Opiate Prescribing in Workers’ Comp: What are the Solutions?

The Opiate Prescribing in Workers’ Compensation session at the California Workers’ Comp & Risk Conference in Dana Point offered some bold statements – opioids are not just a workers’ comp problem, they are a societal problem, and it is going to take us a decade to get out of this problem, starting with the doctor.

Panelists included Roman Kownacki, MD, MPH, Medical Director, Occupational Health at Kaiser Permanente and Patti Williams, Risk Manager at City of Huntington Beach.

Positive Trends:

Prescription frequency still varies widely by state. Studies show that California is one of the lowest prescribers of opioids. This subject is getting much more attention in the medical and workers’ compensation communities, with many associations revising guidelines related to it. In fact, the California Medical Board is currently drafting new guidelines that are scheduled for implementation in 2015.

Changes are also being made in the retail and political landscape. For instance, pharmacys are changing how they accept prescriptions from physicians by following up to confirm diagnosis and if the prescription is appropriate as a result. Improvement is being seen in states that have enacted these changes. In addition, the FDA and DEA are starting to get involved by reclassifying certain medications by class by weighing the potential for abuse versus medical benefit.

Finally, more and more activist groups are emerging. Notable groups are the Physicians for Responsible Opioid Prescribing (PROP) and the National Coalition Against Presecription Drug Abuse (NCA).

Negative Trends

Opioid abuse still remains a major problem in the workers’ compenation area. Why is that? One panelist suggested that employers do not experience these cases regularly, so it is “out of sight, out of mind” until one surfaces. When that occurs, it is often too late. Because of this, the panel stressed the need for early intervention and monitoring. If you have a managed care program, it should be their responsiblity to monitor this for the employer, but the employer must give them perameters.

Another issue is the new guidelines, themselves. There will be a large variety of them out there – some that parallel each other and some that contradict – so which guidelines do the physicians follow to avoid potential addiction?

The panel cited two statistics:

• 1% of physicians are prescribing 33% of opioids.
• 10% of physicians are prescribing 80% of all the opioids.

What was once voluntary is slowly becoming madatory, but will mandates make a difference? This group, more than most, must be given guidelines and processes to adhere to.

Finally, the panel pointed out that heroin as a replacement for opioids is becoming a major problem and should be on everyone’s radar because opioids are often a gateway drug to heroin. There has been an 80% increase in heroin use over last year, alone. It is moving from the inner city to the suburbs and is a much cheaper alternative that is easier to obtain.

Goals

Opioids can be very helpful to manage extreme pain on the short term. The panel cited that the absolute goal is to ensure appropriate prescribing of opioids to injured workers and avoid unintended results. To do this, physicians must be aware. They must descrease the migration from acute use to chronic use in addition to planning for long-term management of abusive cases and know how to address them. They agreed that the pendulum is shifting and are optimistic that the positive signs for change are here.