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Narcotic prescriptions linked to higher costs


A California Workers' Compensation Institute study points to what it calls an "alarmingly high" use of narcotics to treat workplace injuries.

Yet evidence-based medicine findings suggest that opioids should not be necessary to the degree that they are currently used to treat common lower back sprain and strain claims, said Alex Swedlow, vp of research for the Oakland, Calif.-based CWCI.

Preliminary results of the study of 171,000 insured and self-insured claims show a correlation between the use of narcotics and increased claims costs, time away from work, claim duration and litigation, Mr. Swedlow said.

The study, final results of which are to be released in June, also found drug addiction to be an issue.

Claims adjusters conducting a peer review of CWCI's data said that when they review claims with a certain number of narcotics prescribed, they must start setting aside reserves to pay for detoxification program costs, Mr. Swedlow said.

At Boston-based Liberty Mutual Group Inc., efforts to address claimant addiction to narcotics such as OxyContin now go beyond setting aside detox program reserves, said Dr. David Deitz, the insurer's vp and national medical director for commercial professional services.

Liberty Mutual has begun contracting with vendors specializing in finding and treating issues that drive injured workers to use narcotics. They address more than just the addiction, Dr. Deitz said.

An interdisciplinary chronic pain management program, for example, could help a worker that has undergone several back surgeries, but failed to obtain pain relief. Such a program might use therapy to strengthen muscles while rebuilding lost confidence in the claimant's ability to function.

But efforts must start early to identify factors that might lead to addiction before it becomes a problem, Dr. Deitz said. Liberty Mutual trains its claims adjusters and case nurses, and works with the pharmaceutical benefit managers with which it contracts, to flag claims where there is potential for misuse of narcotics.

The insurer's medical directors can then discuss flagged claims with treating physicians to assure certain drug prescriptions are appropriate.

Memphis, Tenn.-based Sedgwick Claims Management Services Inc. says it closely monitors claims in which narcotics such as OxyContin are prescribed to make certain the prescriptions make sense for specific injuries.

Additionally, third-party administrators such as Sedgwick typically narrow drug formularies to therapies found to be appropriate for specific injuries, said Kimberly A. George, vp and managed care practice lead for Sedgwick. That helps eliminate prescription misuse, she said.

Still, various research suggests widespread use of narcotics in the nation's health system, including in workers comp.

Preliminary results from the CWCI study, for example, show opioids are used in more than 25% of the lower back claims the organization examined.

The CWCI study focused on lower back injuries that occurred between 2002 and 2004 and did not include major conditions such as claims with spinal cord damage.

It found that temporary disability claimants treated with opioids average 105 paid days off in contrast to the average of 30 days, than when narcotics are not prescribed.

The preliminary findings also show that when opioids are present in a claim, there is a 322% greater likelihood for litigation, a 264% greater likelihood for lost time from work, and 38% more likely for a claim to remain open longer and incur additional costs.