Knowing the Facts About Medication Adherence Among Those with Serious Mental Illness

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1 FALL 2015 VOLUME #01 IN G E N UI TY HE A LTH : PRESCRIPTION DRUG REPORT A Review of Medication Monitoring Results of People in Treatment for Serious Mental Illness Knowing the Facts About Medication Adherence Among Those with Serious Mental Illness

2 ONE OF THE MOST SERIOUS PROBLEMS IN PSYCHIATRIC CARE THERE S A GOOD CHANCE THAT TODAY, EACH ONE OF US WILL INTERACT WITH SOMEONE WHO HAS faced serious mental illness in the past year. 1 That is, one of 25 adults in the United States was so afflicted with mental illness in the past year that he or she could not go to work, attend school or buy groceries. The consequences are enormous, both for the people with a serious mental illness and those of us without one. Untreated mental illness can lead to hospitalizations, homelessness, incarceration and episodes of violence. But there s an even deeper story here: the seriously mentally ill even when being treated frequently are not following their treatment regimen. Nonadherence to antipsychotics is one of the most serious problems in psychiatric care. 2 Ingenuity Health, a service of Ameritox, provides medication monitoring primarily through urine drug tests to psychiatrists and other clinicians treating the seriously mentally ill. Ingenuity Health provides medication monitoring for nine antipsychotics, which are among the most commonly prescribed to treat those with schizophrenia, bipolar disorder and major depressive disorder. The results presented in this report are based upon nearly 23,000 urine drug samples of people prescribed antipsychotics through March More Than 23,000 Patients Sampled Prescribed Drug Not Found Non-Prescribed Drug Found One or More Illicit Drugs Found 1 Any Mental Illness (AMI) Among Adults. (n.d.). Retrieved January 16, 2015,from - See more at: https://www.nami.org/learn-more/mental-health-by-the-numbers#sthash.b83lpyq1.dpuf 2 Medication Noncompliance Among the Mentally Ill, Mental Illness Policy Org PAGE 2

3 Nearly 23,000 samples from patients prescribed an antipsychotic analyzed by Ingenuity Health revealed: % 33% 19.7% Did not contain the prescribed antipsychotic Contained a non-prescribed medication Contained an illicit drug These big-picture results demonstrate that likely medication nonadherence, along with the non-medical use of prescription drugs and abuse of illicit drugs, is complicating the treatment of the seriously mentally ill. PAGE 3

4 A TANGLED WEB: ILLICIT DRUG USE IT IS IMPOSSIBLE TO CONVEY HOW DEEPLY ENTRENCHED SERIOUS MENTAL ILLNESS IS WITHOUT considering how often it is combined with a substance use disorder. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are approximately 8.4 million adults in the United States with a co-occurring mental illness and substance use disorder. 3 IT IS OFTEN DIFFICULT TO DISENTANGLE THE OVERLAPPING SYMPTOMS OF DRUG ADDICTION AND OTHER MENTAL ILLNESSES, MAKING DIAGNOSIS AND TREATMENT COMPLEX. Nora Volkow, M.D., Director of the National Institute on Drug Abuse Ingenuity Health s results offer insight into the breadth of this problem: 35% of the samples contained either a non-prescribed opioid, a non-prescribed benzodiazepine, THC or cocaine (the numbers below do not add up to 35 percent, due to some samples containing more than one of these substances). 6.4% benzodiazepine 14% opioid 18.6% THC (the active ingredient in marijuana) 4% Cocaine 3 SAMHSA, National Survey on Drug Use and Health, 2012 PAGE 4

5 OPIOID MISUSE: A DANGEROUS COMPLICATION AMONG THOSE WITH SMI FOR THE SERIOUSLY MENTALLY ILL, THE MISUSE AND ABUSE OF OPIOIDS SEEMS TO BE AN ESPECIALLY dangerous co-occurring disorder. For starters, there is the overall risk of overdose for anyone who misuses opioid pain relievers, like oxycodone, hydrocodone and oxymorphone: 16,235 people died in 2013 from overdosing on prescription opioids. 4 Additionally, opioid abuse results in a worse prognosis for a person with mental illness. Layered onto that is that opioid abuse results in a worse prognosis for a person with mental illness. People who are actively using are less likely to follow through with their treatment plans. They are less likely to adhere to their medication regimens and more likely to miss appointments, which lead to more psychiatric hospitalizations and other adverse outcomes. 5 Ingenuity Health s results call attention to significant use of non-prescribed opioids among the seriously mentally ill and an even higher level of abuse among those who are not taking their antipsychotics. Among Ingenuity Health samples: 14% opioid was detected 13% 17.4% opioid was found when the antipsychotic WAS detected opioid was found when the antipsychotic was NOT detected 4 National Center on Health Statistics, CDC Wonder 5 NAMI Dual Diagnosis Fact Sheet, Jan PAGE 5

6 OPIOID MISUSE: THEIR DANGEROUS MIXES IN PATIENTS PRESCRIBED AN ANTIPSYCHOTIC, AS REPORTED ON THE PREVIOUS PAGE, 14 PERCENT OF the time the patient is also found to have taken a non-prescribed opioid. Often, that is not the only nonprescribed drug or illicit drug discovered in the patient s system. Here, we show the details**: Among Ingenuity Health samples: 14% opioid was detected 62% opioid only 18% opioid and marijuana 3.5% opioid and cocaine 9.5% opioid and a non-prescribed benzodiazepine 4.2% opioid and a non-prescribed benzodiazepine and marijuana 2% opioid, cocaine and marijuana **.8 contained various other combinations PAGE 6

7 BENZODIAZEPINES: IMPORTANT BUT DANGEROUS DRUGS FOR THE MENTALLY ILL BENZODIAZEPINES ANTIANXIETY DRUGS ARE WIDELY PRESCRIBED TO THE SERIOUSLY MENTALLY ILL: in one study, one out of four patients was prescribed an antianxiety drug at remission from a mood episode. 6 Yet Centers for Disease Control researchers found that drugs often prescribed for mental health conditions were involved in nearly 30 percent of prescription drug overdose deaths. 7 Antidepressants were involved in 18 percent of overdose deaths and antipsychotics in six percent of overdose deaths. Patients with mental health or substance use disorders are at increased risk for nonmedical use and overdose from prescription painkillers as well as being prescribed high doses of these drugs, said CDC Director Tom Frieden, M.D., M.P.H. APPROPRIATE SCREENING, IDENTIFICATION, AND CLINICAL MANAGEMENT BY HEALTH CARE PROVIDERS ARE ESSENTIAL PARTS OF BOTH BEHAVIORAL HEALTH AND CHRONIC PAIN MANAGEMENT. Tom Frieden, M.D., M.P.H., CDC Director CDC Researchers Found: Among Ingenuity Health samples: 30% Drug overdose deaths involving drugs prescribed for mental health conditions 6.4% benzodiazepine was detected 18% Drug overdose deaths involving antidepressants 6% Drug overdose deaths involving antipsychotics 6.1% benzodiazepine was found when the antipsychotic WAS detected 7.1% benzodiazepine was found when the antipsychotic was NOT detected 6 The Journal of Clinical Psychiatry: Benzodiazepine use and risk of recurrence in bipolar disorder: a STEP-BD report 7 Pharmaceutical Overdose Deaths, United States, 2010, in the Journal of the American Medical Association PAGE 7

8 A UNEXPECTED FIND: THE SURPRISING PREVALENCE OF UNEXPECTED ANTIPSYCHOTICS Whether attributable to unclear communication about starting and stopping medications, or prescriptions from more than one clinician, many patients are taking medications not known to their primary prescriber. Among Ingenuity Health samples: 6.5% antipsychotic was detected among all samples 6.3% antipsychotic was found when the prescribed antipsychotic WAS detected 7.3% antipsychotic was found when the prescribed antipsychotic was NOT detected We made the decision to publish this internal data in the hope that making it available will help people living with a serious mental illness understand that the results their clinicians gain from monitoring their medications can produce productive discussions that help improve patient care. We also hope that this information can enrich the efforts of public officials, health care workers, community groups, educators and media to address the issues around serious mental illness. FOR MORE INFORMATION, PLEASE VISIT: INGENUITY HEALTH. ALL RIGHTS RESERVED. INGENUITY HEALTH IS A SERVICE OF AMERITOX, LTD. IHU E. LOMBARD STREET, SUITE 1610 BALTIMORE, MD

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