By John Stahl, Esq.
A May 2012 report from the National Council on Compensation Insurance Holdings, Inc., (NCCI) addressed the conclusions of the American College of Occupational and Environmental Medicine (ACOEM) that “the overuse of opioid therapy to treat chronic pain conditions is becoming epidemic in the United States” and that “there are many treatments that should be considered before opioids.”
Although the ACOEM referred to the overall American healthcare system, its conclusions are highly relevant to workers’ compensation. Statistics have shown that “pill mills” and other medical facilities are prescribing workers’ compensation claimants (claimants) an undue amount of narcotics.
The NCCI report, which was entitled “Narcotics in Workers’ Compensation”, stated specifically that all prescription drugs totaled roughly 19-percent of workers’ compensation medical costs. The narcotics OxyContin and Hydrocodone-Acetaminophen ranked number one and number three respectively among those medications.
Concern regarding this heavy reliance on narcotics extended beyond their expense. The cited ACOEM research observed “markedly elevated death rates that have paralleled increases in consumption of opioids [narcotics].” Further, a prior NCCI report noted “a correlation between drug abuse treatments and heavy narcotic use.”
Overview
The current NCCI report is based on data regarding medical services that claimants received between 1996 – 2009 for compensable harm that occurred between 1994 – 2009.
The applicable definition of “narcotic” was “drugs with active ingredients listed in the International Narcotics Control Board’s List of Narcotic Drugs Under International Control.” The report emphasized that that definition did not include Tramadol and other “weaker drugs” that other studies of narcotics included.
Prescription Trends
The NCCI research showed that wide-spread narcotics use is concentrated among a small population of claimants; specifically, “the narcotics consumed by the top 1 percent of claimants receiving narcotics accounts for close to 40 percent of all narcotics costs.” The slight decrease in this trend in 2009 suggested that this population is starting to use fewer narcotics.
The top 10-percent of that population accounted for approximately 80-percent of all workers’ compensation narcotics costs.
The report stated further that “while the probability of continued use declined with time, narcotic use could continue for many years.” NCCI concluded similarly that prescribing narcotics early in the claim cycle increased the probability of both prolonged use of a narcotic and of increasing higher doses of those drugs.
Increasing Narcotics Costs
The data revealed that overall per-claim narcotics costs increased an average of 18-percent annually from 2001 to 2004; this decreased to an average of 1-percent until 2008 and jumped 14-percent between 2008 and 2009.
Other statistics showed that the cost of narcotics remained roughly 21-percent of the total workers’ compensation prescription drug cost during the study’s period. This result suggested “that workers’ compensation narcotic costs are keeping pace with the growth of total prescription drug costs.”
In terms of actual dollars, the average per-claim cost of narcotics was $18 in 2001 and $35 in 2009.
Shifting Popularity of OxyContin
OxyContin ranked number one among workers’ compensation claims prescriptions in 2003. It ranked number 8 in 2007, number 3 in 2008, and number one again in 2009.
The cited reason for the cyclical result was “the unsteady road to the availability of a comparable generic.”
NCCI explained that Oxycodone HCL was the active ingredient in OxyContin and has been available generically for several years; a patented time-release system was OxyContin’s distinction.
Litigation regarding the enforceability of OxyContin’s patents resulted in the patent holder allowing limited distribution of a generic form of Oxycontin for a few years until 2009.
Introducing generic and competing brand-name narcotics similarly affected the degree to which physicians prescribed claimants other narcotics during the period on which the study was based.
What this Means
The experts agree that some claimants are being overprescribed costly and dangerous narcotics. Although the NCCI report does not offer alternatives, other studies have shown that options that include physical therapy and simply living with some pain have been effective.
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