Opioids in Workers' Comp: the Prescriber Problem

Thursday, March 10, 2011 | 0

By Joe Paduda
CompPharma and Health Strategy Associates

The Pareto Principle states that 20% of the causes generate 80% of the effects.

The Pareto Principle doesn't apply to physicians prescribing opioids, at least not in California. It's far worse than that.

The California Workers' Compensation Institute just released a report that indicates three percent of prescribing physicians accounted for 65% of Schedule II narcotic costs.

Just as striking, the top one-tenth of the claimants receiving Schedule II narcotics got their scripts from 3.3 different docs compared to an average of 1.9 across all claims.

These expensive, potentially addictive, and physically debilitating drugs aren't just prescribed for claimants with serious, complex injuries such as burns, multiple trauma, crushing injuries and the like. In fact, nearly half the Schedule II opioid scripts in California are for minor back injuries.

The report, by well-respected - and highly experienced researchers Alex Swedlow, John Ireland, and Greg Johnson, provides a most compelling picture of the prescribers, claimants, and conditions at the center of the explosion in narcotic usage in workers comp. As always, this isn't a workers' comp-specific issue; in fact we're only now beginning to come to grips with a problem that has reached its tentacles into nearly every community in the nation.

Six percent of the U.S. adult population admits to abusing prescription drugs far outweighing the abuse of all non-prescription drugs. And a large proportion of that abuse is centered on Schedule II narcotics; while there's been a 61% growth in use of all medications in the decade ending in 2008, the growth in Schedule IIs has been six times that at 380%, leading to more deaths from prescription drugs than illicit drug use, alcohol-induced deaths, or firearm-related deaths.

The study itself was based on an analysis of almost seventeen thousand CA WC claims incurred between January 1993 and December 2009, claims that had a total of 9,174 prescribing physicians. Remember that number...

Ninety-three physicians wrote a third of all scripts for Schedule II narcotics, scripts that accounted for 42% of narcotic dollars, or $36.6 million.

There's a lot more information in the study by Swedlow et al, much of it equally alarming. The increase in narcotic opioid usage certainly leads to increased risk of addiction and diversion, reduced ability to return to functionality and work, higher cost, and potentially poor medical outcomes.

One of the tools necessary to control over-prescribing of Schedule II drugs is a Prescription Drug Monitoring Program. Unfortunately, the state with, arguably, the worst diversion problem in the nation - Florida - has Governor who is unable, or unwilling, to grasp the severity of the problem.

For more info on the study, click here.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers, and owner of Health Strategy Associates, a Connecticut employer consulting firm. This column was reprinted with his permission from his Managed Care Matters blog at http://www.joepaduda.com