Purpose: In an effort to reduce potentially inappropriate narcotic use, we implemented a narcotic intervention mailing program aimed at prescribers of narcotics for patients with narcotic medication fill patterns suggesting potential misuse. We hypothesized that our program would reduce potentially inappropriate narcotic use and narcotic medication costs.
Methods: This was a retrospective cohort study within a Medicare Prescription Drug Plan. Intervened patients (N = 15,066) were compared with control patients (N = 16,107) with similar potentially inappropriate narcotic use who had not received the intervention at the time of the study. Patients were categorized as having potentially inappropriate narcotic use if they met at least one of five criteria during the 3-month identification period: 1) overuse of meperidine; 2) inappropriate use of nasal butorphanol; 3) concomitant use of two long-acting narcotics; 4) multiple prescribers for the same narcotic; and 5) multiple pharmacies where the same narcotic was filled. The primary outcome was the resolution of potentially inappropriate narcotic use during a 3-month follow-up period. Logistic regression was performed to evaluate the intervention effectiveness after adjusting for age, gender, geographic state, chronic disease score, type of potentially inappropriate narcotic use, number of distinct narcotics, number of narcotic fills, narcotic medication costs, and oncology medication use. Narcotic medication costs were compared during the identification and follow-up periods.
Results: The rate of resolution of potentially inappropriate narcotic use was significantly higher for intervened patients than controls (74% vs. 70%, p<0.0001). After adjusting for differences between cohorts, intervened patients were 19% more likely to have their potentially inappropriate narcotic use resolved than controls (adjusted OR 1.19; 95% CI 1.13-1.25; p<0.0001). On average, follow-up period costs of the narcotic medications were reduced by $23.10 for intervened patients and increased by $40.16 for control patients.
Conclusions: A narcotic intervention mailing program aimed at prescribers resulted in resolution of potentially inappropriate narcotic use and a reduction in narcotic medication costs.
Candidate for the Lee B. Lusted Student Prize Competition