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Opioid dependency drugs on rise in comp


The workers compensation industry is seeing a rise in the percentage of claims containing prescriptions for drugs used to manage opioid dependency or overdoses, even as claims with opioids continue to decline.

A July 19 report by Enlyte LLC showed that comp opioid prescriptions fell 1.3% in 2022, with associated costs declining 2.5%. Prescriptions for opioid dependency drugs and those used to reverse overdoses rose 11.6%.

Nikki Wilson, Omaha, Nebraska-based senior director of clinical pharmacy services at Enlyte, said the new data reflects improved education around opioid dangers.

“The shift has gone to alternative pain management,” she said, most notably a rise in drugs to treat opioid dependency.

Experts said the rise in such drugs could partly be the result of still-evolving prescribing regulations.

Reema Hammoud, Southfield, Michigan-based assistant vice president, clinical pharmacy, for Sedgwick Claims Management Services Inc., attributed the increase in opioid dependency drugs in part to there being “no exit plan” for those taking medication-assisted treatment. 

“We don’t have clear guidelines on how long to use those medications,” Ms. Hammoud said of opioid dependency drugs. “That’s why patients who are prescribed those medications often stay on those medications.”

Ms. Hammoud said dependency drugs don’t cure opioid use disorder but merely help with withdrawal symptoms.

“Patients are still getting that pain relief without going into addiction or dependency,” she said.

The problem is that there is no “cure” for opioid use disorder, so injured workers who are put on the dependency drugs as part of their comp benefits could potentially stay on them indefinitely.

Ms. Hammoud said the currently accepted recommendation is to include psychotherapy or cognitive behavioral therapy along with dependency-assisting medication.

Naloxone, a drug used to reverse an opioid overdose, is also on the rise in comp, and Ms. Hammoud said one reason could be new provider requirements to prescribe the drug alongside opioids anytime a high-dosage opioid prescription is filled.

“It doesn’t mean they’re actually using it; it’s for safety’s sake,” she said. “That’s why we’re seeing an increase in naloxone, because some states are requiring the prescription.”

Tina Brletich, Ponte Vedra Beach, Florida-based vice president of managed care and clinical in workers comp for AmTrust Financial Services Inc., said the network is seeing increases in medications to assist with overdose reversal and the management of withdrawal symptoms.

“It’s not surprising, really,” Ms. Brletich said of the Enlyte report’s findings concerning both opioids and dependency medications. “The industry trend is a decrease in opioids. Certainly, regulations have been rolled out by states. We’ve seen similar trends at AmTrust in terms of decrease in opioids as well.”

Del Doherty, owner of Houston-based pharmacy benefit manager ProdigyRX, said providers, in comp and in general health care, are striving to be more “proactive and preventative” when it comes to prescribing dependency drugs.

“Clinically, it is the right thing for the patient if a prescriber sees this as something that could be beneficial for the patient,” Mr. Doherty said.

And if an injured worker does overdose on opioids, a naloxone prescription is less costly than a trip to the emergency room, he said.