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Use of non-opioid therapies increasing

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The overall utilization of opioids among injured workers has steadily decreased in recent years as the use of nonsteroidal anti-inflammatory drugs and anticonvulsants has increased, Coventry Workers’ Comp Services said Monday.

Early intervention programs, education initiatives and the adoption of state-based closed formularies and medical guidelines are among efforts that caused opioid utilization and dosages to decrease from 2014 to 2015, according to the workers comp cost and care management solutions provider’s 2015 First Script Drug Trends Analysis.

From 2014 to 2015, opioid use fell 3.2% and opioid scripts with a morphine equivalent dose greater than 100 – a morphine equivalent dose of 120 or more typically is considered high – decreased 3.9%, Downers Grove, Illinois-based Coventry said in the report.

“In the last few years there has been a slow yet continuous shift away from opioid medications to alternative non-opioid therapies,” according to the report. It states that managed opioid prescriptions are often replaced with anticonvulsants, while unmanaged prescriptions that are dispensed or billed out-of-network are often replaced with nonsteroidal anti-inflammatory drugs.

Among the managed population, the utilization of anticonvulsants, which are commonly prescribed to treat chronic pain, increased 6.1% from 2014 to 2015, the report states.

In last year’s drug trends analysis, Coventry said anticonvulsant utilization increased 4.4% from 2013 to 2014.

Though common side effects of anticonvulsants include dizziness and fatigue, the therapeutic class is generally considered to be safer than opioids.

Meanwhile, the use of nonsteroidal anti-inflammatory drugs increased 12.9% in the unmanaged population from 2014 to 2015.

“The growing use of non-opioid medications to treat pain … is favorable from a clinical perspective and is a trend we expect to continue,” Coventry said in the report.

Overall, the total cost per claim increased 0.8%, due to a 6.5% increase in the overall average cost per script and a 5.4% decrease in scripts per claim, the report states.

According to last year’s report, the overall average cost per claim increased 7.3%, with the average cost per script increasing 12.9% and the average scripts per injured worker decreasing 5%.

“First Script’s cost per claim edged up less than 1% because a decrease in utilization largely offset an increase in cost per prescription,” Coventry said in the report. “This moderation is evidence that it is possible to bend the cost curve and slow a major force in overall medical inflation.”