By CYRIL TUOHY, managing editor of Risk & Insurance®
For years, doctors, pharmacists, pain-management specialists, workers' comp experts and third-party administrators have known about the narcotic epidemic afflicting the injured American worker.
Still, statistics released earlier this month from the Centers for Disease Control and Prevention came as a shocker. For the first time, overdose deaths involving narcotic pain relievers exceeded deaths involving heroin and cocaine combined.
"Prescription drugs are easier to buy than beer," said Gary Mills, director of the Pacifica Pain Management Service in St. Helena, Calif. More than 70 percent of the prescription drug abusers were getting their pills from friends and relatives, he said.
Mills spoke earlier this month during a session on prescription drug abuse during the 20th Annual National Workers' Compensation and Disability Conference® & Expo in Las Vegas.
The 36,450 drug overdose deaths in 2008 approached the 39,973 deaths from motor vehicle crashes as the leading cause of injury death in the United States, the authors of the report also said.
"The epidemic of overdoses of OPR (opioid pain relievers) has continued to worsen," the CDC said in a release. The numbers paint a sad, ugly tail of the addiction in the treatment of chronic pain and injury and the diversion of drugs meant to alleviate that pain.
In 2007, nearly 100 people per day died of drug overdoses in the United States, the CDC report revealed. The death rate of 11.8 per 100,000 people in 2007 was about three times the rate in 1991, and prescription drugs have accounted for most of the increase in those death rates since 1999, the CDC also said.
Of the 36,450 deaths attributed to drug overdoses in 2008, a drug was specified in 74.5 percent or 27,153 of the deaths, the CDC report found. One or more prescription drugs were involved in 73.8 percent or 20,044 of the 27,153 deaths, the report also found. Narcotic pain relievers were involved in 73.8 percent or 14,800 of the 20,044 deaths from prescription drug overdose, the CDC report said.
On the prescriber side of the equation, unethical doctors, sometimes operating out of their own offices or dispensing from chronic pain clinics, or "pill mills," are much too quick to prescribe powerful painkilling drugs to treat injured patients, said long-time workers' comp experts.
These doctors dispense narcotics with very little evaluation and follow up, and often do so because they make more money that way, according to many workers' comp and pain management experts.
Even so, very few doctors are responsible for the bulk of writing the prescriptions for narcotic pain relievers sold under brands like OxyContin and Lidoderm. Only 3 percent of doctors accounted for 62 percent of prescribed narcotic pain relievers, the CDC report found.
Dr. Gerald Pearlman, co-owner and medical director of Rx Cost Containment, said a relatively small number of doctors share responsibility for the opioid use epidemic. Pearlman made his comments during a telephone interview with Risk & Insurance® on Nov. 22. Rx Cost Containment develops cost-control programs for employers and insurers.
In California, an estimated 80 percent of prescription narcotics are prescribed by 5 percent to 7 percent of doctors, said Pearlman, who has been treating injured workers for the past 35 years.
On the user side, the statistics are just as skewed. The top 1 percent of prescription narcotics users consume 40 percent of all narcotics, said Barry Lipton, Agoura Hills, Calif.-based practice leader and senior actuary with the National Council on Compensation Insurance Inc.
Last year, 57 percent of all injured workers in the workers' comp system were receiving narcotics as part of their therapy, said Rx Cost Containment's Ellen L. Palm-Leis. That percentage, she said, is "alarmingly high." More stringent procedures around prescribing of narcotics is critical to tempering the opioid epidemic, she said.
As part of a crackdown on the dispensing of prescription narcotics, the California State Compensation Insurance Fund has required doctors get approval to dispense narcotics beyond 60 days, said Dr. Bernyce Peplowksi, medical director of the State Compensation Insurance Fund.
The fund is also sending warning letters to the physician and the patient after the first fill of the prescribed narcotic, and forcing doctors to discuss their prescription narcotic issues with other doctors, Peplowski said.
She spoke at the National Workers' Compensation and Disability Conference® & Expo detailing some of the fund's "multifunctional" responses to the prescription narcotic epidemic.
November 23, 2011
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