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Few Patients Received High Amounts of Opioids from IHS-Run Pharmacies


OIG has been tracking opioid use in Department of Health and Human Services programs since 2016. Previous OIG evaluations have assessed opioid use in both Medicare and Medicaid, including identifying beneficiaries at serious risk of misuse or overdose. This issue brief focuses on IHS, which serves an American Indian and Alaska Native (AI/AN) population that may be at increased risk of misuse or overdose. Between 2016 and 2017, AI/ANs experienced a larger percentage increase in deaths involving prescription opioids than any other group. In addition, previous OIG work found that some IHS hospitals did not always follow IHS policy when prescribing and dispensing opioids.


We analyzed prescription drug data for opioids received from IHS-run pharmacies between May 2018 and April 2019. We calculated patients' morphine equivalent dose-a measure that translates various opioid formulations and strengths into a standard value-to compare opioids received across patients and prescriptions. In addition, we reviewed IHS documents regarding IHS's policies for prescribing and dispensing opioids and steps that IHS has taken in response to the opioid crisis. We also conducted interviews with IHS officials and staff to understand (1) the results of IHS's efforts; (2) how IHS monitors opioid use and opioid-related activities; and (3) challenges that IHS faces in preventing and detecting opioid misuse.


OIG's analysis of IHS data on prescription drugs showed that few patients received high amounts of opioids from IHS-run pharmacies. IHS has taken a number of steps to ensure appropriate opioid use among its patients, and IHS officials highlighted positive outcomes from these initiatives. However, IHS could improve the efficiency of its opioid monitoring systems by further automating its system for electronic health records (EHRs). Additionally, IHS officials reported challenges in using State-run prescription drug monitoring programs (PDMPs) and in tracking patient care received outside of IHS; both factors can limit IHS staff's ability to monitor opioid use.


We recommend that IHS (1) assess the costs and benefits of updating its EHR system with tools to support more automated monitoring and (2) request support from States and Federal partners to address challenges in using State run PDMPs. IHS concurred with both recommendations.