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The Florida-based ratemaking and research organization has issued new data on the use of narcotics in the workers' comp system. It shows several continuing trends about the use and misuse of prescription medications.

"Although early use of narcotics is not a sign of continued narcotics use, early use of narcotics with high morphine equivalent amounts -- or a lot of narcotics -- is indicative," said Barry Lipton, NCCI practice leader and senior actuary. "Based on people who initially got large doses, after 12 quarters 15 percent [of them] are still on narcotics. It sort of levels out, but it doesn't really go to zero."

Major findings. NCCI defined narcotics as those listed in the International Narcotics Control Board's List of Narcotic Drugs under International Control, 49th edition. It includes hydrocodone BIT/acetaminophen, a schedule III drug, but excludes weaker narcotics such as Tramadol.

NCCI's previous research, Workers' Compensation Prescription Drug Study: 2011 Update, revealed the relatively expensive narcotic OxyContin as the most prescribed workers' comp drug in service year 2009, moving up from the number three spot in the previous year. Use of the less expensive generic time release version of the drug has shrunk due to the reassertion of patent right for OxyContin, Lipton explained.

Attempts to reduce the costs of expensive medications may be leading to narcotics abuse in the case of one drug. A generic alternative to the medication Actiq has raised concerns and prompted an alert by the Food and Drug Administration.

"The people who make it came out with Fentora," Lipton said. "It's stronger than Actiq. There have been overdoses because they are not cutting back."

While it has the same active ingredient as Actiq, the FDA's alert noted serious side effects -- including death -- associated with its use due to misunderstanding of dosing instructions or inappropriate substitution of Fentora for Actiq. "Conversion to Fentora must include a dose reduction," NCCI reported.

Market share of Actiq decreased almost entirely from 2005 to 2009. Fentora has taken over about half the market while the generic fentanyl citrate has taken the rest.

The study also revealed:

• "The top 1 percent of narcotic users consume 40 percent of all narcotics," NCCI reported. The data shows the top 5 percent of users consume more than 70 percent, and the top 10 percent of narcotic users in the workers' comp system consume 80 percent of all narcotics.
• Per claim narcotics costs have increased. In 2001, the average cost per claim for narcotics was $18. It rose to $29 in 2005 and held relatively steady for the next several years, but increased to $35 in 2009.
• The share of medical claims receiving narcotics within one year after injury has increased. In 2001, 8 percent of medical claims received narcotics within one year following injury. By 2004 it was 11 percent, and by 2008 it was 13 percent.
• Narcotic use in workers' comp is highly concentrated by active ingredient. For example, hydrocodone BIT/acetaminophen is included in more than 20 percent of the narcotics prescribed in the workers' comp system. Other active ingredients that were dominantly present included oxycodone HCL, oxycodone HCL with acetaminophen, fentanyl, morphine sulphate, oxymorphone HCL, and fentanyl citrate.

Read more at the WorkersComp Forum homepage.

November 14, 2011

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