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CHICAGO — The workers compensation industry continues to address the epidemic of opioids, which have been used to treat chronic pain for years even though they have been found to be ineffective in treating long-term pain.
Speakers at the 2017 Workers Compensation conference sponsored by the Claims and Litigation Management Alliance and Business Insurance Thursday in Chicago discussed the reasons behind the opioid epidemic and possible future trends during a panel on powerful prescription drugs.
“We are in this big problem with opioids in this country,” said Teresa Bartlett, senior vice president and medical director at Memphis, Tennessee-based Sedgwick Claims Management Services Inc. Dr. Bartlett said an attempt by medical professionals to properly address pain, involvement from “Big Pharma” and the U.S. Food & Drug Administration’s approval of oxycodone, a drug originally intended for end of life care, all are possible explanations for the current situation.
“Purdue Pharma began telling doctors, ‘This drug is your savior for the pain. We are in a decade of pain control. We are all monitoring whether you're managing people's pain. This drug is safe, it's not addictive, it won't have any side effects, it's the perfect answer to your patients’ problems,’ ” said Dr. Bartlett.
The cost of the opioid epidemic exceeded an estimated $55 billion in 2011, including workplace, health care and criminal justice costs. “My guess is you could probably double that in terms of what the cost is today in 2017,” said Fort Worth, Texas-based Jennifer Saddy, director of workers compensation at American Airlines.
One way the U.S. government tried to address the issue was by buying out the poppy farms that are the source of drug.
The U.S. government wanted to decrease the yield of the poppy plant grown in Afghanistan. Two years ago, the U.S. government invested $10 billion and hired a private group to buy out the poppy farmers with the goal of reducing the yield from the poppy farms by 25% in hopes of addressing the growing epidemic. Instead, the yield increased 30%, according to Dr. Bartlett.
Experts, who say 40% of drug spend in workers comp is on opioids, urge doctors to do a risk assessment and baseline urine drug screen, and evaluate whether the person’s function would improve on the drug before prescribing opioids. After prescribing, the doctor should implement a pill count and implement a “drug holiday” after a year to see if the patient no longer needs the drug, according to Dr. Bartlett.
Most states are a part of prescription drug monitoring programs, Dr. Bartlett said, but physicians often say they don’t visit the site because they trust their patients.
On the medical marijuana side, 25 states and the District of Columbia have laws allowing medical marijuana, but the FDA has not changed it from a Schedule I to a Schedule II drug, which would allow clinical trials.
Marijuana has been proposed as a possible solution for pain management and reducing the amount of opioids prescribed, but there is not enough evidence to support this, experts say.
“On one hand, you have an increasing number of states that are allowing marijuana as a remedy under workers compensation law under state law, but under federal law it remains illegal,” said Baltimore-based Albert B. Randall, attorney at Franklin & Prokopik P.C.
Nurse practitioners and physician assistants wrote more opioid prescriptions for injured workers in 2013, concluded an analysis released Monday.