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Physicians failing to monitor long-term use of opioids by their patients
Researchers studying workers’ compensation claims have found that almost one in 12 injured workers who are prescribed powerful painkillers such as Oxycontin and Vicodin were still using the prescription drugs three to six months later, potentially leading to addiction and more work loss.
Longer-Term Use of Opioids, by the Workers Compensation Research Institute (WCRI), found, also, that many physicians who prescribe narcotics for injured workers fail to follow recommended treatment guidelines for monitoring their patients. The monitoring includes services such as drug testing and psychological evaluations, which can help prevent misusing opioid drugs, addiction, loss of work and overdose deaths.
The WCRI defined “long-term opioid use” as use by injured workers who were prescribed opioids within the first three months after a nonsurgical injury and had three or more visits to fill opioid prescriptions between seven months and a year following their injuries.
The study was based on nearly 300,000 workers’ compensation claims and 1.1 million prescriptions associated with those claims from 21 states. The claims represent injuries that occurred between Oct. 1, 2006 and Sept. 30, 2009, with prescriptions filled up to Mar. 31, 2011. The states included in this study were Arkansas, Arizona, California, Connecticut, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and Wisconsin.
Painkiller Use Growing
The study findings come amid a surge of painkiller addiction in the United States. Overdose deaths from prescription painkillers—a class of drugs that includes hydrocodone, methadone, oxycodone and oxymorphone—have skyrocketed in the past decade, according to the Centers for Disease Control and Prevention (CDC). “Overdoses of prescription painkillers have increased four-fold since 1999, killing more than 16,500 people in the United States in 2010,” said Courtney Lenard, an official at the CDC’s National Center for Injury Prevention and Control. Lenard directed
SHRM Online to a 2011 American College of Physicians white paper that stated, “The rate of opioid addiction among patients receiving long-term opioid therapy remains unclear, but research suggests increased opioid availability has been accompanied by an epidemic of opioid abuse and overdose.”
Nearly half a million emergency room visits in 2009 were due to people misusing or abusing prescription painkillers, according to CDC statistics. The quantity of prescription painkillers sold to pharmacies, hospitals and doctors’ offices was four times larger in 2010 than in 1999.
Among the WCRI study’s findings:
*Narcotics were given frequently to injured workers for pain relief. More than 75 percent who had more than seven days of lost time, but did not have surgery, received these narcotics.
*Drug testing and screening were used less frequently than recommended by medical treatment guidelines. Drug screening prior to opioid therapy for signs of drug use, and drug testing during therapy for misuse of narcotics and other drug and alcohol abuse, are recommended during treatment for high-risk cases. Patients with a history of drug or alcohol abuse are less likely to benefit from opioid treatment, according to the WCRI. Among claims with longer-term use of narcotics, 18 percent to 30 percent received drug testing in most states studied, with the 21-state median at 24 percent.
*There was low use of psychological evaluation and treatment services. Only 4-7 percent of the injured workers with long-term narcotics use received these services in the median state. In the state with the highest use of these services, only one in four injured workers with long-term narcotic use had a psychological evaluation and one in six received psychological treatment.
Positive Results from Massachusetts
The report did find that the percentage of injured workers in Massachusetts with long-term use of opioids decreased from 11 percent to 7 percent during the time period studied. This was due to certain regulatory changes in Massachusetts during those years, including a 2010 mandatory physician education program that required prescribers, as a condition of license renewal, to receive training in effective pain management and identification of patients at high risk of abuse. Massachusetts also launched a database aimed at stopping patients from doctor-shopping for highly addictive pain medications. Doctors are required to enroll in and monitor the database, which allows providers to see whether a patient has received other narcotics prescriptions in the past year.
Roy Maurer is an online editor/manager for SHRM.
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