Medications We Frequently See in Workers’ Comp Physician Reports

 By Robert G. Rassp, Esq.

The following chart lists the brand or common and chemical names of drugs we regularly see in our cases embedded in medical-legal reports, treating physician reports and subpoenaed medical records. Some physicians randomly use the brand names, and others use the chemical name, causing us mortals much frustration in determining exactly what drugs an injured worker is taking for what conditions. The information here can assist counsel in determining during a deposition of an injured worker or of a physician exactly what medication is person is taking and for what medical condition.

Some trends emerge when you see these medications. For example, drugs that are designated as an NSAID means that they are non-steroidal anti-inflammatory drugs, of which aspirin, naproxen and ibuprofen are commonly known. In virtually all NSAID drugs, FDA required warnings include heart attack, stroke, elevated blood pressure, kidney or liver toxicity and gastro-intestinal bleeding for long term use of these drugs.

Also, medications designated ending in “-am” or “-pam” are generally benzodiazepines, which are anti-anxiety drugs called anxiolytics or “tranquilizers”. We know them better as Valium®, Xanax® and others. These drugs are highly addictive, and counsel is warned about injured workers who are taking this class of drugs on a long-term basis. In fact, CMS (the Centers for Medicare and Medicaid Services) does not allow benzodiazepines to be included in Workers’ Compensation Medicare Set-Aside (WCMSA) arrangements at all because of dependency and addiction.

The same is true for sleep medications such as Ambien and Lunesta, which seem to be the sleeping pills “de jure” as of late. Most physicians should only prescribe a 10- to 15-day supply of these sedative drugs because of dependency that develops quickly for patients who rely on them for sleep disorders. Ambien, Lunesta and drugs like them are great for acute pain, acute depression or shock, such as a death of a loved one, but dependency and addiction are quick to follow. There also is increased risk of sleep walking for patients who are on these hypnotic drugs.

We have included the medications for hypertension, regardless of its class as a beta blocker, ACE inhibitor, angiotensin II receptor blocker, diuretic, or calcium channel blocker. All of these classes of drugs have various side effects including dizziness, chronic cough, loss of libido and frequent urination. The determination of which of these classes of drugs to prescribe depends upon the type of hypertension that is diagnosed, how bad it is and whether or not the heart is involved as well with its own problems.

Also included are the opiate based pain reducers, also called “opioid analgesics,” which are commonly seen in our cases, under a combination of the chemical and brand names. The number, names and types of opiate based narcotics are mind boggling, and it is no surprise that it is not unusual for injured workers to be on many of these drugs at the same time. For example, it is not unusual for an injured worker who has a chronic pain syndrome to be on a fentanyl patch at the same time as he or she is taking oral opiate based medications, such as Vicodin®. If you want to check out a drug that is not listed here, go to drugs.com and pay attention to the FDA references at the website.

We also included diabetes medications so that you can tell if someone is a diabetic, simply based on their intake of medication. So if you see in a medical record that someone is taking Glucophage (metformin), you can be sure that person has definitely been diagnosed as a diabetic. This is because there is no such thing as a preventative diabetic medication.

There are also drugs called “neuroleptics”, which were originally formulated as anti-seizure medications. Recent ones include gabapentin, also known as Neurontin® and pregabalin, also known as Lyrica®. These drugs, though originally formulated for use as anti-convulsive medications, also reduced nerve-based pain (burning type pain) and are now widely used for medical conditions that are thought to be neurogenic such as fibromyalgia, diabetic polyneuropathies and other chronic pain syndromes.

We are not including vitamins and dietary supplements even though some have known powerful effects and perhaps should be regulated as a drug. St. John’s Wort is a known anti-depressant, for example, but it can be purchased in any “health foods” section of a grocery store over the counter. In fact, some prescription anti-depressants warn users of those drugs not to take any dietary supplements with the drug. Some interesting research is emerging now on Omega 3 fish oil. Recent studies have shown that in moderate quantities, Omega 3 fish oil reduces aggression and hostility and also has cardio-protective properties.

Drugs change every year, and new ones emerge all the time as reformulated versions of earlier drugs. This is because of funky patent laws for the formulations of drugs, which last only seven years. A change in the isomer of a drug can buy a drug company additional time for a patent, for example.

Generic drugs are supposed to have the same bio-activity as the brand name but some do not, especially psychotropic and heart medications. This is because of filler products that generic manufacturers use as part of a medication. Sometimes, for example, the coating of a generic drug dissolves at a different rate than the brand named drug, causing a difference in bio-availability of the active ingredient.

© Copyright 2011 LexisNexis. All rights reserved. This article was excerpted from The Lawyer’s Guide to the AMA Guides and California Workers’ Compensation, by Robert G. Rassp, Esq.

Editor's Note: The new 2012 Edition of The Lawyer's Guide to the AMA Guides and California Workers' Compensation will be on sale in January 2012.