There’s a bit of confusion in the comp pharmacy management space, as there appears to be contradictory evidence from two respected sources about the use of narcotic opioids in workers comp.
First, everyone agrees there’s just far too many claimaints getting far too many far too potent narcotics. Perhaps not in those exact terms, but close enough. Heavy duty, potent, potentially addictive, divertable, high-street-value drugs are dispensed far too often in comp.
But there is a bit of disagreement about exactly what’s going on.
First, CWCI, the always-authoritative California Workers Comp Institute, has been researching and reporting on this problem for several years, and their data shows the use of narcotic opioids is increasing. Dramatically.
In contrast, one of the largest work comp PBMs, PMSI, recently published their results which indicate a decline in usage of this type of drug early on in the claim cycle. I asked Maria Sciame, PharmD, PMSI’s Director of Clinical Services what she thought might account for the decrease in the use of opioid analgesics in the acute phase of injury.
Here’s her take (and I quote):
1. increased physician awareness of the potential negative effects of opioids
2. additional organized opioid monitoring strategies (mandatory reporting) associated with opioids may have reduced “off the cuff” opioid prescribing
3. increased awareness of pain management guidelines that call for non-opioids for the initial treatment of mild to moderate pain
4. decreased prescriber fear regarding the use of non-steroidal anti-inflammatory agents over the past year…remember the FDA warnings that have been issued within the past few years regarding the negative cardiovascular affects associated with NSAID use…started with Vioxx…physicians are becoming less cautious and have regained their comfort level with the use of NSAIDs again; thus, replacing narcotics for acute injuries with NSAIDS.
There are a couple other factors worth considering.
a) PMSI’s business all flows thru a PBM, whereas CWCI’s script data is from payers that use PBMs and some that don’t (even in this day and age, some payers don’t use PBMs; go figure). PBMs have clinical management programs in place to address things like early usage of narcotics.
b) CWCI’s data isn’t specific to early usage, whereas PMSI’s is (in this instance)
c) CWCI is specific to California; PMSI’s is national and as NCCI has reported, there are dramatic differences in prescribing patterns across states. NCCI’s research also indicates narcotic usage across the country has stabilized somewhat of late after several years of consistent increases.
So, what does this mean for you?
If you aren’t using a PBM, get with the program. If you are, find out if they are actively, assertively, and effectively managing narcotic opioid scripts and claimants on those scripts. If they aren’t, find out why not (hint, it may be because you’re not able to provide data or support their efforts, if that’s not it, they’ve got some explaining to do)
Ask for data on narcotic usage for claims less than a year old, and older ones as well, and decide if your results are acceptable.
Jul
15
By prescribing potentially addictive narcotics they may end up doing the employee more harm than they know.
I can’t tell you how many patients I evaluate who are taking far roo much narcotic. It works against the worker making a transitional return to work by impairing them in a different way. This particularly problematic with the unsophisticated worker who simply does what the doctor says, instead of critically thinking about the benefits of making an attempt to tolerate a measure of mild-moderate pain.
I have had to recommend a detox far more than should be necessary for relatively minor injuries.