Use of Schedule II narcotics decreases among California injured workers

It seems the recent attention on opioid abuse is paying off. A new study shows the use of these narcotics to treat pain among injured workers has dropped in the last year.

The California Workers' Compensation Institute looked at data from more than 9.2 million prescriptions dispensed in the state's workers' comp system from 2002 to 2011. The results show the lowest level of Schedule II prescriptions since 2007 and the first drop in 10 years.

CWCI researchers were among the first to note the increasing use of the opioids among injured workers several years ago. Their latest research suggests the increased effort by workers' comp payers and others is having an impact.

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"The recent decline in the use of Schedule II opioids was not associated with any significant or explicit changes in California workers' compensation legislation or regulations pertaining to the use of these medications," the research said. "This suggests that the reductions may be associated with increased public awareness of the dangers of Schedule II drugs, as well as enhanced medical management and pharmaceutical controls implemented by the payor and medical provider communities."

The researchers looked at the percentage of California workers' comp prescriptions and prescription payments that were Schedule II and Schedule III opioids. The percentage of Schedule II prescriptions increased steadily beginning in 2002 from 1.2 percent through the second quarter of 2010 to 5.8 percent. It dropped after that from 5.2 percent to 3.8 percent from the second to third quarter of 2011, then to a low of 3.4 percent in the fourth quarter of 2011.

As a percentage of payments, Schedule II opioids represented 19.7 percent in the second quarter of 2010 and dropped to 11.3 percent in the third quarter of 2011. It went up slightly -- to 12 percent in the fourth quarter of 2011.

Oxycodone made up more than half the Schedule II opioids dispensed in the workers' comp system in the past 10 years and accounted for nearly half of all dollars spent for Schedule II opioids. Fentanyl ranked second in terms of payments and accounted for 29 percent of reimbursements -- "a disproportionate share given that it represents only 14.2 percent of the Schedule II opioid scripts, which reflects the high average cost of these prescriptions," the study said. "Morphine ranked third in terms of Schedule II opioid expenditures, accounting for 13 percent of the total dollars paid for these drugs, followed by Oxymorphone with 6 percent of the total opioid expenditures, also a disproportionate share of the payments due to a relatively high average cost per prescription."

In contrast, Schedule III opioids as a percentage of workers' comp prescriptions and prescription payments was relatively steady throughout the study period at about 20 percent. Schedule III opioids have less potential for abuse or addiction than Schedule II opioids. The overwhelming Schedule III drug category was hydrocodone with acetaminophen, available as Vicodin, Lortab, and Norco.

Read more at the WorkersComp Forum homepage.

August 13, 2012

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