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Compliance with Narcotics Guidelines
April 10-12, 2012 Walt Disney World Swan Resort
Accepted Learning Objectives: 1. Describe how managed care programs, employers, health
care providers and insurers are susceptible to increased workers compensation costs due to prescription drug abuse.
2. Identify strategies employers and medical professionals can use to help drug-dependent and addicted employees regain control of their lives and return to work using results of CompPharma’s survey, “Prescription Drug Management in Workers’ Compensation – The Eighth Annual Survey.”
3. Describe how Washington State has addressed the over use of opioids in workers’ compensation.
Disclosure Statement
• Joseph Paduda has disclosed that he has a relationship with Reckitt Benckiser’s Suboxone Sublingual Film.
• Dr. Richard A. Victor has disclosed no relevant, real or apparent personal or professional financial relationships.
Narcotics Use And Compliance With
Guidelines Richard Victor, J.D., Ph.D.
Executive Director Workers Compensation
Research Institute
Today’s Outline
• About heath care in workers’ compensation
• Relevant findings from 2 WCRI studies • About WCRI
About Workers’ Compensation
• Century-old social program • Injured workers receive medical care, income
benefits, rehabilitation • Patients entitled by law to “all necessary care” • Patients have no deductibles or copayments,
no formularies or step therapy • Physician dispensing is common in a growing
number of states • Prices near AWP
Workers’ Compensation Facts
• Employers pay $79 billion in 2008 • Medical care represents more than
half of the cost • 4.6 million work-injuries • 2.3 million involve lost time from work • 20% of total—lost more than 1 week
from work • Median lost time is 16 weeks
Common Medical Conditions In Workers’ Compensation
Medical Condition % Of Cases
Spine conditions
Sprain, strain and nonspecific spine pain 21%
Neurologic spine pain 7%
Other musculoskeletal conditions
Non-spine sprain and strain 15%
Shoulder inflammation 7%
Knee derangement 4%
Carpal tunnel syndrome 2%
Trauma
Fractures 10%
Laceration or contusion 12%
Other conditions 21%
Cases With > 7 Days Of Lost Time
Today’s Outline
• About heath care in workers’ compensation
Relevant findings from 2 WCRI studies • About WCRI
Two WCRI Studies Of Area Variations In Prescribing Patterns
Major Findings From WCRI Narcotics Studies
Data
• Nonsurgical cases • Patients lost more than 1 week from work • Results presented for episodes of
disability • Snapshot at an average of 24 months
after injury
Data
• 17 states that represent more than 60% of WC benefits in the U.S.
• 360,000 Rx for 75,000 nonsurgical episodes of disability
• 16% to 50% of all episodes in each state
Most Patients Get Rx Pain Medication
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008
Most Patients Get Narcotics
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008
Unusually High Use Of Narcotics In NY, LA, PA, And MA
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008
Also Higher Use Of Narcotics In CA, MD, NC, And TX
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008
Average Worker In Four States Had More Narcotic Pills Per Episode Of Disability
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008
Practice Patterns Favor Schedule II Narcotics In Northeast & Mid-Atlantic States
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008
Major Findings From WCRI Narcotics Studies
Longer-Term Use Of Narcotics
• Study definition – First narcotic Rx filled within first 3 months
after injury – Narcotics continued after 6 months
post-injury – 3+ Rx fills during months 7–12
• Nonsurgical cases
Longer-Term Use Common In Louisiana And New York
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008
Longer-Term Use Also More Likely In PA, TX, CA, MA, And NC
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008
Modest Interstate Variation In Median MEUs Per Episode of Disability
50th Percentile 75th Percentile 90th Percentile
Mo
rphi
ne E
qui
vale
nt U
nits
Pe
r Cla
im
Substantial Interstate Variation Very Substantial Interstate Variation At The 90th Percentile
Nonsurgical Claims With > 7 Days Of Lost Time That Were Identified As Longer-Term Users Of Narcotics, Injuries From
October 2005 To September 2006, Prescriptions Filled Through March 2008
Common Guideline Recommendations For Monitoring & Management
Nonsurgical Claims With > 7 Days Of Lost Time That Were Identified As Longer-Term Users Of Narcotics, Injuries From
October 2005 To September 2006, Prescriptions Filled Through March 2008
Few Longer-Term Users Received Services For Monitoring/Management
Few Longer-Term Users Received Services For Monitoring/Management
Nonsurgical Claims With > 7 Days Of Lost Time That Were Identified As Longer-Term Users Of Narcotics, Injuries From
October 2005 To September 2006, Prescriptions Filled Through March 2008
Today’s Outline
• About heath care in workers’ compensation
• Relevant findings from 2 WCRI studies About WCRI
About WCRI
• Nation’s largest independent think tank on workers’ compensation public policy issues
• Published hundreds of peer-reviewed studies since founding in 1983
• Membership organization—diverse • Not make recommendations nor take
positions on issues
About WCRI: Focus Of Current Health Policy Research Agenda
About WCRI: Focus Of Current Health Policy Research Agenda
Today’s Outline