At the 2017 WCRI Annual Issues and Research Conference a panel discussed the latest WCRI research on the opioid epidemic and the steps states are taking to counter this epidemic. The panel was:
- Dr Vennela Thumula – WCRI
- Dwight Lovan – formerly of Kentucky Department of Workers’ Claims
- Judge Omar Hernandez – Massachusetts Department of Industrial Accidents
According to preliminary WCRI study findings (subject to change) the frequency of opioids per claim has declined for most states between 2010 and 2015. They are seeing significant reductions in the morphine equivalent amount that injured workers received with some states seeing reductions over 30%. A factor in this is the CDC guidelines for prescribing opioids which were published in March 2016. In addition, states with the largest reduction of average opioid amounts per claims all had very strong PDMP regulations including requiring physicians to check the database before prescribing. Another factor is the DEA reclassifying Vicodin as a Schedule II drug instead of a Schedule III, which requires more protocols on the physician when prescribing.
- In 2000 Kentucky was leading the nation in opioids deaths per 100,000 people. At that time they significantly outpaced other states. Unfortunately, by 2014 opioid deaths had swept across the nation with overdoses replacing auto accidents as the leading cause of accidental death nationwide.
- Kentucky had a PDMP in place in the late 1990’s, but it was not mandatory and access to this was limited to only physicians and pharmacies.
- In 2004 they tried to pass a bill allowing TPAs, carriers, and PBMs to access this database but this bill was strongly opposed by plaintiff attorneys and was defeated.
- In 2012 Kentucky passed their “pill mill bill” to address the issues associated with these the over-prescribing of opioids. Included in this bill was the requirement that physicians check the PDMP prior to prescribing opioids and this had to be documented in the patient files. The bill also required drug testing for patients receiving opioids.
- In 2014 some of the “pill mill bill” law was rolled back to add exceptions for long-term care facilities, hospice and end of life treatment.
- Right now in Kentucky HB296 has passed the House and is being considered in the Senate. This bill requires the Commissioner to adopt and implement both treatment guidelines and prescription formularies. It appears this bill is likely to pass and become law.
While Kentucky has made considerable progress in this area there is still more to do. The “pill mills” have been essentially eliminated by the regulations targeting these facilities.
Massachusetts is considering an Opioid Alternative Treatment Pathway. Either the insurer or injured worker can initiate a request to participate in this program, but both parties must agree as this is a voluntary process. If both parties agree to participate, the insurer incurs the cost for the program including alternative treatment for the injured worker. The program seeks to be a tool to address excessive opioid prescribing by giving attorneys, judges and injured workers quicker access to medical professionals to make treatment decisions. This program would only apply to post lump-sum cases so that the only issue on the claim is future medical benefits. Workers would be assigned a care coordinator as part of their participation in the OATP program. Once the program is up and running it would be a two-year pilot with status updates provided monthly to the regulators.