In recent years, there has been a disturbing rise in the use of narcotics to treat pain, including pain from work-related injuries. While narcotics can provide pain relief for certain types of occupational injuries, the rate at which they’re being prescribed is indicative of a much more casual approach to their use than the Food and Drug Administration considers safe. Originally intended for the treatment of severe and chronic pain or cancer-related pain, narcotics such as Percocet, OxyContin, and Vicodin are now routinely prescribed to treat injuries such as lower back pain. Use of these painkillers can have potentially dangerous impacts. The Centers for Disease Control and Prevention reports that between 1999 and 2011, overdose from prescription painkillers more than doubled and deaths quadrupled. Between 2010 and 2012, deaths from prescribed painkillers were more than double the deaths from heroin overdose.
The Unintended Outcomes
According to Dr. Will Gaines Jr., national medical director for Liberty Mutual Insurance, treating providers and others involved in workers compensation claims should be aware of the potential serious ramifications of prescribing narcotics. They must more carefully consider the risks and unintended consequences of using these medications to treat work injuries. He notes that the inappropriate use of narcotics can lead to problems more serious than the injuries themselves. “Due to the harmful and sometimes dangerous side effects associated with these narcotics,” Dr. Gaines says, “injured workers often lose time from work beyond the usual time for their injury to heal. This results in the employer having to bear additional medical and leave costs and lost productivity.”
Strategies for Curbing Narcotics Abuse
Laura MacArthur, registered nurse and product manager of pharmacy management for Liberty Mutual Insurance, describes several issues that should be considered as part of any treatment plan for occupational injuries. “It’s important for the claims management process to identify high-risk situations — those cases in which there may be a likelihood of dependence on the narcotics — and to raise a red flag when intervention seems warranted.” MacArthur adds that strategies such as lowering an injured worker’s dosage, transitioning to less dangerous medications, and using nondrug therapies should be considered as alternatives. Additionally, she says, “Organizations should have policies about what to do when narcotics are used, and help employees recognize that return to work can be affected by use of these drugs.”
Gaines and MacArthur recommend four strategies for curbing narcotics abuse in workers compensation case management:
- Appropriate treatment: Having the injured worker treated early on by a provider experienced in occupational injuries will help the worker recover sooner, making the use of narcotics for pain relief much less likely.
- Proactive claims management: Closely monitoring claims can help identify the inappropriate use of narcotics early on. For example, predictive modeling helps flag cases that have the potential to escalate. Claims managers can also look for early warning signs, such as multiple pharmacy or physician use (“doctor shopping”), depression, or addictive behaviors (e.g., smoking or alcohol abuse).
- Pharmacy benefit manager: Your pharmacy benefit manager should be flagging “outlier” prescriptions for claims managers to investigate. Questions to ask:
- Is the prescription appropriate given the worker’s type of injury or course of treatment?
- Does the number of recommended refills align with standard protocols?
- Treating physician consults: If the primary treating physician lacks experience in treating occupational injuries or safely prescribing narcotics, Gaines and MacArthur recommend opening a dialogue with the physician about the treatment plan and the appropriate use of narcotics. Methods of opening such a dialogue include:
- Utilizing a peer-to-peer physician review, initiated either by a pharmacy benefit manager or carrier-employed physician, such as a regional medical director
- Having a nurse case manager attend the injured worker’s next visit to the treating physician
- Conducting an independent medical exam of the injured worker
Narcotics abuse can translate into extended employee absence, lost productivity, and higher claims costs; therefore, it’s important to help prevent the overuse of narcotics in the treatment of on-the-job injuries.
 New York Times. “F.D.A. Likely to Add Limits on Painkillers.” Jan. 25, 2013. Retreieved on April 29, 2013 from http://www.nytimes.com/2013/01/26/health/fda-vote-on-restricting-hydrocodone-products-vicodin.html
CDC-National Center for Health Statistics, Data Brief, No. 166, September 2014
Morbidity and Mortality Weekly Report. Vol. 62, No. 39. Oct. 3, 2014