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.