More than 100 Medicaid recipients in South Dakota received opioid prescriptions from April 1 to July 31 that were at least six times higher than the maximum recommended by the federal government, according to data released Friday.
Medicaid is a health care program jointly funded by the state and federal governments. The federal Centers for Disease Control and Prevention is telling medical professionals to use caution when prescribing opioids at any dosage.
Opioids are painkillers such as morphine, hydrocodone and oxycodone that are often prescribed under brand names such as OxyContin, Percocet, Vicodin, Percodan, Tylox and Demerol. Their power is measured in morphine milligram equivalents, known as MMEs.
The CDC warning specifically says clinicians “should carefully reassess” increasing dosage to 50 MME per day and “should avoid” increasing dosages to 90 MME or more per day.
The state’s Medicaid Pharmaceutical and Therapeutics Committee, a panel of medical doctors and pharmacists, looked Friday at the prescriptions issued to South Dakota Medicaid patients who chronically use opioids.
A chronic user was defined as someone who used opioids for at least 90 consecutive days during the 120-day period. The report didn’t include cancer patients.
The report showed: 118 people at dosages less than 50 MME; 99 people at doses of 50 to 99 MME; 91 people at doses of 100 to 199 MME; 40 people at doses of 200 to 249 MME; 16 people at doses of 250 to 300 MME; and 114 people at more than 300 MME.
Committee members asked that a letter be prepared so it can be sent to five people who came up most often as prescribers of opioids to Medicaid patients.
Dr. James Engelbrecht, who practiced rheumatology — bones and joints — at Rapid City Regional Hospital until he retired in December 2015, suggested the letters bear the names of all committee members.
“If you want to have an impactful letter, have some faces,” Engelbrecht said.
Mike Jockheck, a pharmacy consultant for the state Department of Social Services, said he would take “a deeper dive” into the histories of the five most-frequent prescribers.
They are two physician assistants, two physicians and a nurse practitioner. Their names weren’t identified.
Dr. Rick Holm, an internal medical specialist from Brookings, said he was willing to put his name on the letter.
“I do like that idea,” Jockheck said.