Workers' Compensation

Narcotics Use Mismanaged: Guidelines Ignored

The most disturbing conclusion that the Workers’ Compensation Research Institute (WCRI) presented in a webinar entitled “Use of Narcotics and Compliance with Guidelines” was that many workers’ compensation claimants (claimants) who were prescribed narcotics were not provided recommended services for monitoring and managing long-term use of those drugs. These services included overseeing that use and treating its ill effects.

Other major findings were:

  • Most claimants who were prescribed pain medication for compensable harm were prescribed narcotics; and
  • Massachusetts, Pennsylvania, Louisiana, and New York had particularly high usages of narcotics.

Study Parameters

WCRI evaluated non-surgical medical claims in the 17 states that represented two-thirds of all workers’ compensation medical benefits in the United States. The 75,000 claims on which the study was based involved at least 7 days of lost time. Most claims involved treating chronic pain.

The underlying compensable harm of the claims occurred between October 2005 and September 2006. The 36,000 total prescriptions, which consisted of narcotics and non-narcotics, were issued through March 2008.

The study looked at drugs that medical practices and pharmacies dispensed; it excluded hospital-dispensed prescriptions and injectables.

The criteria for classifying narcotics use as longer-term were that a medical provider prescribed a narcotic within three months of a claimant initially being treated for compensable harm and that the claimant continued using narcotics at least six months after the compensable incident.

The examined narcotics included the usual Schedule II suspects; primary ones were OxyContin, Percocet, and Morphine.

The state and federal guidelines against which WCRI compared narcotics-related treatments that claimants received included:

  • Official Disability Guidelines (ODG)
  • American College of Occupational and Environmental Medicine (ACOEM) standards
  • American Pain Society guidelines
  • Colorado Treatment Guidelines (2005 Fee Schedule)
  • Utah State Guidelines

Failure to Follow Guidelines

The guidelines on which the study based its benchmarks recommended three general practices for preventing and treating narcotics addictions. These were:

  • Random urine drug testing
  • Psychiatric evaluation and treatment
  • Active physical therapy

WCRI discovered that less than one-fifth of the study states’ claimants who were longer-term users received three of the four suggested treatments.

  • Between 6 and 13 percent received random urine drug testing
  • Between 6 and 13 percent received psychiatric evaluation and treatment
  • Seventy to ninety percent received active physical therapy

Prescription Statistics

The data revealed that roughly 55 percent of claimants in Michigan and other typical states who received pain medications received narcotics; this percentage was roughly 85-percent in Louisiana.

Other statistics from high-use states were that the Morphine Equivalent Amount (MEA) of prescriptions ranged between 3,000 and 4,000. This was roughly three-to-four times the average amount.

WCRI discovered as well that Northeast and Mid-Atlantic states tended to prescribe claimants narcotics more frequently than states in other regions. For example, more than 20-percent of the prescriptions in Massachusetts were for Schedule II narcotics.

An above average number of longer-term narcotics users in high-use states was a primary reason for that high use. An example was that approximately one-in-seven claimants in Louisiana and New York who used narcotics were longer-term users.

Significance of Study

The research revealed several things that can help reduce the expense and other ill effects of high narcotics use among claimants; the most important lesson is that the states at the lower end of the spectrum have shown that treating chronic pain does not require heavy reliance on narcotics.

Another lesson is that it seems that most, if not every, state needs to be a better job following guidelines that have determined effective methods for monitoring and reducing narcotics use.

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