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Formulary, legislation helped reduce Arizona opioid use

Arizona opioids

PHOENIX — Like much of the country, Arizona has been hard hit by the opioid epidemic. But efforts by state lawmakers, the industrial commission and health and substance abuse agencies have helped curb prescriptions.

At the annual Workers Compensation Research Institute’s 35th annual Issues and Research Conference in Phoenix on Thursday, members of the Arizona Industrial Commission explained how the state’s adoption of a drug formulary and the commission’s work with other stakeholders in Arizona is slowly reducing the amount of those drugs prescribed in the state to injured workers.

Since 2012, Arizona has seen a steady uptick in the deaths from opioid abuse. In 2017, the opioid epidemic in the state hit a record high, with 949 opioid deaths reported — twice the number of deaths as 2012, according to figures provided by the Arizona Industrial Commission.

In fall 2017, the Arizona Department of Health Services concluded in its research that in the six months prior, more than 227 million opioid pills had been prescribed in the state.

“That’s 33 pills for every Arizonan,” said Jason Porter, deputy director and general counsel for the state’s Industrial Commission in Phoenix.

In 2018, the state’s legislature passed the Arizona Opioid Epidemic Act, adding a $10 million infusion to improve uninsured and underinsured people with improved access to opioid abuse or misuse treatment and enacting criminal penalties for opioid manufacturers found guilty of defrauding the public. It also will require all e-prescribing of all opioid prescriptions — which took effect in most of the state’s counties on Jan. 1, 2019, with the rest to follow in July — in an effort to reduce prescription forgeries, and limits first fill opioid prescriptions to five days for first-time opioid recipients, with a few exceptions.

It also allows insurers or the Industrial Commission to ask physicians to obtain updated patient utilization reports, and states that insurers or self-insured employers are not liable for bad faith or unfair claims processing for any act reasonably necessary to monitor or assess the appropriateness of a patient’s opioid use. The state’s health department also launched a hotline for medical professionals to consult on patients with complex pain issues and opioid use disorder.

But work on opioid reduction in workers compensation started even earlier when, in 2012, the state adopted legislation to require the Industrial Commission to develop and implement a process for the use of evidence-based treatment guidelines to treat injured workers. The commission convened a panel of medical specialists, insurance claims representatives, self-insured employers and attorneys to evaluate various drug formularies adopted by other states. A survey of the state’s physicians found the Office Disability Guidelines’ Workers Compensation Drug Formulary to be the clear favorite. On Oct. 1, 2016, the treatment guidelines went into effect but only for management of chronic pain and opioid use for pain management, along with a framework for dispute resolution. On Oct. 1, 2018, the ODG’s reach was expanded to cover all body parts and conditions of injured workers.

“We wanted the use of treatment guidelines to help reduce any delays in treatment requiring medical authorization,” said Jacqueline Kurth, medical resource office manager at the Industrial Commission of Arizona in Phoenix. “We also wanted a process that would not create some undue administrative burden on our system and … would include an efficient and timely dispute resolution process and maintain the integrity and functionality of our current workers compensation system.”

Ms. Kurth said the “open and transparent” approach and input from a diverse panel aided in the successful implementation of the treatment guidelines. 

“Despite the dire projections — many stakeholders thought the sky was going to fall and we didn’t know what to expect when we rolled out drug formulary — everything went smoothly,” Ms. Kurth said.

The combination of these efforts has reduced opioid prescriptions in 2018 by 36% compared with 2016, and led to a 60% decrease in doctor shopping, said Mr. Porter. The state has also reported a 37% increase in the number of doctors checking patient utilization reports and a 78% decrease in the number of first-time opioid recipients given prescriptions for more than 90 morphine equivalent units since 2016.

On the workers comp side, data from the Boca Raton, Florida-based National Council on Compensation Insurance has found that the change in the amount of oxycodone pill equivalents dispensed to injured workers was reduced by 13% between 2016 and 2017 in Arizona.

“In Arizona, the opioid epidemic didn’t start overnight, and it’s going to take time and additional effort to reduce the trend,” said Mr. Porter. “We have begun to see some meaningful improvements.”

The Arizona Medical Board declined to comment for his story and the Arizona Medical Association did not immediately return calls for comment.





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