by Kim Krisberg
Researchers studying workers’ compensation claims have found that almost one in 12 injured workers who begin using opioids were still using the prescription drugs three to six months later. It’s a trend that, not surprisingly, can lead to addiction, increased disability and more work loss – but few doctors are acting to prevent it, explains a new report from the Massachusetts-based Workers Compensation Research Institute (WCRI).
Report researchers looked at longer-term opioid use in 21 states and how often doctors followed recommended treatment guidelines for monitoring injured workers’ use of the prescription painkillers. In the states studied, researchers found “relatively low compliance” among physicians when it came to implementing monitoring services such as drug testing and psychological evaluations and treatments, which can help prevent opioid addiction and its often-unfortunate outcomes. The report, authored by Dongchun Wang, Dean Hashimoto and Kathryn Mueller, states:
Opioids have been widely prescribed for and filled by injured workers — about 55 –85 percent of injured workers received narcotics, despite medical recommendations to avoid routine prescription and to limit the use of opioids to more severe pain or pain which is unresponsive to other analgesics. The growing public concerns regarding overuse and abuse, which often result in emergency room visits and even overdose deaths, are shared by the workers’ compensation health care community. These concerns are increasingly important public policy issues, given the limited evidence of the effectiveness of opioids in treating chronic noncancer pain.
According to the report, which is based on almost 300,000 workers’ compensation claims and 1.1 million associated prescriptions in 21 states, use of both drug testing and psychological evaluation and treatment were low. For workers’ comp claims associated with longer-term opioid use, only 18 to 30 percent were drug tested in most of the states studied. Psychological services uptake was even lower: Only 4 to 7 percent of injured workers with longer-term opioid use received such services in the average state. And even in states with the highest uptake, there’s a lot of room for improvement: Only one in four such workers received a psychological evaluation in those states, and one in six received psychological treatment.
Among the states studied, the highest utilization was found in Louisiana and New York, where one in six and seven injured workers (respectively) with narcotics were categorized as longer-term users. The rate was about one in 10 in Texas, Pennsylvania, South Carolina, California and North Carolina, and one in 20 in Arizona, Wisconsin, New Jersey, Indiana and Iowa. The report states:
Narcotics were frequently received by the injured workers for pain relief…in typical states, more than 3 in 4 injured workers who had more than seven days of lost time, had no surgery but took prescription pain medications received narcotics for pain relief. …In 10 of the 21 states, the percentage of claims with narcotics that were identified as longer-term users of narcotics increased 1–3 percentage points.
However, policy interventions can make a difference, as was seen in Massachusetts, where the percentage of longer-term narcotic users declined by about 4 percent from 2007–2009 to 2009–2011. While researchers noted that “more rigorous analysis” is needed to explain the Massachusetts decline, they did highlight policies that may have contributed, such as mandatory education for prescribers of controlled substances and better utilization of the state’s Prescription Drug Monitoring Program, an online portal where authorized users can view a patient’s prescription history.
Similarly, the report cited a Texas Department of Insurance finding that fewer opioids were being prescribed to injured workers after state policymakers adopted a guideline-based closed formulary for the state’s workers’ compensation system — a move that reins in prescribing authority. According to recent statistics from the Texas agency, the rate of opioid prescriptions dispensed to injured workers went down by 10 percent and associated costs declined by 17 percent.
“This (WCRI) study addressed a very serious issue: how often doctors followed recommended treatment guidelines for monitoring injured workers under their care, who are longer-term users of narcotics,” said Richard Victor, WCRI’s executive director, in a news release. “This study will help public officials, employers, and other stakeholders understand as well as balance providing appropriate care to injured workers while reducing unnecessary risks to patients and costs to employers.”
Prescription painkiller abuse is a growing problem throughout U.S. communities. Consider this startling statistic: For the first time since 1980, the number of unintentional poisoning deaths in the United States exceeded deaths from motor vehicle crashes — and the overwhelming majority of those poisoning deaths were due to drugs. According to the Centers for Disease Control and Prevention, drug poisoning deaths involving opioids more than tripled from 1999 to 2008, from 4,000 to 14,800. In just one state, Ohio, unintentional drug poisoning deaths increased a whopping 350 percent from 1999 to 2008, largely driven by prescription drug overdoses — that’s four deaths each day.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for a decade.