Which states have the most narcotic usage and what’s working?

This morning’s opening session at the WCRI packed more insight into an hour than anyone could reasonably expect to digest. That’s not a criticism but rather a compliment directed at the four speakers.
First, the macro view as provided by WCRI’s Dongchun Wang. Massachusetts, Pennsylvania, Louisiana and New York had narcotic utilization significantly higher than the other study states, with NY occupying the top spot.
Massachusetts had by far the largest percentage of Schedule II drugs used as pain medications.
Long term usage of narcotics is a critical issue in comp: claimants on these drugs are not likely returning to work and incur higher medical costs. Again NY and LA had high percentages of claimants on narcotics who continued using them for an extended time. WCRI also examined public policy implications of their research findings on long term narcotic usage. Researcher Dongchun Wang reported data indicating compliance with chronic pain guidelines was all but non-existent (my words not her’s). The data showed only 7% of users were drug tested while 4% had psych evaluations/treatment.
This is a disaster. 19 out of 20 claimants prescribed narcotics over the long term are pretty much on their own. These prescribing physicians are NOT complying with the basic treatment guidelines.
Addiction, which Pain Management physician Janet Pearl MD defined as a psychological dependence on a drug, is a very significant and all-too prevalent among work comp claimants using opioids over an extended period. Pearl also noted that there is no evidence to support high dose opioid therapy while moderate dosing helps with pain but NOT with function.
Finally Colorado work comp medical director Kathryn Mueller MD described how her state addresses the issue. My main takeaway involves Colorado’s decision to pay physicians for managing chronic pain based on a code-based reimbursement for review of drug screens, and the implementation and monitoring of opioid agreements.
This is one of those blindingly obvious solutions that every payer and state should implement now. Paying a physician to do the extra work required in managing claimants with chronic pain is just common sense.