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Important information on prescribed narcotic therapy

December 1, 2014

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As misuse, abuse, and overdose become more common in patients who have been prescribed narcotic therapy, health care providers and managed care organizations are faced with the challenge of controlling overutilization. The most recent data shows that more than 16,000 lives are lost each year due to opioid-related overdoses. The death toll from accidental overdose has surpassed that of motor-vehicle accidents, making it the leading cause of death for the first time in the history of the United States.1

To help facilitate more appropriate usage and prescribing, Independence will require prior authorization on all high-dose and high-potency narcotics effective January 1, 2015.

Prescribing narcotic therapy

Independence encourages you to keep in mind the following information when prescribing narcotic therapy to your patients:

  • The most commonly abused opioid prescription drugs are: codeine, morphine, methadone, oxycodone (Oxycontin®), hydrocodone, hydromorphone, oxymorphone, meperidine, and fentanyl.2
  • The recommended maximum daily morphine equivalent dose (MED) should not exceed 120 mg per day. Above this dose, risks of physical dependence, tolerance, and adverse reactions must be balanced with the pain relief benefit as well as functionality and quality of life issues.3
  • Consider the balance of long-acting and short-acting medications. The current recommendation for dosing breakthrough medication is 10 ? 15 percent of the daily long-acting dose.4
  • Fentanyl patches should not be used in patients without sufficient body mass. Absorption is decreased in cachetic patients because the drug accumulates in skeletal muscle and fat and is then slowly released into the blood.
  • Ultram® became C-IV as of August 18, 2014.
  • Hydrocodone (e.g., Vicodin®, Lortab®) became C-II on October 6, 2014. These products will no longer be able to be called in to pharmacies or be refilled. A new hardcopy prescription will need to be issued for each fill.

When additional help is needed, providers should instruct patients to contact their mental health/ substance abuse services provider. Members with Magellan Behavioral Health, Inc. coverage can call 1-800-424-4238.

Look for more information on prescribing narcotic therapy in future editions of Partners in Health UpdateSM.

1 Pennsylvania Guidelines on the Use of Opioids to Treat Chronic Noncancer Pain. Pennsylvania Medical Society.

2 www.drugabuse.gov. National Institute of Drug Abuse.

3 Franklin, Gary M. Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology. Neurology 2014; 83; 1277-1284.

4 McPherson, Mary Lynn. Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing.

Magellan Behavioral Health, Inc., an independent company, manages mental health and substance abuse benefits for most Independence members.

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