Workers comp outperforms nation in reducing opioid prescribing

An examination of opioid prescribing in workers compensation when compared to U.S. Centers for Disease Control and Prevention data show that entities in charge of treating injured workers are doing a better job at reducing the prescribing of powerful painkillers.

Nationwide, the average days’ supply per opioid prescription increased 33% from 13 days in 2006 to almost 18 days in 2015, according to research released by the CDC in July, while the amount of opioids prescribed per capita in 2015 was approximately three times as high as in 1999.

The CDC’s annual study of opioid prescribing shows that opioid prescribing in the United States peaked in 2010 and then decreased each year through 2015, but remains at high levels and varies from county to county.

Meanwhile, nearly half of the states included in a study of opioid prescribing in workers compensation cases have seen reductions in the frequency and strength of powerful pain medications given to injured workers, according to a study released in June by the Cambridge, Massachusetts-based Workers Compensation Research Institute.

“Year over year we (in workers comp) are decreasing,” said Nikki Wilson, Omaha, Nebraska-based pharmacy product director for Coventry Workers’ Comp Services, which also released its own 2016 Drug Trends Series report in June, finding that opioid prescribing is down.

Specifically, Downers Grove, Illinois-based Coventry found an 8.5% drop in opioid utilization and a 9.9% decline in cost per claim, according to the latest batch of pharmacy data that compared 2015 prescription figures.

Ms. Wilson, whose company oversees prescribing for injured workers via claims management programs and other interventions, said there’s a clear incentive for the workers comp industry.

“Because opioids for us and for everyone in workers comp are the most prescribed … that makes us pay attention,” she said. “Part of the motivator is paying for (the drugs).”

Because of claims management programs and workers comp formularies that call for utilization reviews of drugs, those who prescribe under workers comp are “jumping through more hoops” than those who prescribe under group health, Ms. Wilson said.

The CDC, meanwhile, has acknowledged that providers overall need to further reduce the amount and strength of prescriptions.

“The amount of opioids prescribed in the U.S. is still too high, with too many opioid prescriptions for too many days at too high a dosage,” said Anne Schuchat, M.D., acting director of the CDC, in a press statement. “Healthcare providers have an important role in offering safer and more effective pain management while reducing risks of opioid addiction and overdose.”

The CDC is working on using what it now understands to spur change, wrote Dr. Debbie Dowell, one of the authors of the CDC’s report, in an email. In 2016, for example, the CDC released guidelines for opioid prescribing.

“We have overestimated the benefits of opioids for chronic pain and underestimated their risks,” she wrote. “Increased opioid use for chronic pain increases amounts of opioids prescribed because prescriptions are written for more types of problems, because prescriptions are written for longer time periods when they are used for types of pain that persist, and because dosages tend to increase gradually when opioids are used long term. We now know that for most people with chronic pain, other treatments are safer and more effective over the long term. … Clinical practice changes often take years even in the face of new evidence about benefits and risks.”

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