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

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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