Early opioid monitoring stressed

Opioid prescribing has become more restrictive due to regulatory and legislative changes in recent years, but the painkillers can still complicate catastrophic claims, experts say.

In opioid cases, it’s important to have active claim management from the very beginning, said Amy Bilton, shareholder at Nyhan, Bambrick, Kinzie & Lowry P.C. in Chicago.

“Believe it or not, I recommend claims handlers (and attorneys) start watching when the prescription goes longer than three days,” she said. “That is not to say that every case with more than three days of opioid use should have aggressive case management on it. It’s just my first flag. As more gets prescribed, I really start to watch closer, particularly when it gets to 30 milligrams of morphine equivalency per day.”

Ms. Bilton says her approach is based on U.S. Centers for Disease Control and Prevention guidance from 2017 that found the probability of long-term opioid use increases after just five days of use, and even relatively low doses of opioids of 20 to 50 morphine milligram equivalents increase the risk of opioid dependence.

Lisa Haug, managing director of medical management at Safety National Casualty Corp. in St. Louis, said when opioids are involved, the insurer sends out nurses to the employee’s doctor appointments to communicate with the provider, act as an educator for the patient and liaison and stay on top of the claim “so we don’t have an opioid problem.”

Many functional restoration programs are available to help with opioid addicted workers, and although they can be expensive, they can dramatically improve the quality of life of the injured worker and “you won’t have to pay for narcotics for the rest of their life,” she said.

“If you can get the right resource at the right time for the right patient … it can change the trajectory of a claim,” Ms. Haug said.