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Regulation seen as crucial to curbing opioid excesses in workers comp

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Prescription drug monitoring programs and “pill mill” laws can curb opioid prescribing and use, but observers say other regulatory tools such as closed formularies might control the opioid epidemic better as it relates to workers compensation.

Published online Monday by The Journal of the American Medical Association, a new study by researchers from the Baltimore-based Johns Hopkins Bloomberg School of Public Health says Florida's prescription drug monitoring program and pill mill laws were associated with “modest reductions” in opioid prescribing and use — including declines of 1.4% in opioid prescriptions, 2.5% in opioid volume and 5.6% in morphine milligram equivalents, or dosage — one year after their 2010 implementation.

The study, “Effect of Florida's Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use,” looked at 2.6 million patients, 431,890 prescribers and 2,829 pharmacies in Florida, the intervention state, and Georgia, the control state, between July 2010 and September 2012.

The study didn't look at workers comp claims, but the reductions in opioid prescribing and use are comparable to the single-digit decreases “we're seeing in (workers comp) pharmacy benefit management drug trend reports,” which address comp systems in all states, said Michael Gavin, Duluth, Georgia-based president of medical cost management company PRIUM. “It makes me wonder whether the Florida regulations are really what's driving the observed decreases or whether the broader attention focused on this incredibly important public health issue might be more causally related to the decreases.”

From 2003 to 2009, prescription drug overdose deaths in Florida rose more than 80%, so the state passed legislation in 2010 requiring pill mills, “or rogue pain management clinics,” to register with the state, among other things, according to the study.

For patients outside the workers comp system, diverting their prescriptions to others is a big concern, Mr. Gavin said. But, in workers comp, “pill mills are a bit of a red herring,” he said.

“It's not uncommon for the really large payers in our space to get distracted by the concept of pill mills and think, 'All my injured workers who are getting excessive opioids must be getting those from pill mills,'” he added.

While the industry occasionally deals with such facilities, what's driving the opioid epidemic in workers comp is “legitimate, well-intentioned physicians who are undereducated on pain management and who are prescribing too many opioids” to injured workers, Mr. Gavin said.

“There's a significant amount of excessive prescribing of opioids” in workers comp, said John Eadie, New York-based director of the Prescription Drug Program Monitoring Center of Excellence at Brandeis University. “The more doctors are able to monitor their patients and restrict their access to unnecessary opioids and also benzodiazepines, the healthier the workers compensation program recipients are going to be.”

Closed drug formularies, which ensure workers are getting approved medications, “are probably the single biggest regulatory lever we can pull in our industry to really make an impact,” Mr. Gavin said.

Prescription drug monitoring programs are also important, but significant results come from requiring prescribers to access the state-run databases before prescribing controlled substances, Mr. Eadie said.

States including New York, Massachusetts and Tennessee require health care providers to access such databases before prescribing opioids. Most states, including Florida, don't have such requirements.