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Debate Rages Over Use of Fentanyl for Pain Relief Among Injured Workers
The agency that administers the workers' comp program for federal employees has issued a new policy to monitor and manage the use of the narcotic fentanyl. According to at least one expert, it represents a rare, and perhaps the only, time the agency has taken such an intense interest in medical treatment for reasons other than financial costs.
The federal government's interest in the use of fentanyl to treat injured workers coincides with a recent report on the use of the drug to treat claimants in the California workers' comp system. It also calls into question whether and how far government authorities should intercede in regulating medical decisions in workers' comp systems. "The National Institute on Drug Abuse identified fentanyl, an extremely potent narcotic, as an emerging drug of abuse with multiple deaths reported annually due to its abuse." Thus began a bulletin from the Department of Labor's Office of Workers' Compensation Programs.
"What the DOL is doing, and I think rather arbitrarily, is telling physicians ... how to practice medicine," said Gordon Reiselt, an attorney who represents claimants in the federal workers' comp system. "I think the DOL is crossing a boundary." Reiselt compares the OWCP action to the dosing guidelines implemented in Washington state several years ago. He says the result in Washington has been fewer physicians willing to prescribe opioids to avoid being inspected and monitored by state authorities. "I don't think they're protecting anybody," Reiselt said. "I think they are trying to scare the physicians into backing off. It will scare them. It will hurt a lot of people." Reiselt said he received a letter from a treating physician who had been contacted about his prescribed use of fast-acting fentanyl for a claimant. In it, the physician says studies show the drug works extremely well for individuals suffering from non-cancer-related breakthrough pain, and he notes that the Food and Drug Administration is considering its use for non-cancer pain. "I would hope that you would consider the use of a limited number of this medication for [the claimant] given that his injuries came in the service of his country, that this medicine is not being misused or abused by him," the letter states. "It is not being overprescribed and it is an incredibly effective medication for this gentleman." Whether the OWCP or any other regulating entity could be overstepping its bounds by clamping down on the use of specific medications is up for debate. Some observers say it's critical for authorities to take action to prevent what they believe is the out of control off-label use, misuse, and abuse of opioids in the workers' comp system. "My initial thought is, it's good. It's the OWCP being proactive," said Edward Daniel, a former OWCP official who now works with injured federal workers. "Let's impose another name: oxycodone. This was prescribed by physicians and it was addictive and people got hooked." Daniel says there are many medications that have been shown to be beneficial for conditions aside from those for which they were designed. He believes the OWCP is not trying to completely eliminate the use of fentanyl but merely seeking justification for its use. He also points out that OWCP said in its bulletin that it would pay for drug rehab for a claimant who became addicted to the drug. "OWCP has been notified by the NIDA that this is a narcotic that is very habit forming and they're not going to be a part of it unless the person meets the criteria," he said. "I look at this, and I say this is good. They're trying to be responsible instead of writing a blank check." Read more at the WorkersComp Forum homepage. June 13, 2011 Copyright 2011© LRP Publications |
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