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Problems arise when opioids continue to decline in comparison



Workers’ compensation opioid prescribing fell to a record low last year, a new report shows, but experts say the picture is complicated, with other drugs taking over the pain management space, among other factors.

AmTrust Financial Services Inc. reported in October that only 15.2% of its reimbursement claims for 2021 were for an opioid prescription, down from 60% in 2017 and 25% in 2018. The data represents a 75% drop in prescriptions containing an opioid over four years , the insurer said.

The figures are in line with other reports.

Enlyte Group LLC subsidiary Mitchell International Inc. reported in July that 30.3% of injured workers in 2021 had opioid prescriptions. Worker spending on opioid compounding has fallen more than 62% since 201

6, according to data collected in 2021 by Maggie Valley, North Carolina-based consulting firm CompPharma LLC.

However, concerns are emerging that other drugs are moving in to replace opioids as a pain reliever in comp. Primarily are non-steroidal anti-inflammatory drugs; neurological drugs, such as gabapentin, which target nerve pain; topical creams; muscle relaxants; and anti-anxiety drugs in a class called benzodiazepines, according to experts.

The latter two are of particular concern, as they are considered sedatives similar to opioids, but not as deadly, experts say.

“While opioids have declined significantly, it’s become a more diffuse problem, and it’s now branching out into other controlled substances,” said Silvia Sacalis, a licensed pharmacist in Tampa, Fla., and vice president of clinical services for Healthesystems LLC.

“These are other controlled substances that unfortunately have similar side effect profiles to opioids with sedation and impact on cognition, which is what prevents injured workers from returning to work.”

Sacalis added that “it is now more important than ever to be vigilant” when it comes to managing prescriptions.

Melissa Burke, Southington, Connecticut-based vice president and director of managed care and clinical for AmTrust, said managed care in comp is moving away from drugs — whenever possible.

“There are many ways to treat pain other than with opioids, and that’s where the industry has gone,” she said. “We are very vigilant about making sure (the workers) have what they need.

“If it’s post-op, if they have an immediate need for a pain medication, they get it; we certainly don’t stand in the way of that. But we make sure that step two and phase two of their injury recovery is to find something that addresses their pain management needs and addresses what’s causing the pain.”

Sometimes the answer is alternative drugs to opioids, she said. This means “identifying if there really is an anti-inflammatory need, or do we need something for neuropathy? Do we need a non-pharmacological treatment, like acupuncture treatment? Do they just need cognitive behavioral therapy to address what internally drives them to focus on their pain?” She said.

Doctors are also getting better at looking at alternatives and proceeding with caution, says Dr. Adam Seidner, Hartford, Connecticut-based medical director for Hartford Financial Services Group Inc.

“Physicians are making sure they’re doing the right assessment and that they have the right management and that they feel comfortable taking care of these patients, both in acute and chronic pain situations,” he said. “Proper management of acute pain is … important because if not done properly, it can lead to long-term, chronic pain.”

And while opioids have dropped “drastically” by comparison, that doesn’t mean the industry’s work is done, said Joe Paduda, Skaneateles, New York-based president of CompPharma LLC.

“Although the actual prescription reporting by workers’ compensation claimants, for workers-paid drugs, has gone down, that does not mean that all of the patients who were taking workers-paid opioids are not still taking opioids.”

There is reason to suspect that injured workers are taking advantage of group health policies, or paying cash for opioids, and still going to work, he said.


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