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State, federal efforts to curb opioid abuse set to grow

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Workers compensation professionals expect that efforts to curb opioid abuse will become more prevalent among state legislatures following passage of a new law in Massachusetts and the release of the U.S. Centers for Disease Control and Prevention's prescribing guideline.

In the same week, Massachusetts Gov. Charlie Baker signed a bill into law that limits first-time opioid prescriptions to seven days, among other things, and the CDC released its hotly anticipated guideline for prescribing opioids for chronic pain — excluding cancer, palliative and end-of-life care.

Neither the Massachusetts law, which begins to phase in this year, nor the CDC's recommendations were written specifically for the workers comp industry, but sources say both have the potential to positively influence physicians who treat injured workers.

For example, regarding Massachusetts' H. 4056 legislation, “even if you add in the cost and time associated with an extra office visit (after seven days), I think the earlier assessment as to the benefits and risks of the initial drug regimen will drive better decisions,” said Mark Pew, senior vice president at Duluth, Georgia-based medical management company Prium.

In addition to establishing a seven-day limit on first-time opioid prescriptions, the Massachusetts law requires doctors to check the state's prescription monitoring program database before writing prescriptions for Schedule II and III narcotics.

States like New York, Massachusetts and Tennessee also require health care providers to access databases before prescribing opioids, and sources say more states are likely to follow suit.

Since October, Connecticut has required health care providers to check the state's database before prescribing more than a 72-hour supply of any controlled substance and at least every 90 days for ongoing treatment of any patient.

“This plays into a macro trend,” said Rick Jung, CEO of Portland, Oregon-based Clinicient Inc., a provider of physical therapy electronic medical records and billing software.

The health care industry is moving away from the fee-for-service model and toward what Mr. Jung called “payment-for-performance or payment-for-outcomes.”

“If (physicians) just keep prescribing opioids and the patient not only doesn't get better, but they get worse and they perhaps get on a more serious substance — heroin addiction has come from this — … the compensation for the provider will be impacted,” Mr. Jung said.

Despite drawing criticism from some workers comp professionals for not addressing long-term users of opioids, the CDC's opioid recommendations are a step in the right direction, sources said.

The guideline recommends increasing the use of other effective treatments, such as nonsteroidal anti-inflammatory drugs and physical therapy, and stresses the importance of prescribing the lowest possible effective dosage to reduce risks.

As more physicians adopt these best practices and as more patients begin to understand the risks associated with opioids, “we expect decreased use of opioids in all populations, including those who have been on these drugs for years and are offered alternative — and more effective — treatments,” Marcos Iglesias, vice president and medical director at Hartford Financial Services Group Inc. in Hartford, Connecticut, said in an email.

Dr. Iglesias added that he would eventually “like to see the CDC guideline expanded to address the use of opioids for acute pain in addition to chronic pain.”

Though not all of the legislation and recommendations out there will have an impact on workers comp legacy claims, “as America ages, as obesity grows, as all of the macro global health issues in our society continue to advance, (it) will have a sizable impact,” Mr. Jung said.

Sources noted that evidence-based formularies for drugs prescribed to injured workers will also help change prescribing behaviors and hopefully stop opioid addiction before it starts.

While Nebraska is currently considering a closed formulary, Tennessee's formulary is expected to take effect in August, and California has been tasked with creating one by July 2017.

Meanwhile, the CDC said in a statement that it “will continue to work with states, communities, and prescribers to prevent opioid misuse and overdose by tracking and monitoring the epidemic and helping states scale up effective prevention and treatment programs.”