Opioid-based prescription medications have proven to have an adverse effect on the recovery and return to work following a work injury when not used correctly. These dangers include overdose, addiction, and a gateway to other more powerful legal and illegal substances. It has also reduced the capacity of employees to return to work following an injury and required claim teams to incur significant additional expenses on a claim’s medical and indemnity portion.
Changes in how opioid-based prescription medications have had a positive impact on results following a work injury. In some instances, it has resulted from claim teams battling treating doctors when these powerful prescription drugs are introduced as part of a treatment regimen. Recent studies demonstrate how these medications can be used effectively to provide pain relief and what needs to be done to reduce the chances of issues.
Avoiding the Prescription Drug Waterfall
In the recent past, powerful prescription drugs with an opioid-based composition were frequently used and approved to reduce pain levels experienced by injured employees. In addition to problems with addiction, members of the claim team ended up paying for other drugs when an opioid was introduced:
- Opioid-based prescription medication cause constipation. The result was drowsiness and constipation;
- Inclusion of a stimulant to counteract drowsiness. These drugs are added to the employee’s regimen to awaken the user. Other medications are often needed to counter the effects of constipation;
- Use of Ambien and sedative-hypnotics to battle insomnia. Prescribed stimulants reduce a person’s ability to sleep. A third medication was required to counter this side effect. Without sleep, an employee cannot recover from the injury; and
- The waterfall continues: Other medications are required to counter the side effects of drowsiness.
Absent addiction to opioid-based medications, their presence promoted the need for additional costly medications to counter one side effect after another. This translated into unnecessary costs on medical spending during the life of a claim.
Limited Use Opioid-Based Prescriptions Can Have Some Benefit
A recent study funded by the National Cancer Institute, the National Institutes of Health, and the Roswell Park Alliance Foundation highlighted how opioid-based prescription medications could benefit someone suffering from a work injury and outlined guidelines to ensure they are used in a directed manner. When done correctly, this can avoid problems associated with the prescription drug waterfall and other significant negatives such as addiction and accidental overdose.
Brief Limited Use – 3 Days or Less
The study reviewed that post-operative patients used opioid-based medication for three days or less. This included cancer treatment centers where extreme pain is often associated with invasive procedures following surgery. According to the survey results, limited use of opioid-based medications for a brief period “led to a significant reduction in opioids dispensed postoperatively and was associated with significantly decreased conversion to chronic opioid use in postsurgical patients.”
The results from this study highlight how these medications can be used in workers’ compensation claims that involve surgery:
- Limitations on the use of opioid-based medications prevent harmful side effects such as addiction, which tend to start after one week of use;
- Use of opioid-based medications immediately following surgery to avoid common side effects of long-term use, such as constipation, memory loss, and insomnia;
- Brief use of opioid-based prescriptions significantly reduces money spent on other medications that may not be as effective in pain relief. Allowing for faster recovery following surgery allows the injured employee to make quicker progress toward returning to work.
Now is the time to consider approval of opioid-based prescription medications on a short-term basis for claims that involve surgery. Care should always be used with safeguards to prevent addiction.
Common Red Flags of Opioid Prescription Abuse
Members of the claim team and other interested stakeholders should always be on the lookout for injured employees misusing opioid-based prescription medications. This should also include instances where such medications are not a part of the available treatment plan. Common red flags of abuse include:
- Use of pharmacies outside the employee’s immediate home location;
- Multiple pharmacy reimbursements that appear to be excessive;
- Instances where prescriptions are lost, stolen, or misplaced; and
- Inconsistent medication refill history or consistent early requirements for refills.
Never be afraid to ask questions regarding opioid-based prescription medications – but do so professionally and compassionately.
Opioid-based prescription medications should be of concern when introduced into a workers’ compensation claim. This is based on a sordid history that has caused death and pain and inflated the cost of claims. There is evidence they can benefit an injured employee following surgery, but they should be used with care. Interested stakeholders should examine their claim practices and determine how they can benefit an employee’s recovery and be used to reduce program costs.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is the founder & lead trainer of Amaxx Workers’ Comp Training Center, which offers the Certified Master of Workers’ Compensation national designation.
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