With a 127 percent increase in retail sales of opioids from 1997 to 2007, researchers set out to examine the dose and costs of opioids in the workers' comp system. Their findings, published in the Journal of Occupational and Environmental Medicine, lend further support to the need to address the issue.
The data. The authors looked at claim and prescription data from the Louisiana Workers' Compensation Corp., a private insurer that writes workers' comp for nearly one-third of the state. Of the claimants included, 1,642 were treated for chronic pain and 691 for acute pain. Chronic pain was defined as pain that lasts longer than three to six months and/or persists beyond the normal time for tissue healing.
While the use of opioids in the workers' comp system varies from state to state, Louisiana had the second highest average annual cumulative dose of the medications prescribed for nonsurgical claims with more than seven days of lost time -- 3,513 mg of morphine per claim, from 1996 to 2002. Only New York was higher with 4,040 mg per claim. For most states, the average was between 1,000 and 2,000 mg, the authors said.
Findings. There was a significant cumulative yearly increase in morphine milligram equivalents prescribed for claims with acute pain as well as chronic pain, the study says. In addition to looking at the dose and cost of opioids for acute and chronic pain, the authors compared the use and cost of short-acting, or immediate release, and long-acting, or controlled release, opioids.
"What we found interesting was that the cost per MME for both long-acting and short-acting opioids was approximately the same -- $0.6 to $0.7," the report says. "Nevertheless, the expense for claims utilizing long-acting medications was eight times higher . . . than claims involving only short-acting medications in treating what we defined as chronic pain. This suggests that once a decision has been made to utilize long-acting medications, the annual cumulative dose of opioids prescribed increases dramatically."
Despite the apparent increased volume in long-acting opioids to treat chronic pain patients, the authors cited a lack of evidence suggesting its effectiveness. "The increases in the annual cumulative dose of opioids used and the reliance on long-acting opioids to treat chronic pain takes place despite the evidence that their use does not decrease pain nor increase function for injured workers," the research says. "In fact, in workers' comp claimants prescribed opioids, there is an increased risk of delayed return to work."
Possible solution. A preferred drug list adopted by the LWCC may be part of the answer to increased opioids use in the workers' comp system, the authors suggest. Adopted in 2004 to guide medical providers on using opioids and other medications, the PDL has apparently affected the dose and types of opioids prescribed.
"The PDL undoubtedly constrained long-acting opioid use as evidenced by a sharp reduction in cumulative MMEs of long-acting opioids between 2004 and 2006," the study says. "After the PDL was adopted, there was a significant decrease in the amount paid per MME for short-acting opioids, presumably because more generic medications were used after its adoption."
The authors said stakeholders should look more closely at chronic pain patients who are prescribed long-acting opioids. "We found that the annual cumulative dose of opioids to treat acute pain averaged around 14 MMEs, whereas the use of long-acting opioids to treat chronic pain averaged approximately 110 MMEs. It seems that special vigilance should be directed at these individuals because the potential for overdose is significant among individuals at these high dosage levels, with an 8.9 odds ratio of overdose for individuals prescribed 100 mg opioids or more daily."
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March 1, 2012
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