Monday, April 2, 2012

Opioids Just the Start: The True Complexity of Drug Regimens

With our industry's intense focus on chronic opioid therapy, I thought it would be enlightening to point out that the opioid itself is generally the most expensive and prominent drug in the regimen, but typically leads to the use of a host of other medications, often used to treat the side effects of the opioid therapy.

Does this picture look familiar?

I'm consistently shocked at the content of the medical records we review here at PRIUM.  Often (though I acknowledge, not always), each of these conditions is treated as if it arose independent of the opioid therapy itself.  The treating physician documents the lack of good sleep hygiene, the muscle spasms, the depression, the weight gain, the sexual dysfunction, the constipation... all as if they arose as separate and distinct diagnoses.

The reality is that the physician is likely aware of the connection between the chronic opioid therapy and its side-effects, but I suspect documenting such is tricky.  To do so explicitly would lead to the logical conclusion that the opioid "trial" has failed and the drug(s) clearly need to be weaned and/or discontinued.  But this isn't what the patient wants - the patient wants his drugs.  He's in pain and that pain needs to be treated, even if that means the patient's medicine cabinet looks like a veritable retail pharmacy operation.  

Welcome to the reality of 21st century medicine: patient-directed care and a plethora of pills. 

All the more reason to STOP opioid therapy if it does not lead to clearly documented functional improvement.  There is no other valid clinical test.  If you're seeing opioid therapy on a claim without documented functional improvement, you're going to be paying for a lot of different drugs down the line (if you're not already doing so). 

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