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Prescriptions for opioid use disorder medications are on the rise in workers compensation, a trend worth watching, experts say, as most of the drugs being prescribed — buprenorphines — are still considered opioids in some cases.
Enlyte Group LLC said in its most recent drug trends report that prescriptions for drugs to manage opioid use disorder saw a 7.4% increase from 2020 to 2021. The April 19 report noted that opioid prescriptions overall continued to drop — a long-term trend in workers compensation.
Experts say buprenorphine products are not to be confused with methadone, also used to manage opioid dependency but only available via a clinic, or Naxolone, which is used in opioid overdoses.
While some of the prescriptions for opioid use disorder medications are being used to curb opioid dependency, some may be used for pain management, said Nikki Wilson, Omaha, Nebraska-based director of clinical products with Mitchell Pharmacy Solutions, an Enlyte company.
Some buprenorphine products are indicated for pain while others are being used to manage dependency, she said.
“The thing is prescribers use them interchangeably” for both reasons, and “it’s difficult to vet where and when,” she said, adding that her team is looking more closely at prescribing behaviors and will follow up with another drug trends report later this year.
Such drugs represent a small percentage of overall drug utilization in comp — less than 1%, Ms. Wilson said. But tracking the medications is important because the 7.4% increase stood out, she added.
Silvia Sacalis, a Tampa, Florida-based licensed pharmacist and vice president of clinical services for Healthesystems LLC, also noticed the trend with regards to buprenorphines, which in some cases are being prescribed “off label,” or not as intended.
“It is not supposed to cause the same level of addiction as opioids, but the reality is that is not really the case,” she said. “Healthesystems clinical pharmacists continue to recommend tapering of chronic buprenorphine use with the ultimate goal of discontinuation when being used off label for pain.”
Reema Hammoud, Southfield, Michigan-based assistant vice president of clinical pharmacy for Sedgwick Claims Management Services Inc., said caution is needed in prescribing buprenorphine products.
“There are certain criteria that physicians need when it is prescribed for pain,” she said, adding that the drug hits the same opioids receptors as the traditional painkillers.
“We don’t just want to jump to prescribe it to people in pain. … My problem is when the physicians prescribe this and there is no exit strategy. Essentially (patients) become dependent on buprenorphine.”
Formularies also come into play with opioid use disorder medications such as buprenorphine, as some state formularies require preauthorization, some have set time limits on the drugs, and some look at why the drug is being prescribed, according to Brian Allen, Salt Lake City-based vice president of government affairs, pharmacy solutions, for Mitchell International Inc.