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Opioid prescriptions down in California, but more effort needed

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The use of powerful painkillers among injured workers in California has decreased in recent years, but opioids still account for more than a quarter of all prescriptions filled in the state.

“We are seeing some measurable changes in the use of opioids for new claims in California, which is encouraging, but there (are) still far too many,” said Joseph Paduda, principal of Madison, Connecticut-based Health Strategy Associates L.L.C.

The use of medical provider networks and the independent medical review process, among other efforts, have led to recent declines in the number of opioid prescriptions per user and lower dosages, the Oakland-based California Workers' Compensation Institute said in a report released last week.

“It will be important to monitor” recent positive trends “and to explore what may be driving them,” CWCI said in the report. “This information may be useful to those charged with shaping policies to govern the use of opioids in workers compensation.”

But “we are a long way from winning the battle,” Mr. Paduda said, noting that “no measurable progress” has been made to address legacy claims.

He added that “there are efforts underway by workers comp pharmacy benefit managers that are having a positive result,” such as flagging opioid prescriptions for intervention and reaching out to prescribers. “We just need to redouble those efforts.”

Accounting for 27.2% of prescriptions filled in California's comp system in 2014, opioids have become “the single largest category of medications prescribed to injured workers” in the state, according to CWCI's report, which uses data from more than 10.8 million California workers comp prescriptions dispensed between January 2005 and December 2014.

The category “ranked well ahead” of anti-inflammatory drugs, musculoskeletal therapy agents, ulcer drugs, anticonvulsants, antidepressants and dermatologicals, the report states.

One contributing factor is cost, as the average payment per opioid prescription increased by 85% between 2005 and 2014, while the average payment for all other prescriptions increased by only 39%, according to the report.

In the meantime, California regulators are working to develop a closed formulary for medications prescribed in workers comp to change prescribing behaviors and stop opioid addiction before it starts, sources said.

“Federal and state policymakers are implementing a variety of strategies to address” increased opioid use, “including treatment guidelines, prescription drug monitoring programs, provider education and formularies,” according to a report released last month by a committee of the Middleton, Wisconsin-based International Association of Industrial Accident Boards and Commissions.