Drug prescriptions in U.S. often dangerous and inappropriate
Two recent reports highlight costly and widespread use of prescription medication in the United States that raise concern. Recently, the Department of Health and Human Services, Office of Inspector General, launched an investigation into prescribing practices among doctors. What they found was questionable practices for prescription drugs that include pain medications and antipsychotics that are paid for under Medicare part D and Medicaid.
Elderly and disabled at high risk from prescriptions
The finding suggests many physicians are writing potentially dangerous medications for the elderly and disabled.
The report, published by the inspector general of the Health and Human Services Department uncovered more than 700 physicians with questionable prescribing practices writing prescriptions for drug that have a high potential for addiction and abuse.
"The review found more than 2,200 doctors whose records stood out in one of five areas: prescriptions per patient, brand name drugs, painkillers and other addictive drugs or the number of pharmacies that dispensed their orders," wrote ProPublica reporters in a press release.
The reporters are urging Medicare officials to take a closer look at physician prescribing practices. In response to the investigation and ensuing recommendations, Medicare officials say they have been working to monitor the overuse of narcotics.
Yet, CMS officials also note the importance of Medicare beneficiaries having access to the medication they truly need. A past study shows many elders skip needed prescriptions due to cost.
Inspector General uncovers unsavory prescribing practices
The DHHS report highlights concerns about the growing problem of prescription drug abuse that they say is a ‘serious and growing problem”.
Data collected for the report was extracted from Prescription Drug Event records that provide:
• Name of the patient
• The dispensing pharmacy
• Prescribing physician
• The name of the medication
CMS developed 5 measures to describe questionable part D Medicare drug prescribing practices that included:
• Prescriptions per patient
• Brand name drugs,
• Painkillers or other addictive drugs
• The number of pharmacies that dispensed the medicines
Anyone can search for a doctor’s name along with a list of the drugs they prescribe – something that has never before been public.
Currently, 32 million people receive their medications through Medicare’s drug plan. In 2009, there were over 1 million prescribers treating the elderly and disabled.
The CMS report showed prescribing practices varied widely among doctors, depending on specialty. More than 700 doctors who general care were found to have questionable prescribing practices.
More than half of 736 physicians wrote prescriptions for extremely high amounts of controlled substances that have the potential for addiction and abuse.
CMS concluded physicians should have more oversight and training, with follow-up for those whose prescribing practice is questionable.
The finding also showed one doctor in California with what CMS calls ‘extreme outliers’ with regard to prescriptions cost Medicare 9.7 million dollars.
The total cost of prescriptions written by ‘extreme outliers’ totaled $352 million, according to the report.
Drug dispensing trumps patient safety
A ProPublica report from Tracy Weber, Charles Ornstein and Jennifer LaFleur last month suggested drug dispensing has trumped patient safety.
Weber, Ornstein and LaFleur searched hundreds of millions of records. They found one Miami psychiatrist who repeatedly prescribes the same drug to dementia patients that carries a ‘black box’ warning that the medication can cause death.
Some physicians use drugs to treat patients that are not approved for the condition being treated.
A physician in Oklahoma gives a drug developed for Alzheimer’s disease to children with autism even though there is little scientific evidence that medication, which is Namenda, has any benefit. He says it calms autism behaviors.
Another drug, carisoprodol, which was pulled from the European market in 2007, is widely prescribed, also found in the ProPublica investigation. There were more than 500,000 prescriptions written for people over age 65 for the muscle relaxant in 2010. Yet, the medication is not recommended for people over age 65 due to risk of side effects that include risk of fall from dizziness, sedation and clumsiness.
The ProPublica team interviewed doctors to try to understand why they are prescribing dangerous drugs and using them in unapproved ways.
The Miami psychiatrist, Enrique Caruso, who prescribes antipsychotics to patients with dementia, said he has no choice.
“Drugs keep them safe and ease their anxiety, Caruso told ProPublica: "You have to submerge them in medication to avoid a catastrophic event."
But other experts say his prescribing practices are ‘alarming’. Three-quarters of prescriptions written by the psychiatrist to treat seniors with dementia was for the drug Seroquel that the FDA warn should not be used for patients with dementia due to risk of death.
The physician also routinely uses the drug zolpidem or Ambien that is considered highly risky for geriatric patients because of risk of confusion, falling and fractures.
But Medicare has not questioned him about his prescribing practices, nor provided any oversight.
Caruso was terminated from participating in the state’s Medicaid program in 2005. According to a public memo, Medicaid investigators believed he lacked "awareness or oversight of the medication prescribed.”
One of the problems leading to dangerous prescription drug dispensing is the way Medicare’s part D drug program is run, which is separate from beneficiaries’ medical care.
Part D Medicare was pushed through in 2003 under the Bush administration. Democrats were concerned because the plan eliminated Medicare’s ability to negotiate with drug companies for lower drug prices; essentially giving pharmaceutical companies a “blank check”.
Medicare expects insurance companies to be on alert for inappropriate prescriptions, but the companies don’t have enough information to intervene to protect patients.
Insurers are also not allowed to reject drugs claims, except in rare instances.
Thomas Barker, who was CMS's top lawyer when the program was being formed, said CMS "They just did not want to be accused of letting the Part D plans interfere with a physician's medical judgment.”
One in 7 people in U.S. takes a prescription drug
The in-depth report from ProPublica, and CMS’s response that they agree more oversight is needed to ensure Medicare recipients are not receiving dangerous and inappropriate drugs is in timing with another Mayo Clinic study showing one out of 7 people in the U.S. is taking a prescription medication.
Of concern, is that the second and third most widely prescribed drugs are those for mental health and drugs that have the potential for addiction.
The most commonly prescribed drugs, the report found, include antibiotics, antidepressants and opioid painkillers.
Study author Jennifer St. Sauver, Ph.D., a member of the Mayo Clinic Population Health Program in the Mayo Clinic Center for the Science of Health Care Delivery said in a press release, "Often when people talk about health conditions they're talking about chronic conditions such as heart disease or diabetes. However, the second most common prescription was for antidepressants — that suggests mental health is a huge issue and is something we should focus on. And the third most common drugs were opioids, which is a bit concerning considering their addicting nature."
The finding also showed women and elders receive more prescriptions overall.
Gwen Olson, a former drug representative and author of "Confessions of an Rx Drug Pusher" says drugs companies are not in the business of health and healing. She says pharmaceutical companies are instead focused on 'disease maintenance and symptom management".
The two reports highlight rampant use of prescription drugs in the U.S., many of which are addictive and dangerous, yet widely prescribed for elders and disabled individuals.
Another concern is that the pharmaceutical industry, especially prescribing psychiatric drugs, does nothing to cure underlying health problems; creating a vicious cycle of disease maintenance, not cures.
The findings are concerning, but also begs the question about what consumers can and really should do to ensure they are not taking inappropriate prescription drugs.
Should it be the sole responsibility of CMS to oversee drug safety and appropriateness?
Consumers do have a responsibility to take advantage of pharmacist counseling available anytime a prescription is filled. If you don’t have time to spend one on one, read your medication inserts.
Many insurance companies offer annual drug review with a pharmacist, free of charge. Pharmacists can then communicate with physicians directly when concerns are identified, yet few people take advantage or even know about all of their insurance benefits.
If you are one out of 7 in the U.S. taking one or more prescriptions, or if your loved one is on multiple medications for pain or depression, take it upon yourself to find out if they are safe, addictive or even appropriate. Until CMS provides more oversight to prescription drugs, you could be at risk.