Prescriptions for medications for opioid use disorders are increasing in work compensation, a trend worth looking at, experts say, because most of the drugs prescribed – buprenorphines – are still considered opioids in some cases.
Enlyte Group LLC said in its latest drug trend report that prescriptions for drugs to manage opioid use disorders increased by 7.4% from 2020 to 2021. The April 19 report noted that overall opiate prescriptions continued to decline – a long-term trend among workers’ compensation.
Experts say that buprenorphine products should not be confused with methadone, which is also used to treat opioid dependence but only available through a clinic, or Naxolon, which is used in opioid overdoses.
While some of the prescriptions for opioid use medications are used to curb opioid addiction, some can be used for pain management, says Nikki Wilson, Omaha, Nebraska-based clinical product manager with Mitchell Pharmacy Solutions, an Enlyte company.
Some buprenorphine products are indicated for pain while others are used to manage addiction, she said.
“The thing is, prescribers use them interchangeably”; for both reasons, and “it’s hard to control where and when,” she said, adding that her team is taking a closer look at prescribing behaviors and will follow up with another drug trends report later this year.
Such drugs represent a small proportion of the total drug use in comp – less than 1%, Wilson said. But tracking the drugs is important because the 7.4% increase stood out, she added.
Silvia Sacalis, a licensed pharmacist in Tampa, Florida and vice president of clinical services for Healthesystems LLC, also noted the trend toward buprenorphines, which in some cases are prescribed “off-label” or not as intended.
“It’s not meant to cause the same level of addiction as opioids, but the reality is that is not the case,” she said. “Healthesystems clinical pharmacists continue to recommend the reduction of chronic buprenorphine use with the ultimate goal of discontinuing treatment when used off-label for pain.”
Reema Hammoud, Southfield, Michigan-based Vice President of Clinical Pharmacy at Sedgwick Claims Management Services Inc., said caution is required when prescribing buprenorphine products.
“There are certain criteria that doctors need when prescribing for pain,” she said, adding that the drug hits the same opioid receptors as the traditional painkillers.
“We do not just want to jump in to prescribe it to people with pain.… My problem is when doctors prescribe this and there is no exit strategy. Essentially (patients) become addicted to buprenorphine.”
Formulations also come into play with medications for opioid use disorders such as buprenorphine, as some government formulations require pre-authorization, some have set time limits for the drugs and some are looking at why the drug is prescribed, according to Brian Allen, Salt Lake City-based Vice President of Pharmacy Solutions. Mitchell International Inc.