Yesterday I posted on the most recent CWCI study on Opioids in the California Work Comp system, noting that fewer than a hundred docs were responsible for prescribing 42% of the narcotic spend.
If that isn’t troubling enough, in an email conversation with lead author Alex Swedlow, I learned that the top ten physicians prescribe 17% more drugs than their peers in the top one percent of prescribing docs (93 docs are in the top one percent).
And, these top ten docs prescribe 34% more morphine equivalents than the others in the top one percent.
Recall that the top one percent of docs who prescribe narcotics are already prescribing far more than the average prescriber, so the top ten are outliers to the outliers.
Is it possible these outliers to the outliers are doing the right thing? Are they just treating the sickest, most pain-ridden claimants? Doing their best to alleviate high levels of chronic pain?
Highly doubtful. It is much, much more likely that these docs, who represent a mere one-tenth of one percent of all docs who prescribed Schedule II narcotics are a major problem, massively contributing to the addiction problem, adding huge costs to the system, and doing little to help their patients. As I said last fall in a post about CWCI’s research on narcotic usage in California’s work comp system;
“CWCI analyzed the impact of these drugs on claim costs, and found a strong correlation between increasing levels of Schedule II payments and adverse effects on injured worker recovery. Swedlow reported claimants that received the highest narcotic dosage levels had 200% higher medical costs than claimants receiving lower dosages.”
An earlier study reported by Business Insurance’ Roberto Ceniceros had similar findings:
“temporary disability claimants treated with opioids average 105 paid days off in contrast to the average of 30 days, than when narcotics are not prescribed.
The preliminary findings also show that when opioids are present in a claim, there is a 322% greater likelihood for litigation, a 264% greater likelihood for lost time from work, and 38% more likely for a claim to remain open longer and incur additional costs.” [emphasis added]
Kudos to CWCI for continuing to shine a very bright light on a very ugly problem, one that should be the highest priority for PBMs, regulators, payers, and prosecutors working in California.
Mar
8
This is not a comment, but a legitimate question: What is the DEA doing to monitor physicians who are running these Pill Mills? Physicians are required to renew their DEA every few years (and pay a hefty registration fee to do so). The assumption is that some of this fee goes to regulate physicians who ar abusing their license. While other regulatory agencies can set rules and regulations, it’s the DEA that holds the hammer and can revoke a physician’s DEA. In years past, the DEA worked with state and local requlators to monitor physician utilization and sanction physicians who abused their prescribing privledge. What’s the DEA doing now?