The Opioid Epidemic

Frequent Opioid Abusers Rely On Prescriptions

New CDC findings on opioid abuse point to need for prescription curbs.
By: | March 6, 2014

The Centers for Disease Control just provided one more reason why workers’ compensation payers should maintain or implement claims-management practices that encourage physicians to limit inappropriate or unnecessary opioid prescribing.

According to new analysis, users who are at the highest risk of overdosing on the prescription narcotics — those who use opioids for nonmedical reasons at least 200 times a year — are likely to obtain them with a doctor’s prescription, the CDC reported March 3, 2014.

In contrast, most people who occasionally abuse the pain medications to get high, but are not at high risk for overdose, obtain them for free from a friend or relative.

CDC Director Tom Frieden, M.D.

CDC Director Tom Frieden, M.D.

“Many abusers of opioid pain relievers are going directly to doctors for their drugs,” CDC Director Tom Frieden, M.D., said in a statement. “Health care providers need to screen for abuse risk and prescribe judiciously by checking past records in state prescription drug monitoring programs.  It’s time we stop the source and treat the troubled.”

Public abuse-prevention efforts nationwide mostly have focused on those infrequent users who obtain the medications from friends or family for free, according to the CDC. Programs such as “take-back events” and other efforts to collect unused prescriptions have targeted preventing the lower-risk users from obtaining the drugs.

But the high-risk population also obtains the drugs through prescriptions.

“CDC’s new analysis shows that these highest risk users get opioids through their own prescriptions 27 percent of the time, as often as they get the drugs from friends or family for free or buy them from friends,” the agency said. “And they are about four times more likely than the average user to buy the drugs from a dealer or other stranger.”

The CDC’s conclusions follow from data collected for the years 2008 through 2011 from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health.

To prevent the misuse of opioids such as oxycodone and hydrocodone, state and federal initiatives have undertaken a number of measures, such as encouraging workers’ comp programs to identify improper patient use of opioids, according to the CDC.

To help stem the inappropriate use of addictive narcotics, workers’ comp payers have increasingly relied on practices such as pharmacy benefit manager programs that flag multiple opioid prescriptions and peer-to-peer discussions with prescribing physicians.

While the CDC advises that providers need to check state prescription drug monitoring programs, not all states have such measures in place and those that do vary in their enforcement.

With the opioid abuse problem gaining greater recognition, however, state lawmakers are taking up the cause.

A bill now before Arizona’s lawmakers, for example, would establish physician reporting requirements and preauthorization before providing opium-based narcotics to workers comp claimants.

The legislation mandates practices such as requirements for doctors to provide insurers or self-insured employers a treatment plan within five days when a claimant’s drug testing results reveals “inconsistent” use of the prescribed drugs.

Roberto Ceniceros is a retired senior editor of Risk & Insurance® and the former chair of the National Workers' Compensation and Disability Conference® & Expo. Read more of his columns and features.

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