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Opioid substitutes factor in greater use of blood pressure medications

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Opioid substitutes factor in greater use of blood pressure medications

More injured workers are taking nonsteroidal anti-inflammatory drugs or antidepressants in lieu of powerful opioids, which has contributed to an uptick in the use of blood pressure medications.

The overall use of opioids by injured workers continues to decline due to tighter regulations, early intervention programs and other efforts, according to recent drug trend reports by pharmacy benefit managers.

The decline, which workers compensation professionals have celebrated, has resulted in greater use of NSAIDs, antidepressants and anticonvulsants to treat chronic pain, sources said.

The shift toward nonopioid therapies is one reason for the 14.4% increase in utilization of cardiovascular/antihypertensive drugs reported in the 2015 “First Script Drug Trends Analysis” released Monday by Coventry Workers' Comp Services.

NSAIDs, such as Advil and Motrin, and antidepressants, such as Prozac and Tofranil, “have the potential to elevate blood pressure in certain patients,” said Nikki Wilson, Omaha, Nebraska-based pharmacy product director at Coventry. “Sometimes a doctor will choose to try to manage with (an ancillary) medication versus changing out the (nonopioid) drug that may be the cause. It's all a cost/benefit issue.”

The aging workforce also could be contributing to the uptick in utilization of cardiovascular/antihypertensive drugs since older people are more likely to have high blood pressure, Ms. Wilson said.

Though physicians focus on treating workers' industrial injuries, they can't ignore comorbidities that also need to be managed, she said.

Presumption laws are another possible driver, said Mark Pew, senior vice president at Duluth, Georgia-based medical management company Prium.

“Historically … hypertension is not a compensable diagnosis,” Mr. Pew said. However, under such laws, firefighters, police officers and other first responders are presumed to have developed certain diseases on the job and are entitled to workers comp benefits.

In Express Scripts Inc.'s 2015 “Workers' Compensation Drug Trend Report” released in April, the PBM noted a 16.9% increase in the utilization of cholesterol-reducing drugs.

Express Scripts said in the report that while blood pressure medications aren't usually associated with occupational injuries, “some clients (typically municipalities) may design custom formularies that cover conditions such as high blood pressure or high blood cholesterol, due to the nature of the work performed by their employees.”

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