Opioids in Workers' Comp: Attacking the Messenger

Thursday, March 31, 2011 | 0

By Joe Paduda
CompPharma and Health Strategy Associates

On March 23, WorkCompCentral had a piece by Greg Jones noting complaints by the California Society of Physical Medicine and Rehabilitation and California Society for Industrial Medicine and Surgery about the study on physician prescribing of opioids recently released by the California Workers' Compensation Institute.

I received a copy of the letter as well, and frankly was surprised for several reasons.

What was most troubling was the statement that, "Alone, the report's findings do not indicate that there is anything inappropriate."

I would argue that the findings absolutely indicate there is something very, very wrong going on here. In fact, a relatively few physicians are "handling the bulk of the prescriptions"; that was amply demonstrated in the analysis and results provided in the report, the details of which were discussed in detail therein.

In addition, the statement that "we are not surprised by these early findings" was quite troubling. I certainly was surprised.

Why was this not surprising to the medical society? Was it not surprising that a relatively few physicians were treating patients with low back sprains and strains for extended periods with relatively high doses of narcotics, when all evidence-based clinical guidelines do not support such treatment?

The letter suggested CWCI conduct a deeper analysis to determine whether the treatment was appropriate based on treatment guidelines.

Huh?

Every treatment guideline I've heard of, including Official Disability Guidelines, American College of Occupational and Environmental Medicine, Washington state, none of them supports extended use of opiods for treatment of musculoskeletal issues. None.

I would also note that the letter called into the question the methodology itself. The author of the letter's statement that "it is clearly misleading to use the initial diagnosis" is inaccurate. Even a cursory review of the study methodology reveals the researchers used a rather sophisticated clinical grouper to identify the PRIMARY diagnosis, which may well not be the initial diagnosis.

Finally, the letter asserted that others had mis-cited or misinterpreted the CWCI work, and requested CWCI somehow correct, clarify, or take steps to correct those misinterpretations. Studies are cited and discussed and reviewed and analyzed in the media and by individuals all day every day; I just don't think CWCI has the time, resources, or obligation to monitor what everyone says about their research.

I guess the net is I'm really taken aback by the letter.

There's clearly abuse going on here, along with bad medicine and out of control prescribing of very addictive, dangerous medications that are ripe for diversion and abuse. I'm just very surprised that instead of taking this seriously, a medical society would attack the messenger. There's something very rotten going on, and denying it is the wrong approach.

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