Retrospective DUR Curbs Unsafe Opioid Combo Therapy

Retrospective drug utilization review (DUR) programs can reduce potentially unsafe concomitant opioid and central nervous system (CNS) medication use.

Opioids are the most common medication class contributing to drug overdose, which is currently the leading cause of unintentional death in the United States. Among opioid-related deaths, concomitant benzodiazepines and antidepressants are most often cited.

Retrospective DUR programs have proven successful in addressing the opioid mortality epidemic in different patient populations, but their utility for potentially unsafe opioid and CNS combination therapy is unknown.

To determine the programs’ effectiveness in this area, researchers combed through pharmacy claims data from more than 2.2 million commercially insured adult members continuously enrolled in a Midwest Blue Cross Blue Shield plan from May 2, 2013, through February 15, 2014.

Of those members, 980 met the DUR program criteria of having 1 or more paid claims for an opioid with at least a 200 mg morphine equivalent dose (MED) daily and a concurrent claim of another opioid, benzodiazepine, or antidepressant.

The researchers then sent out a survey to 671 prescribers managing pain therapy for these 980 members, asking them to reevaluate the members’ pain therapies.

The majority of the 231 returned surveys indicated that no change to pain management therapy was made, but 8.5% of responses indicated that the opioid dose was decreased, and 14% indicated some other change, such as plans to perform a urine screen or discontinuing a medication. Most respondents (62.3%) reported that the retrospective DUR program was useful in their daily practice.

To assess the effectiveness of the DUR program, the researchers reapplied the previous program criteria to the 734 members who still had Blue Cross Blue Shield pharmacy insurance 120 days later, and they found that only 528 were still taking potentially unsafe opioid and CNS combination therapy—a 28.1% observed reduction from the pre-DUR period.

“Because the drug overdose epidemic is the leading cause of unintentional death in the United States, managed care organizations are well positioned to use multiple strategies such as care management and academic detailing—as well as member education regarding fraud, waste, and abuse—as follow-up to a retrospective DUR program for a comprehensive approach to further manage and reduce high-risk opioid use,” the researchers concluded.

Their findings were published in the Journal of Managed Care & Specialty Pharmacy.