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By DAN REYNOLDS, senior editor of Risk & Insurance®

The challenges are clear and the discussion was passionate.

With Mark Walls, assistant vice president for claims with St. Louis-based Safety National moderating, risk managers, brokers, carriers, consultants and regulators took on two of the industry's most nettlesome issues, co-morbidities and the epidemic use of narcotics.

And despite the vast breadth of the topic, from aging and overweight workers, to an American culture that is perhaps best described as sick in both body and mind, there was one concept that emerged free and clear from the discussion.

We need much more education in every facet of the workers' compensation cycle, from educating doctors about the distinct categories of pain, to educating workers about the power and danger of the pain-killing medications they now seek with such frequency.

Consider this dynamic, which was brought up Christina Preisig, the outspoken and opinionated senior vice president¿managed care, with Blue Bell, Pa.-based PMA Companies.

How can non-English speaking workers, injured and in pain, possibly know about the danger of addictive painkillers when they walk into a doctor's office, she said.

Preisig said companies might want to consider including pharmacy educational materials in their personnel and orientation materials. We might add that they should make sure they are available in translation.

Now consider that the vast majority of us, even those of us who speak and read English with some degree of proficiency, receive our education on medications from pharmaceutical company advertisements. We are not educated properly and our doctors, many of whom got through medical school with only one class in pharmacy, so the industry wisdom goes, are not educated enough either.

Mark Noonan, a Boston-based managing principal in the casualty practice with Integro Insurance Brokers, said our doctors in workers' compensation are not well educated on the distinctions between acute, subacute and chronic pain. In many cases, he said, they don't look beyond the short term in devising treatment plans. "They don't think beyond the 60-day window," Noonan said.

What's needed, Noonan and others said during this panel is an approach to pain treatment and management that considers the life and health of the patient in the long-term. Current "short-term" fixes like prescribing the powerful pain drug Actiq for a lower-back injury are anything but. Long-term addiction, and in many cases fatalities due to overdoses can result.

Karen Caterino, a risk manager with the state of Nevada, bemoaned the fact that the conference's host state now leads the nation in drug overdose deaths, and this is in a state where physician dispensation is not allowed. Caterino also said her state is using a drug formulary for prescription guidelines and wonders why more states and companies don't do the same, although many do.

In fact, overdose deaths from prescribed narcotics now outstrip deaths from cocaine and heroin, a chilling reminder of the degree to which this fast-moving menace has infected workers' compensation.

Ken Martino, the CEO of Crawford Co. subsidiary Broadspire, put it best. He pointed to the large-scale dysfunction in our culture. Obesity, drug addiction and the psychological problems that healthcare providers and workers' compensation claims administrators are fighting hard to contain may be beyond their control no matter how hard they work at it.

"We are a mess," Martino said. And nobody on the panel argued with him.

November 11, 2011

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