Report reveals startling increase in painkiller overdose deaths

Deaths from overdoses of opioid pain relievers now exceed fatalities from heroin and cocaine combined, the government reports.

The latest statistics are further evidence of the need to address the growing problem of opioid abuse in the workers' comp system, including monitoring patients.

The Centers for Disease Control and Prevention reports nearly 15,000 deaths from overdoses of powerful painkillers in 2008 -- more than three times the number less than 10 years before. The drugs include many prescribed for injured workers, including OxyContin -- the number one prescribed drug in workers' comp, according to the latest research from NCCI.

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Ohio: Coordinated services program rule in the works (03/05/12)

Monitoring injured workers who are prescribed opioids is among the recommendations in many clinical guidelines, including those from the American College of Occupational and Environmental Medicine and the Official Disability Guidelines. One drug monitoring company says a large percentage of injured workers who are tested are likely to be noncompliant.

"We find 35 percent of our samples in workers' comp don't contain the drug the physician says is being prescribed," said Mitch Freeman, vice president of workers' comp sales for Ameritox, a drug monitoring company. "That's a huge discrepancy between what is perceived to be taken and what is [taken]. Additionally, almost 25 percent [of the tests] contain a narcotic that the treating physician is not indicating are being prescribed."

Ameritox, which has conducted more than 250,000 drug screenings nationwide in the workers' comp system over the past five years, initially started the screenings to help contain costs. Ultimately, they found it is not a unit problem.

"The focus was on what was being paid for by the payer," Freeman says, "and what we found out is that what the payer is paying for is not necessarily what is being taken by the claimant."

That can add up to large, unnecessary expenses in the workers' comp system, according to the company. It cited a recent study that found patients that were likely noncompliant had approximately 12 percent higher medical costs.

"There are a number of reasons; it's across the board," Freeman said. "It's not only pharmacy costs, but ER and physician visits."

Freeman says he was particularly surprised that more than a third of the drug monitoring tests Ameritox conducts show injured workers are not taking the painkiller prescribed. "I always felt there was some level of nonadherence in workers' comp. . . . I would not have guessed it to be that high."

Freeman said whatever the reason for injured workers failing to take the medication -- diversion, a patient's intolerance to the drug -- it still adds up to extra costs in the workers' comp system. That, plus the potential overuse of the painkillers have prompted payers to become more involved.

"Treating physicians do order monitoring on a regular basis," Freeman says. "But as these guidelines come out and payers are realizing how much of a problem it is, they are stepping in."

Read more at the WorkersComp Forum homepage.

December 1, 2011

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