WCRI hosted a webinar yesterday to discuss WCRI’s latest research into long term users of opioids, policy options and recommendations. The event topped the list of best-attended webinars – the problems associated with opioids and potential solutions thereto is a critical issue facing all workers’ comp payers.
Dr Dongchun Wang started with a review of WCRI’s new information – with a focus on longer-term usage – lost time, musculoskeletal-related injuries without surgery who received opioids more than 6 months after injury. Here are a few of Dr Wang’s highlights:
- In Louisiana, one in six claimants who received opioids early on were long term users, in other states it is one in ten.
- The use of other treatment modalities in conjunction with opioids was quite low – 24% of claimants from 2009 – 2011 were receiving drug testing – ten points higher than the two previous years – whoever range was from 18% – 30%.
- This was far better than psych evals – which were in the mid-single digits. Very few claimants are evaluated on the front end for psych issues, or get psych treatment.
Dr Kathryn Mueller followed up with a discussion of the global pain problem and attendant issues with opioid over-prescribing and abuse. Claimant MEDs (morphine equivalent dosage) varied by a factor of four across the study states. This despite consistent guidance from all sources recommending limited use of opioids. ACOEM calls for limiting opioids to 3-10 days while all guidelines re CNCP (chronic non-cancer pain) essentially include the same treatment for pain – limited opioids, use of NSAIDs, manage not end pain, use CBT (cognitive behavioral therapy, 6-10 visits typically). Opioid therapy is a very small part of pain therapy, which should also require documentation of functional improvement and change. Dr Mueller also:
- recommended accessing PDMsP.
- recommended including weaning language in all opioid agreements.
- noted there are no studies that show long acting opioids are preferred or have better outcomes than short acting – and no evidence for or against a specific drug.
- noted CO has a drug monitoring payment code to encourage payment for physicians managing opioids
- said re urine drug monitoring, that physicians need confirmatory testing of metabolites and not just in-office screening
Dr Dean Hashimoto finished up; we will review his comments in a later post.