At the 2018 IAIABC Annual Conference a panel discussed efforts to control inappropriate opioid use in workers’ compensation claims. The speakers were:
- Dr Gary Franklin – Medical Director, Washington State Department of Labor and Industry
- Dr Dinesh Govindarao – Chief Medical Officer, State Compensation Insurance Fund
- Joe Paduda – Principal, Health Strategy Associates
The opioid epidemic has lead to over 200,000 deaths. Hundreds of thousands of individuals have become dependent or addicted to these medications. These opioid addictions are having a big impact on both group health and workers’ compensation.
The first step in controlling inappropriate opioids is to prevent these prescriptions from happening in the first time. Opioids should never the first medication prescribed for pain. They should only be used for acute pain immediately post injury or surgery, and the prescription should be for a very short period of time (3 days or less). Education of injured workers regarding opioid medications is also important. Patients need to understand what is and is not appropriate use for opioids, and also what the side effects are. Education of physicians is also important. Communicate your opioid prescribing expectations with your network physicians and let them know that exceptions to these guidelines will require utilization review approval.
Payers need to develop a systematic way to treat the millions of patients already on long term opioids. You need to see if tapering is appropriate and if so how this can be appropriately done. The starting point with this is to identify the high-dose age claims so they can be reviewed. Your PBM should be able to provide this information.
It is important to provide an alternative pain treatment for those that get tapered off opioids. Things like cognitive behavioral therapy, active physical therapy (exercise), and multi-disciplinary pain management programs have been proven effective. The goal is teaching the patient ways to cope with their pain without using opioids. One challenge in this area is that physicians receive very little training in pain managment so they do not always understand the potential alternatives to opioids. One carrier provided CEU classes to physicians on alternatives to opioids for pain management.
There is no simple solution for chronic pain as every patient responds differently. There is no magic pill. Success requires teamwork and multiple interventions. Don’t expect overnight success and be ready to make changes if something is not working.
From a regulatory standpoint, it is important to have strong regulations in place to assist in controlling physicians who refuse to follow widely accepted treatment guidelines. Drug formularies and prescription drug monitoring programs are a very important tool in this. However, there are many states where the regulatory framework is not in place to support these efforts, especially when it comes to allowing for alternative pain treatments under workers’ compensation.