Problem Prescribers Identified
Recently in the news, CVS Caremark announced that it will stop filling opioid prescriptions for physicians classified as “excessive prescribers”. Excessive prescribers were classified on the basis of those who wrote opioid prescriptions for younger patients, patients paying primarily with cash or for those people driving long distances to fill prescriptions. Those practitioners that stood out were “prescribing 20, 30, up to 50 times as much pain medication as the average prescriber...”1
In a related development, drug manufacturers have come under increased criticism for not sharing information they have on potentially problem prescribers. Purdue Pharma, manufacturer of Oxycontin, is protecting its list of more than 1,800 doctors suspected of prescribing pills excessively. They have alerted law enforcement or medical boards to only 8% or 154 physicians on the list of problem prescribers. 2 Purdue Pharma has continued to profit from prescriptions written by these physicians, many of whom were prolific prescribers of OxyContin. The company has sold more than $27 billion worth of the drug since its introduction in 1996.3
In 2010, the Centers for Disease Control and Prevention reported 38,329 drug overdose deaths nationwide, which was the 11th consecutive year showing an increase. “Medicines, mostly prescription drugs, were involved in nearly 60% of overdoses deaths that year, overshadowing deaths from illicit narcotics.” Opioids, including Oxycontin and Vicodin were the biggest problem, contributing to 3 out of 4 medication overdose deaths, according to a report issued recently by the AMA. Dr. Thomas Frieden, head of the CDC and Prevention said many doctors “don’t realize how addictive these drugs can be, and that they’re too often prescribed for pain that can be managed with less risky drugs.” 4 For decades, physicians avoided prescribing narcotic painkillers for anything but cancer and end-of-life pain, because they feared the risk of addiction and overdose. As drug companies pushed for broader use, doctors began prescribing them for bad backs and other ailments. 5 In 2007 Purdue paid in excess of $600 million to settle government charges that it trained its sales representatives to mislead physicians about the risks of addiction and overdose from Oxycontin. 6
After Purdue introduced a tamper-resistant formulation in August of 2010, sales plummeted. Prescriptions for Opana, a narcotic painkiller that could still be crushed and snorted shot up about 400%. Two years later when Opana’s crush resistant version came to market, their sales also plunged. Oxycontin’s original formula, which is not tamper resistant, remains on the market, free from competition from generic drug manufacturers.
1 CVS stops filling painkiller prescriptions by ʻoutlierʼ doctors, CommonHealth post 8/21/13 by Martha Bebinger.
2 “Problem prescriber data exists...”, Fierce Practice Management, post 8/28/13, by Debra Beaulieu
3 “Oxycontin maker closely guards its list of suspect doctors,” latimes.com, 8/11/13 by Scott Glover and Lisa Girion
4 “Drug overdose deaths up for 11th consecutive year,” APʼs The Big Story, Feb. 19, 2013 by Lindsey Tanner.
5 “Oxycontin maker closely guards its list of suspect doctors,” latimes.com, 8/11/13 by Scott Glover and Lisa Girion.
6 “Purdue and OxyContin: A timeline”, latimescom, 8/11/13.