When the pandemic struck two years ago, a year-long strategy in the occupational injury industry was to control opioid prescriptions – a goal that has continued despite interruptions stemming from COVID-19 claims and disruptions.
Experts say opioids in new injured workers continue to trend downward, as government mandate forms, monitoring programs and other protocols seem to work to curb the long-term use of addictive painkillers. Still, new, adjusted federal guidelines, along with opioids in older claims, will be challenging. (See related history).
“The pain does not go away,” said Silvia Sacalis, vice president of clinical services for the health care benefit company Healthesystems LLC in Tampa, Florida. “We are moving in the right direction when it comes to continuing to focus on that … and ongoing vigilance will be important.”;
Workers ‘opioid spending has fallen by more than 62% since 2016, according to data collected in 2021 by Maggie Valley, North Carolina-based consulting firm CompPharma LLC, which also found that total workers’ pharmacy costs have fallen by 38% in the past decade.
“All of the guidelines that have come into force in recent years have helped reduce opioids in our industry,” said Reema Hammoud, Southfield, Michigan-based Vice President of Clinical Pharmacy for Sedgwick Claims Management Services Inc. “Overall, everyone does what to do. ”
Preliminary data released by Cambridge, Massachusetts-based Workers’ Compensation Research Institute, at its annual conference in March showed that forms – lists of prescription drugs approved for use by injured workers, now in place in 17 states – have been particularly effective. , as most require a multi-step review of most opioid prescriptions.
In California, where workers’ insurance went into effect in 2018, drug use and payments fell “immediately” after implementation, according to WCRI. For opioids alone, there was a 38% reduction in prescriptions for injured workers between the fourth quarter of 2017 and the second quarter of 2018.
Another WCRI study, released last year, found that other government policies contributed to reducing opioids for injured workers. Prescription drug monitoring programs – introduced over the last five years – reduced the amount of opioids prescribed by 12% during the first year of introduction, and provisions limiting the duration of initial opioid prescriptions resulted in a 19% reduction in the amount of opioids claimed. work injury compensation.
Still, “opioids are still number one in the most widely used therapeutic class for injured workers,” said Nikki Wilson, Omaha, Nebraska-based clinical product manager for Mitchell Pharmacy Solutions, adding that “proactive intervention still remains” despite problems caused by the pandemic.
One such problem was regular access to suppliers, which Ms. Wilson and others said he was bridged by the emergence of telecommunications health.
“We learned things from the pandemic about how to reach people beyond the traditional way of going to a doctor’s office,” she said.
Dr. Dwight Robertson, Pasadena, California-based vice president of managed care services and national medical director of comp insurance company Employers Holdings Inc., said a program started in 2017 that zeros in on opioid prescriptions at the 30-day limit after a claim is not made. It is not inhibited by the pandemic, partly due to telehealth. Other workers’ insurance companies and third-party administrators have similar programs in place.
The employer’s program requires efforts after 30 days, involving both caregivers and patients, to reduce opioid prescriptions. “That discussion resulted in us getting 98% of our complainants – new opioid users – from opioids within 12 months and 100% within the second year,” said Dr. Robertson. “When COVID struck, we continued to do so.”
Still, the industry is now grappling with proposed guidelines from the US Centers for Disease Control and Prevention on opioid prescribing, introduced in February, which some say represent a step away from the 2016 guidelines that drastically restricted opioid prescribing by doctors who feared consequences. Proponents say the voluntary guidelines will put pain management back in the hands of doctors, while critics say the recommendations have the potential to create addiction problems among patients, prompting the creation of the original 2016 guidelines.
“There is still a concern from suppliers that we have gone too far in limiting opioids,” said Brian Allen, Salt Lake City-based vice president of state affairs, pharmacy solutions, for Mitchell International Inc.
Ms Hammoud said that the proposed guidelines are problematic because they are unclear about the upper limits of opioid dosing. “The 2016 guidelines clearly stated the thresholds for opioid overdose. They are very blurred in the new guidelines, almost like we are going backwards.”
The new guidelines are that the pendulum swings back, Sacalis said, adding that the shift is not a bad move and that a more patient-centered approach is better.
“We have literally gone too far in the other direction. There are patients with pain who are not adequately managed,” she said.
“You can use guidelines, analyzes, but in the end you have to find out what works or does not work for the patient,” she said. “You can not completely eradicate opioids, and it does not make sense to eradicate opioids.”
Prolonged painkillers are still difficult to overcome
Prolonged opioid use of older workers’ compensation claims continues to be a problem.
“The opioid issue will remain for another decade and only because fewer people receive opioids and fewer doses … it has no consequence. What is consistent is the existing, older claims,” said Joe Paduda, Skaneateles, New York-based Rector of the consulting firm Health Strategy Associates LLC. “The issue of inheritance claims is a really difficult issue.”
“Are we getting rid of all these long-term opioid users? The answer is no,” said Dr. Dwight Robertson, Pasadena, California-based vice president of managed care services and national medical director of Employers Holdings Inc.
“Once they’ve been on them for 10 years, it’s very difficult,” eliminating opioids, “he said. “But we can reduce (the morphine equivalent dose) and bring it down to a better level. It has happened.”
Reema Hammoud, Southfield, Michigan-based Vice President of Clinical Pharmacy for Sedgwick Claims Management Services Inc., said stronger prescriptions in long-term claims are down due to constant contact and government guidelines that require suppliers to document use.
“It’s not that the medicines are no longer allowed, we just need proper documentation,” she said. “If there is proper documentation and it helps the patient, they can get the medicine.”
Suppliers “must do their due diligence and show that they re-evaluate the injured worker,” Hammoud said.
Nikki Wilson, Omaha, Nebraska-based head of clinical products at Mitchell Pharmacy Solutions, said it has been successful in being proactive with the older claims.
“There is a very high level of touch on the older claims when it comes to coming up with resolutions,” she said.