PHOTOS: MMC Through the Years

Drug Abuse Hikes Workers’ Comp. Risks

Many players in the workers’ comp system are failing to comply with guidelines that recommend periodic drug screening and psychological treatment.
David M. Katz

CFOs worried about mounting workers’ compensation costs at their companies should look closely at how freely — and chronically — doctors are prescribing narcotics to injured workers in states where the companies operate.

The differences among states can be striking. At the top end, one in six injured workers in Louisiana and one in seven in New York were identified as “longer-term users of narcotics” on workers’ comp. claims made between 2009 and 2011, according to a 2012 study sponsored by the Workers’ Compensation Research Institute (WCRI).

In sharp contrast, fewer than one in 20 workers prescribed narcotics were identified as longer-term users in Arizona, Wisconsin, New Jersey, Indiana and Iowa, according to the study, which is based on data culled from nearly 300,000 nonsurgical workers’ comp claims involving more than seven days of work time. More than 1.1 million prescriptions for pain medications (including narcotic and non-narcotic drugs) were associated with the claims, which were made in 21 states.  
“If you are in one of those states [with the highest long-term narcotics use by injured workers], you will probably want to look into it and see how the problem can be addressed,” Dongchun Wang, a WCRI economist and co-author of the study, said during a recent webinar on the findings.
But regardless of the state where a company's operations are headquartered, the corporation runs the risk that its medical costs will rise over time because doctors may be over-prescribing narcotics to employees injured on the job. That's because many workers' comp health-care providers haven't been following recommended treatment protocols. Few injured workers who have used the drugs for years have been screened and tested for them or received psychological treatment for possible drug abuse, according to Wang.

The problem may stem from a bevy of “pain management” statutes and rules passed in a number of states in the 1990s, according to Dean Hashimoto, a doctor in the Partners HealthCare System and a member of the Massachusetts Department of Industrial Accidents Health Care Services Board. Fueled by the consequent growth of pain-specialty programs, practitioners began treating chronic pain “primarily through opioids,” he said during the webcast.

More recently, however, the abuse of painkillers has gotten a great deal of media attention. The issue of controlling the use of prescription narcotics gained currency on April 16, when the U.S. Food and Drug Administration approved updated labeling for a time-release reformulation of OxyContin tablets, a powerful and much-abused narcotic pain killer. At the same time, the agency barred an earlier, fast-acting version of the drug that could be crushed for illicit inhaling and injection.

The FDA also said that it would not approve any generic version of the drug “that [relies] upon the approval of original OxyContin.” That move brought objections from pharmacy benefits managers and claims handlers, who contend that banning generics would merely raise costs for employers without addressing a more fundamental problem: excessive prescription by doctors of such narcotics.
Although the WCRI study did not address OxyContin specifically, it addressed a broader issue: Many players in the workers’ comp system are failing to comply with “medical treatment guidelines for chronic opioid management” that recommend periodic drug screening and psychological evaluation and treatment.

Indeed, the institute’s research suggests that the biggest potential for abuse and the highest potential costs stem from long-term use by the injured. In response to a question during the webinar, Wang estimated that over the first year or two of a claim, prescription may represent just 2 percent to 3 percent of all workers’ comp costs.   
 
But for claims stretching out six or eight years, for instance, “prescription drugs represent 15 percent to 20 percent of all costs,” she said, adding that she had not researched the percentages of opioid use in particular.

Nevertheless, “longer term use of opioids may lead to additional costs, loss of productivity [and] put people at higher risk of opioid misuse and abuse,” she said, as well as accidental death. (The study treats “opioids” and “narcotics” as synonyms, defining the words as synthetic and non-synthetic drugs that act through specific receptors in the nervous system.)

Under protocols in Colorado, a number of actions should accompany any prescription of an opioid, according to Kathryn Mueller, medical director of the Colorado Division of Workers’ Compensation, and a co-author of the study. Nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen, or aspirin, for example) should be considered before narcotics are prescribed. But if opioids are prescribed, their use should be limited to three to 10 days.

The worker should return to work as soon as possible, with no bed rest but within appropriate restrictions on such activities as lifting and time spent sitting, Mueller said. There should be no MRIs or CAT scans unless there are neurological symptoms or if the worker is elderly. Finally, the worker should be provided with “education and reassurance,” she said. “The focus is not eliminating pain but managing pain to restore physical and mental function and quality of life.”