By: The Workers' Compensation Team
Long-term opioid abuse has become a front page issue throughout the country, as doctors, claimants, insurance companies, and employers struggle with the drastic increase in opioid prescriptions in recent years and the potentially disastrous effects of these medications. A quick glance at recent statistics is alarming, as there have been 4,400 deaths in Virginia linked to opioids since 2007.
Nationwide, the Centers for Disease Control and Prevention (CDC) reports that there were 259 million prescriptions written for opioids in 2012, which was more than enough to give every American adult their own bottle of pills. This rise in the frequency and quantity of prescriptions is often traced back to a rise in the use of opioids in the 1990s, as pain became the fifth vital sign to treat. Around this time, pharmaceutical companies focused their efforts on these drugs for an underserved patient population and the pain management specialty grew in the United States.
With more recent focus on the potentially negative outcomes of long-term opioid use, the country has seen changes from the federal and administrative levels down to the state level. Recently the CDC issued new Pharmaceutical Drug Guidelines, recommending shorter durations for opioid use, more patient oversight by physicians, and non-opioid alternatives. Additionally, there have been several recent legislative changes in Virginia, such as a required Prescription Monitoring Program and mandatory continuing education regarding opioids for physicians. Although these legislatives changes affect doctors and patients throughout Virginia, there have not yet been any recent legislative or policy changes that affect workers’ compensation claims specifically in Virginia.
It is imperative, however, that long-term opioid use is appropriately monitored and addressed in workers’ compensation claims, as studies have shown that, in general, the higher the dose level of opioids prescribed, the worse the outcome. As many claims professionals have likely experienced, more opioids tend to equate to higher cost claims, more time out of work, and more litigation in the long term.
Accordingly, the following are some recommended tips in dealing with opioid use in workers’ compensation claims in Virginia. These tips are particularly important in monitoring claims with high dosage opioid use where there is no surgical indication and/or where opioids are used for chronic pain complaints.
- Ensure you are receiving up-to-date medical records from the claimant’s providers, which is the employer/carrier’s right pursuant to Va. Code § 65.2-604. This will allow you to monitor opioid use by the claimant and determine if multiple providers are writing prescriptions for the claimant.
- If a treating physician appears to be contributing to a cycle of opioid abuse, consider an Independent Medical Examination (IME) and/or a records review by another physician. If you are able to secure a contrary medical opinion that there is an alternative treatment plan that would improve the claimant’s chronic pain condition, the Commission may rule in favor of that.
- Consider scheduling a teleconference with the physician or a face-to-face meeting between the physician and the nurse case manager to address any concerns regarding the use of opioids in the claim.
- If the physician is unwilling to address these concerns, consider deposing the physician and coupling that with an IME to position the claim to request a change in treating physician.
Often these types of claims require a multifaceted approach to successfully addressing long-term opioid use. Although the Virginia Workers’ Compensation Commission does not presently have any guidelines or policies aimed specifically at opioid use in Virginia, employers and carriers may still attempt to seek a remedy through the Commission in claims involving opioid use that is not reasonable, necessary, or related to the injury.
