Editor’s Note: This is part of a team report on opioid use by injured workers. For the national story read: Opioid Epidemic Plagues Workers’ Comp
The epidemic of opioid abuse and its impact on workers’ compensation in the Northeast is particularly noticeable in New York and Pennsylvania, where the percentages of injured workers that become longer-term users of opioids are among the highest in the nation.
In its recent study, the Workers Compensation Research Institute found that in New York, 14 percent of non-surgical workers’ comp claims with narcotics were identified as longer-term users of narcotics. That’s the highest percentage among all Northeast states and second only to Louisiana (with 17 percent) in the WCRI study. The underlying data encompassed 21 states across the country and included non-surgical claims with more than seven days of lost time that had injuries arising from Oct. 2008 to Sept. 2009 and prescriptions filled through March 2011.
In Pennsylvania, 11 percent of non-surgical workers’ comp claims with narcotics were identified as longer-term users, tying Texas for the third-highest figure in the research.
For the injured workers, opioids are some of the most commonly prescribed pain medications. Richard Victor, WCRI’s executive director, said that roughly 80 percent of injured workers who get any pain medication prescribed get opioids. And when patients start on opioids, a significant number of them continue to take opioids even six to 12 months later.
“In New York, for example, of those who start taking opioids, one-in-seven are still taking opioids six to 12 months later. In a typical state, it’s one-in-15 or one-in-20,” Victor said.
And one of the medical treatment guidelines in the study recommends that there be periodic random urine drug testing for patients who are on opioids on an ongoing basis. But Victor said this isn’t happening in a large percentage of cases. In the Northeast states like New York, New Jersey and Pennsylvania, only about a quarter or less of non-surgical workers’ comp claims identified as longer-term users of narcotics had urine drug testing, the study found.
One state that could serve as a model for other states is Massachusetts. Among the states that the WCIR tracks, only Massachusetts has shown a significant drop in the use of opioids in recent years. The decline has been observed after the state’s workers’ comp system adopted new pain management guidelines, Victor said. In March 2012, the updated medical treatment guidelines for chronic pain management — which stress increased physician oversight and monitoring of narcotic use among injured workers with chronic pain — required the use of these guidelines for utilization review by workers’ comp payors.
Also in 2010, the state’s prescription drug monitoring program began providing unsolicited reports to prescribers on individuals meeting or exceeding a pre-determined threshold for suspected questionable activities such as possible doctor/pharmacy shopping.
Additionally, the largest group health insurer in Massachusetts, Blue Cross Blue Shield, last year implemented a policy to restrain abuse of opioid prescriptions. These new measures include more stringent requirements for new opioid prescriptions written for more than 30 days.
Across the Northeast, state lawmakers have been proposing new ideas to tackle the epidemic of opioid abuse. In Pennsylvania, for example, there are pending bills that seek to enhance the drug monitoring system.
Pennsylvania currently already has a Prescription Drug Monitoring Program (PDMP) housed in the Attorney General’s office, said Kait Gillis, a spokesperson for the state’s Department of Health.
“We are aware of legislative proposals that would significantly increase the scope of the current PDMP. The Department of Health is currently reviewing PDMPs in other states and different ways they are used by law enforcement, physicians and pharmacists to determine best practices for a PDMP in Pennsylvania going forward,” the spokesperson said.
One pending bill in Pennsylvania, Senate Bill 1300, would establish a Pharmaceutical Accountability Monitoring System to establish and maintain an electronic system for monitoring all scheduled drugs. The bill seeks to reduce the abuse of controlled substances and fraud by providing a tool that will ensure that practitioners making prescribing decisions have complete information about what, if any, other prescription drugs have recently been prescribed to their patients.
SB1300 suggests reporting mechanisms with full confidentiality protections in which dispensers report prescription information to a central repository to help identify patient and practitioner behaviors that give rise to a reasonable suspicion that prescription drugs are being inappropriately obtained or prescribed.
In New York — which last year enacted a law to update and modernize the state’s Prescription Monitoring Program, including the adoption of electronic prescribing and the “real time” prescription monitoring registry — lawmakers have proposed a number of new bills this year to combat the prescription drug abuse.
One pending bill, A01348, would provide additional tools and resources to assist healthcare providers in identifying the symptoms of prescription drug addiction and intervening to prevent the misuse of such substances. The bill would require the Office of Alcoholism and Substance Abuse Services to develop new educational materials for healthcare providers relating to abuse and misuse of prescription drugs.
Another pending bill in New York, A02247, seeks to establish the State Chronic Pain Management Education and Training Council. The Council would advise the Commissioners of Health and Education on establishing standards to advance the management and treatment of chronic pain and to suggest course materials that should be incorporated in continuing education programs for the healthcare professionals that treat patients that have chronic pain. The bill also seeks enhanced funding support for medical school and residency training programs that train physicians in areas of chronic pain management and treatment.
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