Guidelines for Prescribing Pain Meds for Workers' Compensation

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The top medication classes in workers' compensation are drastically different than group health.
The top medication classes in workers' compensation are drastically different than group health.

LAS VEGAS — As many as 10% to 20% of patients who enter the worker's compensation system due to physical trauma go on to develop chronic pain due to either progression of the injury or the initial injury being severe in nature.

Patients who require long-term treatment may have started on typical medications, such as anti-inflammatory drugs and muscle relaxants, but in the long run these patients often have higher use of antidepressants, anticonvulsants, and long-acting opioids, according to Matthew P. Foster, PharmD, a senior clinical pharmacy manager with Helios. 

The most common injuries associated with the worker's compensation program include sprains, strains, burns, lacerations, and punctures, Dr. Foster explained, and some of these injuries go on to become chronic pain issues.

 

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“The top medication classes in workers' compensation are drastically different than group health,” Dr. Foster noted. For worker's compensation cases, opioids, anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, and muscle relaxants top the list of medications that are prescribed, whereas group health medications are more likely to include lipid regulators, antidepressants, beta-blockers, and antidiabetics.1

Currently, opioids are responsible for 30.9% of the total medication spend in workers' compensation. Overall, the top 10 therapeutic classes account for nearly 86% of the total spend, Dr. Foster noted.These prescribing trends can be influenced at least in part with the use of legal changes and treatment guidelines, he said.

One example of how prescriber behavior was influenced occurred when hydrocodone changed from a schedule III to a schedule II controlled substance.

“[Workmen's compensation patients] did see a drop in the number of prescriptions, but there was an increase in other medications, like oxycodone/APAP. Most disturbing was that the quantity per prescription of hydrocodone products went up by 15% to 20%,” Dr. Foster said. 

He noted that this most likely had to do with the physicians not being able to see their patients consistently every 4 weeks, and instead writing prescriptions for longer periods of time to hold patients over until their next visit. “This is one of the more troubling trends we're monitoring […] that there are more of these products being used based on the presumption that there will be a longer period of time in between refills.” 

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