Tag Archives: Opioids

Opioids And Doctor Choice

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

Chicago Mayor Rahm Emmanuel said in 2008 that “You never let a serious crisis go to waste.” In the context of opioids and workers compensation this could mean reforms to workers compensation systems beyond drug formularies If solving the opioid crisis means limiting the number of doctors who can prescribe opioids, then there will be fewer doctors who will treat workers compensation cases.

Additional licensure and certifications aren’t unheard of in the world of occupational health. In 2016, the Federal Motor Carrier Safety Administration implemented a new rule that only doctors on their registry can perform DOT Physical Examinations for truckers and other professional drivers. This reduced the number of doctors who can perform those examinations. 

When I testified on LB 408, a bill that would have implemented drug formularies for opioids under the Nebraska Workers’ Compensation Act, some doctors were testifying that there was little training in regards to prescribing opioids. Though an opioid prescription registry like the DOT examination registry wasn’t proposed, you could certainly see it proposed as a solution to the opioid problem.

By limiting the numbers of doctor who handle workers’ compensation claims through additional licensing requirements, injured employees will have fewer choices for medical treatment and are more likely to have their employer control their care.

Evidence shows that the workers compensation system has made some contribution to the opioid crisis. According to a 2015 report by the Bureau of Labor Statistics over 3.5 million employees were injured at work. Half of those injuries required the employee to miss sometime from work. A study of employees in 25 states done by the Workers Compensation Research Institute revealed that 55 to 85 percent of employees who missed at least one week of work were prescribed at least one opioid prescription.

When I testified on LB 408 the consensus among the doctors testifying on the legislation was that injured workers were more vulnerable to narcotic addiction than other patients who are prescribed narcotic pain medication. Scientific studies give some credence to these conclusions. Workers compensation claims can cause economic insecurity. According to an article in Scientific America, Addiction rates for opioids are 3.4 times higher for those with incomes under $20,000 per year than they are for employees making more than 50,000 per year.

But that article also shared studies that state that pain pill prescriptions are not driving the opioid epidemic. Patients with pre-existing addiction issues are more likely to become addicted to opioids and 75 percent of those who develop opioids start taking opioids in a non-prescribed manner. Furthermore, only 12 to 13 percent of ER patients who are treated for opioid overdoses are chronic pain patients.

Workers’ Compensation is traditionally an area of the law that is controlled by the states. Regulation of drugs is generally an area reserved for the federal government. Any laws imposing additional hurdles or requirements upon doctors who prescribe opioid drugs may have to come from the federal government.

New York Times: C.D.C. Painkiller Guidelines Aim to Reduce Addiction Risk

The following is an exerpt from a New York Times article by Sabrina Tavernise publised on March 15, 2016.

New C.D.C. guidelines on opioids like Percocet are likely to have sweeping effects on the practice of medicine.

In an effort to curb what many consider the worst public health drug crisis in decades, the federal government on Tuesday published the first national standards for prescription painkillers, recommending that doctors try pain relievers like ibuprofen before prescribing the highly addictive pills, and that they give most patients only a few days’ supply.

The release of the new guidelines by the Centers for Disease Control and Prevention ends months of arguments with pain doctors and drug industry groups, which had bitterly opposed the recommendations on the grounds that they would create unfair hurdles for patients who legitimately have long-term pain.

In the end, the agency softened the recommendations slightly but basically held its ground, a testament to how alarmed policy makers have become over the mounting overdoses and deaths from opioid addiction. Opioid deaths — including from heroin, which some people turn to after starting with prescription painkillers — reached a record28,647 in 2014, according to the most recent federal statistics.

Kit Case, Causey Wright's Paralegal & Media Manager

Doctors, Patients and Opioid Abuse

Today’s post comes from guest author Jon Gelman from Jon Gelman, LLC – Attorney at Law.

Getting to the real reasons why doctors prescribe opioids to opioid abusers is an apparent challenge to the essence of the nation’s workers’ compensation system. In a recent article in the New England Journal of Medicine it is revealed that doctors continue to prescribe opioids to abusers because of “…Recent changes in medicine’s philosophy of pain treatment, cultural trends in Americans’ attitudes toward suffering, and financial disincentives for treating addiction …”

Until the workers’ compensation medical delivery program furnishes treatment delivery in an effective and efficient manner the challenge of drug addiction will tragically continue.

More about drug addiction
Jul 27, 2012
Pharmaceutical reform has been a major topic of interest and reform efforts nationally in the workers’ compensation arena. More particularly the alledged abuse of opioids have received particular attention. Several physicians …
May 24, 2012
A recent Texas case holding an employer liable holding an employed liable for a fatal opioid overdose arising out of work-related event highlights again that, the workers’ compensation medical delivery system just isn’t …
Jan 28, 2012
Nursing Home Abuse: Drugging of Patients. Many seriously injured workers end up living in nursing homes for convenience and care. Workers compensation act usual pay for nursing home care, but do they really know what …
Oct 28, 2009
The Wall Street Journal reports today about a claim against pharmacies as a result of customer drug abuse. In the State of Nevada a case is pending that may confer liability upon a drugstore for the consequences of an …