Finally Trending Down

Wednesday, July 18, 2012 | 0

Has opioid prescribing in California's workers' comp system started to tail off?

Perhaps. At least that's the trend noted by the California Workers Compensation Institute in a July 9 study, "Changes in Schedule II and III Opioid Prescriptions and Payments in California Workers Compensation"
http://www.cwci.org/research.html

The study, authored by John Ireland, Bob Young and Alex Swedlow concludes that:

"Over the past ten years, there has been growing concern about the increased use of opioid painkillers – especially Schedule II drugs such as OxyContin, Fentanyl, Morphine and Methadone – which have become widely used for the treatment of chronic pain in injured workers. This study finds that in the second quarter of 2010, Schedule II opioids accounted for 5.8% of all California workers’ compensation prescriptions and 19.7% of the prescription dollars nearly five times the proportions noted in 2002. However, the latest California workers’ compensation pharmaceutical data, updated through the end of 2011, indicates a recent reversal in this trend, with Schedule II painkillers declining to 3.4% of the workers’ compensation prescriptions and 12% of the prescription payments in the fourth quarter of last year, though the use of Schedule III drugs such as Vicodin has remained relatively stable.

The recent decline in the use of Schedule II opioids was not associated with any significant or explicit changes in California workers’ compensation legislation or regulations pertaining to the use of these medications. This suggests that the reductions may be associated with increased public awareness of the dangers of Schedule II drugs, as well as enhanced medical management and pharmaceutical controls implemented by the payor and medical provider communities."

Opioids have gotten lots of bad press in the last decade as use soared and reports surfaced of some overdose deaths, allegations of some drug diversion and concerns about the safety of long term use (including dental consequences) grew. Not to mention concerns about cost.

But these concerns have not been unique to California, as the paradigm of pain management treatment changed over the last couple of decades and new, more aggressive procedures for treatment were adopted. Moreover, in a larger sense medical care in the country is very oriented toward pharmaceutical solutions, and workers' comp is no exception.

But have some of these trends now crested?

Yes, according to the CWCI data.

Julius Young is an applicants' attorney with Boxer & Gerson in Oakland. This column was reprinted with his permission from his Workers' Comp Zone blog.