Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Prescription Abandonment and What it Tells Us

Making choices and ignoring others.

It goes without saying that poor adherence to treatment regimens leads to poorer clinical outcomes in chronic medical conditions.

A study published last year in "The Psychiatrist", and another more recent article in "Annals of Internal Medicine", examined as the main measure of adherence whether patients collected prescribed medications from a pharmacy (and not, in addition, whether the medication was consumed).

In "The Psychiatrist" article, the analysis suggests that supervised consumption and a shorter duration of treatment were the most significant predictors of non-adherence: So, although supervised consumption of methadone reduces the risk of diversion and methadone-related deaths, it may increase the risk of decreased adherence. Perhaps patients do not appreciate being observed so carefully, the resultant increase in illicit heroin use notwithstanding.

The "Annals of Internal Medicine" article found the extremely low rate of opiate abandonment most likely indicates less cost-sensitivity compared to other drugs, and a greater demand for opiates. Of course, patient addiction or plans to divert opiates will also contribute to reduced rates of abandonment. This leads in turn to one of the musings offered by the authors of the study: While prescription abandonment is inefficient for the pharmacy, clinically-speaking not all abandonment is bad. For example a patient's symptoms may have resolved, and thus a prescribed "as-needed" medication is no longer needed. Also, the act of purchasing a medication does not guarantee the patient will adhere to the recommended treatment.

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In addition to the low rate of abandonment for opiates, there was a similarly low rate for anitplatelet medications, and a fairly low rate for blood pressure- and cholesterol- lowering medications, perhaps reflecting that while patients may "need" pain medications, they also appreciate the benefit of taking drugs to avoid catastrophic illness such as stroke and heart attack. Medications such as those for cough-and-cold, or heartburn, had a higher rate of abandonment.

Health care providers and patients would be best served by a mechanism that alerts the prescribing individual as to whether a prescription medication has been abandoned, so that the appropriate intervention can occur. This becomes all the more imperative if that same patient is extremely punctual about picking up an opiate prescription from the same pharmacy; such behavior could be a sign of doctor-shopping, or the manipulation of a single diagnosis-chronic pain-with the willful disregard of other health problems.

It is hoped that further study will elaborate on how electronic prescribing may contribute to pharmacy inefficiency, and how such systems can communicate to members of the health care team patterns of prescription abandonment so that abuse of medications is minimized, and quality of care is maximized.

 

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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