescription misuse and abuse among Medicaid beneficiaries is needed. We have used a multi-state data to demonstrate the association between the two behavioral indicators and opioid overdose. One recommendation would be to use state-specific data to further examine the effectiveness of these two and other behavioral indicators to inform policy formulation in a particular state.


Defining Risk for Prescription Opioid Overdose: Pharmacy Shopping and Overlapping Prescriptions among Long-Term Opioid Users in Medicaid

Zhuo Yang Barth Wilsey Michele Bohm Meghan Soulsby Kakoli Roy

Dominique Ritley Christopher Jones Joy Melnikow

Journal of Pain Received: October 1, 2014; Received in revised form: January 20, 2015; Accepted: January 23, 2015; Published Online: February 10, 2015


[wysija_form id=”1″] Interview with: Dr. Zhou Yang (2015). Pharmacy Shopping and Overlapping Prescriptions Linked To Opioid Overdose 

Last Updated on November 4, 2015 by Marie Benz MD FAAD