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Keeping an Eye on Opioids in Comp

Matthew Riddle

The United States is currently experiencing an epidemic of prescription opioid misuse and overdose. This is probably not the first time you have heard this news, but the sheer magnitude of the problem bears repeating. Overdose fatalities have doubled in the past 14 years, and drug overdose is now the leading cause of accidental death in our country. According to a 2015 report published by the Trust for America’s Health and the Robert Wood Johnson Foundation, drug overdoses killed 44,000 people in 2013. “More than half of these deaths (51.8 percent) were related to prescription drugs, with more than 16,000 deaths related to prescription painkillers, and nearly 7,000 related to anxiety and sleep medications,” the report reads.

Increased prescribing and sales of opioids — a quadrupling since 1999 — helped create and fuel this epidemic. Those of us in the workers’ compensation industry have witnessed this problem firsthand.  Many doctors seem to prescribe opioids with no treatment plan or clear goals in place, and with very little oversight as to how the patient is using (or misusing) the medication. We have seen prescription drug costs soar.  We have seen addiction, overdose, and death resulting from the dangerous combination of opioids and benzodiazepines such as Valium and Xanax.

Dr. Shailesh Patel and others spoke on this subject last week at the South Carolina Workers’ Compensation Educational Association’s annual conference.  Dr. Patel, a pain management specialist, discussed the CDC Guideline for Prescribing Opioids for Chronic Pain released in 2016.  The CDC issued these recommendations as part of an urgent response to the drug overdose epidemic.  The guideline was designed to help providers ensure the safest and most effective treatment for their patients. Among the 12 recommendations in the guideline, three principles are key to improving patient care:

  • Nonopioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care.
  • When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose.
  • Providers should always exercise caution when prescribing opioids and monitor all patients closely.

In the context of workers’ compensation, a basic understanding of these recommendations and the risks involved with opioid medications will help employers and insurance carriers manage medical treatment provided to injured workers.  Risk managers and claims adjusters should be mindful of these issues and recognize red flags that warrant closer inspection of a treating physician’s opinions and recommendations. Being proactive in these circumstances will help prevent dangerous, costly, and ineffective treatment.

Click here for a reference guide to the 2016 CDC Guideline and please do not hesitate to contact us if you have any questions.