Drugging Injured Workers: Narcotics May be Impacting Your Claims Costs
 Sept. 9, 2011

Prescriptions are often written as a standard medical protocol when a physician treats an injured worker. The current concern among employers and carriers is not for the standard prescriptions issued under medical guidelines. The crisis in California and in the United States deals specifically with prescriptions being issued and filled for what are called Schedule II Narcotics. These drugs are listed in the Controlled Substances Act of 1970 and meet the following description: (A) The drug or other substances have a high potential for abuse. (B) The drug or other substances have currently accepted medical use in treatment in the United States, or currently accepted medical use with severe restrictions. (C) Abuse of the drug or other substances may lead to severe psychological or physical dependence.

The drugs are numerous but the names are familiar- Barbiturates, Opium, Oxycodone, Hydrocodone, Seconal, Dexedrine, Demerol, Cocaine, Morphine, Adderall, Oxicontin, pure Codeine, Amphetamines, Fentanyl, Percocet, Percodan, and Pentobarbital. These are not just drug names you hear on a T.V. show. According to a recent California Workers' Compensation Institute (CWCI) report, these drugs are being prescribed at an alarming rate and by a small number of physicians "with 3 percent of the prescribing physicians accounting for 55 percent of all Schedule II prescriptions, 62 percent of all morphine equivalents and 65 percent of all
associated payments in the study sample." (Alex Swedlow, 2011)

CWCI further states that, "Schedule II drugs have a high potential for abuse, have an accepted medical use with severe restrictions, and may cause severe psychological or physical dependence if abused."

Destructive and Harmful During an interview with Roberto Ceniceros for Business Insurance (Ceniceros, 2011)Dr. Bernice Peplowski, Medical Director for State Compensation Insurance Fund, states "there is a place for opioids, but that place is for acute severe pain for a brief period of time or end of life." These prescriptions were developed for cancer patients. The drugs have a specific place in treatment therapy for acute pain." Dr. Peplowski goes on to elaborate that, "other than that, they can be destructive and harmful."

The CWCI’s research found that these drugs had, "supplanted illicit drugs as the leading cause of drug-related overdose deaths." The concern with the overprescribing of these narcotics has driven Florida to begin a statewide crack down on "pill mills" and creating laws forcing pain clinics to limit the access to painkillers such as those listed.

Claims Impact
In addition to increasing the cost of a claim based on the prescription expense (Schedule II narcotics have increased 64% to nearly $280 per prescription according to the CWCI) the use of these extremely strong drugs can also delay recovery. Research shows that the use of these opioid cases was "associated with delayed recovery, escalating medical costs and an increased likelihood of litigation." Certain narcotics are so addictive that detoxification and rehabilitation from the drug may now become part of the claim. Other narcotics were developed with a delivery system that contains a high level of sugar to make the taste palatable and to speed up the delivery by dosing sublingual. The sugar in these drugs could cause dental issues, which now also become part of the original claim.

What Can You Do?
Stay in contact with your employee and work with your insurance carrier to keep the employee working, even if it is for modified or transitional work. Keep this in mind: the use of these drugs increase with the claim’s age and those drugs have a high potential for addiction and abuse- all of which directly affect your claim’s cost.

CompWest Insurance Company is a specialty provider of workers’ compensation insurance to small and medium-sized businesses in the Western United States. For more information, please visit http://www.compwestinsurance.com

Alex Swedlow, M. J. (2011, March 08). Prescribing Patterns of Schedule II Opioids in California Workers' Compensation. Retrieved July 2011, from California Workers' Compensation Institute: http://www.cwci.org/

American College of Occupational and Environmental Medicine. (2011, July). American College of Occupational and Environmental Medicine (ACOEM). Retrieved July 2011, from www.acoem.org

Ceniceros, R. (2011, July 25). Drugs increase employer pain. Business Insurance , pp. 1,18 .

Controlled Substances Act. (1970). Regulatory Information. Retrieved July 2011, from FDA U.S. Food and Drug Administration: http://www.fda.gov/regulatoryinformation/ legislation/ucm148726.htm

Department of Health and Human Services Office of the Inspector General. (2011, Feburary 02). Oversight of the Prescriber Identifier Field in Prescription Drug Event Data for Schedule II Drugs. Retrieved July 2011, from Department of Health and Human Services Office of the Inspector General: http://oig.hhs.gov/


Latest Articles
CompCheck Newsletter