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Amid a glaring public spotlight, a growing body of evidence about the repercussions of using major narcotics to treat chronic pain, and improved medical management, cost containment and pharmaceutical controls, the use of Schedule II opioid painkillers to treat injured workers in California has dropped for the first time in a decade, falling from 5.8% of workers’ compensation prescriptions two years ago to 3.4% of the prescriptions in the 4th quarter of 2011 according to a new California Workers’ Compensation Institute (CWCI) study.
CWCI’s study, based on a review of pharmaceutical data from a sample of 9.2 million prescriptions dispensed to California injured workers from 2002 through 2011, confirms results of earlier research that noted the surging use and cost of Schedule II opioid analgesics such as Oxycodone, Morphine, and Fentanyl from 2002 to 2008, and shows that the use of these drugs continued at near record levels for nearly three years after that, eventually peaking in the 2nd quarter of 2010 at 5.8% of all California workers’ comp prescriptions and 19.7% of the prescription payments – nearly five times the proportions noted in 2002. Data updated through 2011, however, indicate a recent downturn, as Schedule II painkillers declined to 3.4% of California workers’ comp prescriptions and 12% of the prescription dollars in the 4th quarter of last year, the lowest levels since 2007.
According to the authors of the study, the recent decline in Schedule II opioids was not associated with any specific statutory or regulatory changes addressing the use of opioids in workers’ comp, suggesting that the reduction may reflect increased efforts by workers’ comp payers to modify medical cost containment oversight and tighten controls over the use of Schedule II opioids, as well as increased public awareness of the risks associated with these drugs, which may have contributed to a sentinel effect, making doctors and their patients more cautious about using these drugs, and perhaps more willing to seek alternatives for managing pain. Notably, the study found that while Schedule II opioids have represented a declining share of California workers’ comp prescriptions and prescription dollars since the end of 2010, more widely used Schedule III painkillers such as Vicodin, which the FDA says are also addictive but have less potential for abuse, have held steady at about 20% of the prescriptions and 11 to 12% of the payments.
CWCI has issued its study in a Research Update report, Changes in Schedule II & Schedule III Opioid Prescriptions and Payments in California Workers’ Compensation, which is posted on the Institute’s website at www.cwci.org. CWCI members and research subscribers may also log onto the website for a summary Bulletin.