Techniques to Control Run-Away Cost of Narcotics in Workers Comp

All insurers and self-insured employers deal with the long-term medical treatment claims where the injured employees become addicted to one or more narcotics. Narcotics, which are opium based and are excellent for treating pain in the short run, have two problems. First, the human body adjusts to the medication, and in order to continue to obtain the same level of pain relief, the amount of the medication must be increased. Second, narcotics are highly addictive, and the injured employee can go through both physical and psychological withdrawal symptoms when the narcotics are taken away.
Employee Focus Can Shift From Recovery to Obtaining Narcotics
Unfortunately, often the injured employee’s focus shifts from recovering from their injury to obtaining their favorite narcotic(s). The injury, while real, becomes the excuse for obtaining the narcotic. Unless the employee has a very high ethical standard, the level of pain associated with an injury becomes overstated. As pain cannot be measured, the treating physician is relying on the honesty of the employee to determine the need for narcotics to manage the pain.
Also, for the employee with low ethical standards, narcotics become a source of income. Many narcotics prescribed for workers’ compensation injuries are resold by the injured employee. The illicit trade in prescription drugs is a huge problem for law enforcement throughout the country.
There are several techniques insurers and self-insured employers can used to attempt to control, if not stop, the run-away cost of narcotics. 
Techniques to Control Run-Away Cost of Narcotics:
  • Require the physician treating the employee to complete a urine toxicology drug screen at each office visit


  • If the prescribed medication(s) is not in the injured employee’s system, the further replacement of the medication should be stopped


  • If the prescribed medication(s) is in the injured employee’s system, but at a lower level then it should be, the dosage and/or frequency of the prescribed medication should be reduced accordingly


  • If the drug screen included cannabis or other illicit drugs, all narcotics should be stopped, if state law permits


  • Often there is a less expensive narcotic that provides the same level of pain relief to which the injured employee can be switched, for example from oxycodone to tramadol


  • Generic versions are available for many name brand narcotics


  • A request should be made to the nurse case manager to discuss with the medical provider the switching of the claimant from his/her favorite narcotic(s) to an opiate agonist. An opiate agonist is a drug that causes the receptors in the brain to feel the effects of a narcotic, even though the effect isn’t actually occurring.


  • If the medical provider has also been dispensing the drugs to the injured employee, a letter should be sent to the employee, employee’s attorney and the doctor advising all medications will be provided by the pharmacy benefit managing company through the pharmacy benefit card provided to the employee. This accomplishes two things, it removes the incentive for the doctor to over prescribe, and it prevents the employee from self choosing the pharmacies to obtain duplicate prescription refills.


  • A list of medications prescribed along with the dosage amount of each medication prescribed for the injury should be obtained from the medical provider. This list of medications should be provided to the pharmacy benefit management company with instructions to not provide any other medications or higher amounts than the prescribed dosages.


  • If the medical provider is indifferent to controlling the employee’s narcotics addiction, a drug utilization review to verify the adequacy and accuracy of the medications being prescribed should be completed.


  • A senior nurse reviewer can be utilized to constantly oversee and manage the drugs prescribed to an injured employee.
For more information on fighting narcotics addiction, or to obtain a referral to a drug utilization review company or to a nurse case manager, please contact us.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%.

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. Contact:
©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.  

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional about workers comp issues.

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