Prescription drugs and opioids – more bad news

The recently released Centers for Disease Control and Prevention’s (CDC) voluntary guidelines, “CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016”, sends a clear message urging primary care doctors to sharply deter use of opioids for chronic pain. Coming on the heels of the guideline, several studies reinforce the importance for employers to take an active role in managing prescription and opioid use.

Almost all doctors routinely overprescribe pain pills – study

Ninety-nine percent of primary care doctors routinely prescribe potentially addictive opioid painkillers for longer than the three-day period recommended by the CDC, according to a National Safety Council (NSC) survey.

Twenty-three percent of physicians surveyed said they prescribe at least a month’s worth of opioids. Evidence shows that 30-day use causes brain changes. Seventy-four percent incorrectly believe morphine and oxycodone, both opioids, are the most effective ways to treat pain. Research shows over-the-counter pain relievers such as ibuprofen and acetaminophen offer the most effective relief for acute pain.

Other key findings from the poll include:

  • 99 percent of doctors have seen a pill-seeking patient or evidence of opioid abuse, but only 38 percent usually refer those patients to treatment. Only five percent will treat them for abuse themselves
  • 71 percent of doctors prescribe opioids for chronic back pain, and 55 percent prescribe them for dental pain – neither of which is appropriate in most cases
  • 67 percent of doctors are, in part, basing their prescribing decisions on patient expectations; however, a NSC poll in 2015 showed 50 percent of patients were more likely to visit their doctor again if he or she offered alternatives to opioids
  • 84 percent of doctors screen for prior opioid abuse, but only 32 percent screen for a family history of addiction – also a strong indicator of potential abuse

Doctors dodge repackaging restrictions by dispensing new drug formulations

Physicians frequently dispense prescription drugs with new strengths or formulations to injured workers in states that have enacted legislation to restrict drug repackaging, says a study by the Workers Compensation Research Institute. In California, Florida, Tennessee, Pennsylvania and Illinois, the authors found that after reforms passed, physicians started dispensing new strengths and formulations of certain drugs that were previously not seen – or rarely seen – on the market. The variations were sold at a higher cost-per-pill than existing versions.

For example, the study found when dispensed by physicians in first quarter 2014, 7.5-milligram cyclobenzaprine, an extended release strength not found among pharmacy-dispensed prescriptions, was $3.01 per pill. Meanwhile, prices paid for existing strengths were significantly lower – at $0.38 per 5-milligram pill and $0.39 for each 10-milligram pill – when dispensed by physicians.

Abuse of employer-paid opioid prescriptions widespread

Nearly one-third of opioid prescriptions paid for by employers are abused, according to a new report by Castlight Health Inc. The study identified abusers as those who had received more than one 90-day supply of opioids, and who had gotten prescriptions from four or more providers over a five year study period. They excluded patients who were undergoing cancer treatments or in palliative care.

Cost implications are significant – workers who are abusing painkillers cost their employers twice as much in medical costs as non-abusers. The study suggests that those in the “Baby Boomer” age bracket are four times more likely to abuse opioids than younger “Millennial” patients. Their findings also showed that the majority of major cities with higher-than-average opioids abuse rates are rural cities in the South.

Workers’ Comp drug prices rise as utilization falls – Express Scripts

Pharmacy benefit manager Express Scripts Inc. reports in its Workers’ Compensation Drug Trend Report that a decrease in utilization offset rising drug prices in 2015. Workers’ Compensation prescription drug spending per worker increased 2.2%, compared with 1.9% a year ago. Nine of the 25 most commonly dispensed medications in 2015 were opioids, which continue to be the most expensive and highly utilized class of drugs for injured workers despite a 10.9% overall decrease in utilization. High blood cholesterol drugs, nonsteroidal anti-inflammatory drugs and anticonvulsants were the only three therapy classes in the top 10 workers’ comp drug classes that saw increases in utilization last year.

The use of prescription painkillers threatens employees’ safety and your bottom line.

To reduce risk and keep employees safe, the NSC suggests:

  1. Recognize prescription drugs have a big impact on the workplace
  2. Educate all employees about the hazards associated with prescription pain medication use, especially injured employees
  3. Put strong policies in place
  4. Require workers’ compensation and network providers to use opioid prescribing guidelines issued by the American College of Occupational and Environmental Medicine
  5. Expand drug testing panels to include synthetic opioids
  6. Train supervisors and employees how to spot signs of abuse
  7. Screen injured workers for depression, mental health conditions and current or prior substance use
  8. Require network providers to utilize state prescription drug monitoring programs
  9. Treat substance abuse problems as a disease
  10. Know the state and federal laws to ensure no discriminatory actions are taken against applicants or employees who lawfully use prescription medication

To learn more, read The proactive role employers can take: Opioids in the workplace

 For Cutting-Edge Strategies on slashing Workers’ Compensation Costs visit www.PremiumReductionCenter.com

David Leng, CPCU, CIC, CBWA, CWCA, CRM

Author | Speaker | Certified Risk Manager | Certified Work Comp Advisor

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