As the nation continues to grapple with the opioid epidemic, numerous federal organizations are focusing on reducing unintentional drug overdoses. Emerging evidence shows that adverse drug events because of concurrent prescribing are a serious problem. Every day, more than 115 Americans die after overdosing on opioids. In fact, according to the National Institutes on Drug Abuse, concurrent use of benzodiazepines with opioids was present in more than 30 percent of fatal overdoses, but many people continue to be prescribed both drugs simultaneously. Although no national hospital-level measure of the problem exists, according to the Veterans Health Administration, implementing a measure to assess the concurrent prescribing of opioids and benzodiazepines via its Opioid Safety Initiative has helped improve patient safety in veteran health facilities.
To help measure nationwide rates of concurrent prescribing, Mathematica developed the Safe Use of Opioids – Concurrent Prescribing electronic clinical quality measure on behalf of the Centers for Medicare & Medicaid Services. This measure assesses the percentage of adult patients who were prescribed two or more opioids or an opioid and benzodiazepine concurrently after a hospital discharge. The measure aims to reduce preventable mortality and the costs associated with adverse events related to concurrent opioid and benzodiazepine use by doing the following:
(1) Encouraging providers to identify patients with concurrent prescriptions of opioids or opioids and benzodiazepines
(2) Discouraging providers from prescribing two or more opioids or opioids and benzodiazepines concurrently whenever possible
“Developing this measure can raise providers’ awareness of the adverse effects from prescription opioid use,” explained Cindy Cullen, associate director at Mathematica. “In addition to averting potentially tragic outcomes, this opioids co-prescribing measure might also help reduce health care costs.”
The measure aligns with the 2016 Centers for Disease Control Guidelines for Prescribing Opioids for Chronic Pain and opioid prescribing guidelines issued by several state agencies and professional societies. These organizations’ guidelines support the recommendation to avoid concurrently prescribing multiple opioids or opioids and benzodiazepines whenever possible, as the combination of these medications could foster opioid-induced respiratory depression. The National Quality Forum’s Patient Safety Committee endorsed this measure in May 2018.
Designing, producing, and testing measures are critical to health care quality improvement. Mathematica is a pioneer in evidence-based measure development. Combined with expert implementation support, our measures support data-driven decision making that helps providers, payers, and systems improve outcomes and progress together.