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Painkillers, muscle relaxants found in most California polypharmacy claims

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Painkillers, muscle relaxants found in most California polypharmacy claims

Opioids with anti-inflammatories and muscle relaxants was the top three-drug combination present in most workers compensation claims that included injured workers taking multiple drugs, according to a report released Thursday by the Oakland-based California Workers’ Compensation Institute.

Opioids alone are the most prevalent type of drug found in polypharmacy claims that involve five or more concurrent prescriptions, according to the report, which used the institute’s Industry Research Information System database to generate a sample of claims in which prescriptions were dispensed to California injured workers in 2016 and 2017.

For purposes of the study, claims with five or more concurrent medications during the two-year study period were defined as polypharmacy claims, while for comparative purposes the analysts also examined data on claims with fewer than five concurrent prescriptions, according to the study.

Polypharmacy is the simultaneous use of multiple drugs by a patient to treat one or more medical conditions. Ancillary medications are often used to mitigate the risks and side effects of other drugs prescribed to a patient, but combining drugs can present other health risks, including potentially dangerous drug interactions and the risks of overdosing, the report says.

Overall, 43% of the claims in the study sample had no overlapping prescriptions; 33% had two concurrent prescriptions; 20% had three to four concurrent prescriptions; while 4% had five or more concurrent prescriptions and were considered polypharmacy claims.

Among other findings from the study:

The likelihood that indemnity was paid on a claim increased with the number of prescriptions. Just over half (51.6%) of the claims with one to two prescription drugs involved indemnity payments, but that percentage rose to 91.3% for claims with five or more concurrent drugs.

Polypharmacy claims tended to be older: 21.5% of the claims with five or more concurrent prescriptions were at least 10 years old compared to 6% of the non-polypharmacy claims.

Polypharmacy is more common among older workers. More than half (52.3%) of the polypharmacy claims involved injured workers who were 50 years of age or older at the time the drugs were dispensed, versus 38.3% of those who received fewer concurrent prescriptions.

The top diagnostic category for polypharmacy claims, noted in 21.3% of the cases, was back conditions without spinal cord involvement, which includes back sprains and strains, one of the most common work-related injuries. Other common diagnoses included ruptured tendons, tendonitis, myositis and bursitis (10.2% of the polypharmacy claims); shoulder, arm, knee, and lower leg sprains (9.5%); and other heart and circulatory disorders (9.1%).

Opioids and anti-inflammatories were the most common drugs found in claims with three or more concurrent prescriptions. Opioids, anti-inflammatories and muscle relaxants were the top three-drug combination, while the same three drug groups along with gastrointestinal agents were the top four-drug combination.

Among claims with three or more concurrent prescriptions, opioids were present in 13 of the top 20 drug combinations; while among claims with four or more concurrent prescriptions, opioids were present in 16 of the top 20 drug combinations.

Opioids were the most common type of drug dispensed in claims with five or more concurrent prescriptions, noted in one out of every six of these polypharmacy claims. Anti-inflammatories were the number two drug category in the polypharmacy claims, present in one out of every seven of these claims, followed by gastrointestinal agents, muscle relaxants, and antidepressants.

 

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