Polypharmacy, the use of 4 or more medications simultaneously, is a dangerous but frequent practice for chronic pain patients. Unfortunately, because many patients undergoing chronic pain treatment suffer multiple chronic health issues, exposure to drug-drug interactions (DDI) is a common but unintended result, leading to severe consequences for the physical health of patients, as well as a significantly increased financial burden for all involved: patients, providers, and society.
What defines a drug-drug interaction?
A pharmacokinetic DDI involves two or more drugs interacting in such a way that the effectiveness and/or toxicity of one or more of those agents is affected. Physicians' and pharmacists' track record of identifying DDIs have been shown to be poor in the past, with reliance on electronic record keeping that may or may not link with other physician/pharmacist systems further complicating matters. Identifying DDIs has also been made increasingly difficult by the fact that they may present themselves as an alteration in patient physiology, mimicking almost any clinical presentation including other diseases a patient is under treatment for or the physiological changes of aging. Reports are also inconsistent, with wide ranges: 2–30% for hospitalized patients and 9–70% for ambulatory patients, for example.
Will new studies on DDIs shed sufficient light on the subject?
Five recent broad, foundational studies assessing the health care utilization and associated medical costs of opioid analgesics for patients under 18 years undergoing non-cancer chronic pain treatment were assessed. These studies focused on drug-drug exposure (DDE) which is more easily identified and is strongly linked to increasing the potential for DDIs. Researchers’ results yielded a number of findings related to the potential risks and economic implications of DDIs including:
- That drug–drug exposures are prevalent
- DDIs result in significantly higher and substantial costs when they occur
- DDIS can occur in any age group.
- Physicians should consider ways to limit their patients' exposure to potential DDIs.
What measures are being taken to disseminate information on DDIs?
Further studies are being called for to better understand the pharmacokinetics of DDIs and how the costs of DDIs further contribute to the overall cost of the health care system. In the meantime, clinical awareness of the seriousness and scope of drug-drug exposure and interactions prevents effective control of the situation, thus dissemination of this knowledge is key to a positive outcome. All avenues of the medical community are currently involved, including government FDA research and drug label upgrades on selected medications, physician and patient awareness programs from pharmaceutical companies and nonprofits, and enhancement of technology including more streamlined, accurate, prescription databases.
Suitable alternate solutions can be found that do not expose patients to the risk of DDIs
With the chronic pain population growing, awareness of the issues surrounding DDIs is more important than ever. A well informed physician’s practice can improve safety and the outcome of chronic pain treatment patients through doctor/patient education, careful monitoring of chronic pain patients who take concurrent medications, avoiding the prescription of multiple concurrent medications specifically when opioid analgesics ( i.e. codeine, fentanyl, hydrocodone, methadone, oxycodone, tramadol etc.) are involved. This is an area where the expert medical cost containment solutions of ANS Solutions can help. Our
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References
Pergolizzi Jr. , Joseph V., Puenpatom, R. Amy, Summers, Kent H., Taylor Jr., Robert Ecomonic Implications of Potential Drug-Drug Interactions in Chronic Pain Patients. Expert Rev Pharmacoeconomics Outcomes Res. 2013;13(6):725-734.
