Drug testing in workers comp – we need more, not less.

In the online edition of Risk and Insurance, fellow work comp consultant Maddy Bowling authored a piece focused on a rapidly growing segment of the work comp managed care industry – drug testing. Maddy’s a very experienced, and very knowledgeable work comp professional, and I completely agree with her main point – payers would do well to make sure they “connect the dots”.
That said, I have a somewhat different take re drug testing’s purpose and value.
To be clear, I’m referring to the use of urine screening for claimants prescribed narcotic opioids – the Schedule II drugs that are potentially addictive, at risk for diversion, often quite expensive, and not indicated for long-term use for musculo-skeletal ailments. (I’m NOT referring to pre-employment screening or testing post-accident.)
Maddy asks some highly relevant questions:
“aren’t our pharmacy benefit management (PBM) vendors identifying multiple prescribers, multiple prescriptions and potential drug interactions? Aren’t they identifying cases that require detailed drug reviews and possible peer intervention? Aren’t they identifying the top opioid prescribers in your book of business? Isn’t your PBM reviewing your out-of-network pharmacy bills to ensure that they have all the pharmacy information on every injured worker and taking action if anything seems inappropriate?”
All these are important, necessary, and should be part of your pharmacy management program.
But PBMs can’t do everything on their own, and neither can case managers. Maddy observes that on-site case managers can check bottles to see if drugs are being taken, ask about non-prescribed (illicit) drug seeking behavior, and ask the claimant specific questions about compliance. While I respect the ability of many field case managers, it is unlikely they will be able to consistently and accurately discriminate between truthful and less-than-truthful claimants.
Drug testing can provide quantitative evidence of compliance with drug treatment plans. It can also:
– identify illicit drugs in the claimant’s urine (thereby providing evidence of compliance with opioid agreements)
– identify claimants with genetic tendencies to rapidly (or otherwise ‘differently’ metabolize opioids (this from the Mayo Clinic “To optimize treatment for individual patients, clinicians must understand the variability in the ways different opioids are metabolized and be able to recognize the patient characteristics likely to influence opioid metabolism.”
Drug testing is also relatively cheap. We’re talking a few hundred dollars per test;
– equivalent to a few hours of case management,
– a relative bargain when compared to the cost of a couple months of OxyContin and many other opioids,
– and a screaming deal when compared to extended indemnity benefits, settlement costs, and MSAs.
I’m pretty familiar with the monitoring, alert, and management tools in the PBMs’ and payers’ armamentarium. And there’s no question most payers would do well to utilize more of those tools, to, in Maddy’s words, help ‘connect the dots’.
I’m also quite sure there’s far too little use of drug testing in workers comp.
It’s not just me. The State of Washington adopted strict guidelines for opioid prescribing (opens google doc), guidelines that include provisions for urine drug testing.
What does this mean for you?
The overuse and abuse of opioids in workers comp is a disaster – economically, financially, and socially. There’s also no question some individuals metabolize opioids differently. Drug testing can help physicians – and patients – better manage pain, while adding a level of certainty that subjective opinion…can’t.