Are workers’ compensation doctors overprescribing pain meds to injured workers?

It’s no new thing that workplace insurers nationwide are having to pay out billions of dollars in workers compensation benefits and reimbursements every year. The largest of those payouts, naturally, go to employees who are catastrophically injured, losing limbs and function in the process. However, those insurers are now finding themselves addressing another large, fast-growing money vacuum:  payouts to those workers whose injuries have been treated using strong pain medicine(s), some of whom don’t return to work for a good while, if they ever do.

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Workplace insurers are spending an estimated $1.4 billion every year on narcotic painkillers, which are also known as opioids. They’re coming to a startling realization: the medications, if used too early in treatment, too frequently, or for too long, can delay an employee’s return to work and, in turn, up disability payouts and medical expenses for the employee.

A 2008 study of claims by the California Workers Compensation Institute found that workers receiving high doses of opioid painkillers to treat their job-related injuries stayed off the job three times longer than employees having similar injuries, but taking lower doses of many of the same meds.

Accident Fund Holdings is an insurer operating in eighteen states, including here in Georgia. In a 2010 analysis by them, it was found that in cases where medical care and disability payments are combined, the cost of a workplace injury is nine times higher when a narcotic like OxyContin is used than when no narcotic is used.

Drugs like OxyContin, Percocet, and Duragesic are all drugs that are used to treat occupational injuries and are part of a broad problem involving their excessive use, according to experts. Workplace injuries are drawing attention, it seems, because narcotics are often prescribed to treat common problems like back pain even though there’s little evidence of their long-term benefit. Not only do they cause drowsiness and lethargy, but high doses of opioids can lead to addiction and other serious side effects, like overdoses.

“What we see is an association between the greater use of opioids and delayed recovery from workplace injuries,” said Alex Swedlow, the head of research at the California Workers Compensation Institute.

Narcotics prescriptions used to treat workplace injuries jumped 63 percent between 2001 and 2008, according to insurance industry data. Along with that jump in numbers is a jump in costs. In an attempt to find means for reversing the trend, some states (New York, Colorado, Texas, and Washington) have issued new pain treatment guidelines; more are expected to do so soon.

It appears that doctors in four states (Louisiana, Massachusetts, New York, and Pennsylvania) are the biggest prescribers of injured workers’ drugs, according to data review of seventeen states by the Workers Compensation Research Institute, which is a group in Cambridge, Massachusetts. Since taxpayers underwrite coverage for public employees like police and fire personnel, costs are hitting them, as well.

Dr. Bernyce M. Peplowski is the medical director of the State Compensation Insurance Fund of California. According to her, insurer’s policies might have “created a monster.” That’s because during the past decade, insurers readily reimbursed doctors prescribing painkillers while eliminating payments for treatments like therapy, which does not rely on drugs.

On a personal note, most of my Georgia workers’ compensation clients are reticent to take narcotic pain medications unless their pain levels are so severe that they have little choice but to take them.  After taking such medications for a while, we’ll often work together to taper such medicating to avoid addiction issues.

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