Washington state reduces time allowed for unauthorized scripts
The Guideline for Prescribing Opioids to Treat Pain in Injured Workers was developed in conjunction with practicing physicians who specialize in treating injured workers and in pain management. It is part of an ongoing effort.
After six weeks, L&I insurance coverage for opioids will depend on doctors' use of best practices, the department said in a statement. Included are monitoring whether workers are recovering their ability to perform normal activities and screening for side effects or addiction.
"These changes will improve pain treatment for injured workers as well as their safety during recovery," said Jaymie Mai, L&I pharmacy director. "For some doctors, measuring function and screening for risk may be new practices."
The new guideline includes:
- Continuing to prescribe opioids in the absence of clinically meaningful improvement in function or after the development of a severe adverse outcome is not proper and necessary care in the Washington state workers' compensation system.
- Chronic opioid therapy should not be prescribed in the presence of current substance use disorder (excluding nicotine) and cautiously if there is past substance use disorder.
- The department or insurer will cover opioids for up to six weeks when prescribed to treat acute injury or after surgery.
- Use of chronic opioid therapy requires regular monitoring and documentation such as screening for risk of comorbid conditions with validated tools, checking the Prescription Monitoring Program database, assessing clinically meaningful improvement in function, and administering random urine drug tests.
- Workers on chronic opioid therapy who are undergoing elective surgery are more likely to encounter difficulty with post-op pain control. Physicians should develop a coordinated pain management plan, including opioid taper after surgery and discuss expectations with the worker, avoid escalating opioid dose, and not prescribe long-acting or extended-release opioids for post-op pain.
By Nancy Grover
Read more at the WorkersComp Forum homepage.
October 7, 2013
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