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Last Updated
August 22, 2014
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August 14, 2014
Prescription Use Varies by Region, Higher for Children on Medicaid
BACKGROUND: Despite the frequency of pediatric prescribing, little is known about practice
differences across small geographic regions and payer type (Medicaid and commercial). 

Children insured under Medicaid were more likely to have higher prescription use, though regional
variation was a bigger factor for differences in prescription use among children, according to a
study in Pediatrics. Researchers examined drug prescription use for 949,821 children aged 0 to 18
years, finding 54% were covered by Medicaid and 46% by commercial insurance providers. Mean annual
prescriptions were 5.5 per person-year for Medicaid patients and 3.4 per person-year for commercial
patients. 

August 12, 2014
Medication Synchronization Supported by Some Insurance Company Policies
Medication synchronization, programs that allow pharmacists to coordinate a patient’s medications
to be refilled at the same time, may be accessible to more patients as insurers adopt policies to
support the practice. Specifically, Blue Cross and Blue Shield of Vermont and MVP Health Care, the
two largest insurers in Vermont, have agreed to implement prorated co-payments for patients who
wish to begin a medication synchronization program, reports the Brattleboro Reformer. The shift in
policy is part of a nationwide trend to help patients access these programs, which have been shown
to improve patient adherence rates. To synchronize a patient’s medications, pharmacists must often
dispense a special quantity of medication that may be more or less than the original prescribed amount.

See NCPIE Related: “Adherence Action Agenda
Addresses Multpile Chronic Conditions”   

August 12, 2014
ER Visits for Sleep Drug Overmedication Almost Doubles
The number of emergency department visits involving the sleep medication zolpidem (the active
ingredient in Ambien) almost doubled over four years, according to  new report.  Zolpidem is a
medication approved by the Food and Drug Administration (FDA) for short-term treatment of insomnia
and is the active ingredient in the popular sleep aids Ambien®, Ambien CR®, Edluar®, and Zolpimist®
 In 2010, approximately one third or 20,793 of the 64,175 emergency department (ED) visits
involving zolpidem resulted from overmedication. This report examines zolpidem involvement in ED
visits that are related to overmedication, which may occur when a patient takes too much of their
own medications (i.e., exceeds the prescribed or recommended dose). Overmedication visits may
involve multiple medications, but this analysis excludes visits that involved an illicit drug or
prescription medications that were not prescribed for the patient or that were the result of a
drug-related suicide attempt.  All drugs involved in visits attributed to overmedication are
documented; however, for visits involving multiple pharmaceuticals, it is not known which specific
drug or drugs were taken in excess.

August 8, 2014
Emergency Department Visits for Drug-related Suicide Attempts Rise over Six Year Period
Two new reports highlight the rise in drug-related suicide attempt visits to hospital emergency
departments especially among certain age groups. The reports by the Substance Abuse and Mental
Health Services Administration (SAMHSA) show that overall there was a 51 percent increase for these
types of visits among people 12 and older -- from 151,477 visits in 2005 to 228,277 visits in 2011.

One report analyzed the increase in emergency department visits by age and found that the overall
rise resulted from increases in visits by people aged 18 to 29 and people aged 45 to 64.  Visits
involving 18 to 29 year olds increased from 47,312 in 2005 to 75,068 -- a 58 percent increase.
Visits involving people aged 45 to 64 increased from 28,802 in 2005 to 58,776 visits in 2011 -- a
104 percent increase. In 2011, these two age groups comprised approximately 60 percent of all
drug-related emergency department visits involving suicide attempts.  

The other SAMHSA report focused on the 45 to 64 age group, which had the largest increase in
emergency department visits involving drug related suicide attempts, and characterized these
visits. The report found that the majority (96 percent in 2011) of these visits involved the
non-medical use of prescription drugs and over-the-counter-medications. In 2011, these drugs
included anti-anxiety and insomnia medications (48 percent), pain relievers (29 percent) and
antidepressants (22 percent).  Other substances involved in these drug-related suicide attempt
emergency department visits during the same year included alcohol (39 percent) and illicit drugs
(11 percent). 

The report also found that these visits by patients aged 45 to 64 doubled for both men and women
during this time period. 

SAMHSA’s Suicide Prevention Resource Center at http://www.sprc.org  provides information on a wide
range of suicide prevention programs and resources who are dealing with this issue can draw upon.
SAMHSA’s National Suicide Lifeline at 1-800-273-TALK (8255) or
http://www.suicidepreventionlifeline.org/ provides real time,  toll free, confidential suicide
prevention counseling services 24/7 all year round to people in immediate crisis, or who may know
someone who they fear might be considering suicide

August 7, 2014
Prescribing, Taking Antipsychotics, Sedatives, Anxiolytics, Antidepressants, or Stimulants: Take Care
Medications can improve the quality of life for many people, but they also carry the risk of
causing potentially harmful side effects. Dr. Lee Hampton, a medical officer with the Division of
Healthcare Quality Promotion, describes a recent CDC study estimating the number of adult emergency
department visits for adverse events caused by therapeutic use of antipsychotics, sedatives,
anxiolytics, antidepressants, and stimulants in the CDC Expert Commentary series on Medscape.

The study estimated that adverse events from antipsychotics cause more than 20,000 emergency
department visits each year, while adverse events from sedatives and anxiolytics cause more than
30,000 visits annually. The results provide a reminder that risks for serious side effects and the
availability of other treatment approaches should be considered before prescribing medications.
Visit CDC’s Medication Safety Program website to learn more about the study and adverse drug events.