This is a very interesting article from Yesterday's Columbus Dispatch. The Ohio Bureau of Workers' Compensation wants to be the first in the nation to put guidelines for prescribing opiods into the state administrative code. The hope is that such action will reduce opioid dependency by reducing and regulating the Bureau's role in prescribing such prescriptions. Follow the link above or read below. D&M.
The numbers were stunning, even to those who already knew that scores of injured workers were being prescribed potentially dangerous amounts of painkillers.
More than 9,300 workers — nearly 20 percent of claimants receiving medication paid for by the Ohio Bureau of Workers’ Compensation — had prescriptions sufficient to render them physically dependent on opioids.
At least 60 workers were at doses equivalent to 200 Vicodin tablets a day.
“We had to draw a line in the sand,” said John Hanna, the bureau’s pharmacy program director. “ Injured workers do not go back to work when they’re medicated into a stupor. They don’t go back when they’re dead.”
That and other alarming data, gathered as the nation sank deeper into an opioid medication crisis, prompted the bureau to create a pharmacy management program that includes a closed formulary for prescription drugs. Since it was implemented in 2011, total opioid doses for injured workers have declined by 41 percent, and the average daily opioid load per injured worker in 2015 was below the 2003 level, officials say.
The number of workers considered to be opioid dependent based on their prescriptions (the equivalent of at least 12 tablets of 5 milligrams of Vicodin per day for 60 days) has dropped from 9,343 in 2011 to 4,723, Hanna said.
“Part of that is attributable to the formulary; part of that is education,” he said.
Ohio and Washington are the only states that have a closed formulary, which essentially means that there is a list of permitted drugs and dosages for workers’ comp cases. Taxpayers also have saved millions of dollars, although Hanna said the motivation for Ohio’s tightened policies is clinical, not fiscal.
The Ohio bureau wants to go further, becoming the first in the nation to put guidelines for prescribing opioids and rules for workers’ comp cases into the state administrative code. In addition to requiring doctors to develop a treatment plan, monitor it and document whether the worker is improving, the proposed administrative rules also would include guidelines and assurances for weaning injured workers off opioids.
“I don’t know of any other place in the nation that has a rule that says, ‘We’ll pay for your treatment for 18 months,’” Hanna said. “We’ll pay for counseling.”
Pain-management specialist Dr. Kort Gronbach of Mount Carmel Health, who serves on the bureau’s pharmacy and therapeutics committee, praised the efforts. “Everyone on the committee is trying to do the best thing for injured workers,” he said.
The challenge is to make sure the pendulum doesn’t swing too far for chronic-pain patients with debilitating conditions, some of whom can no longer find doctors willing to manage their care, Gronbach said. Some doctors have even posted signs at their offices saying they don’t take pain patients.
“It’s as sad as I’ve ever seen it,” Gronbach said. “It’s been so vilified that my patients, on a daily basis, come in crying.”
One of the trickiest sections in the proposed administrative rule focuses on the “clinically meaningful improvement in function” that must be documented to justify keeping a worker on opioids for many weeks after the injury or surgery.
“Nobody can measure pain,” Gronbach said. “We don’t have a tool for that.”
Still, bureau officials and others say, there is little doubt that liberal prescribing of drugs once largely reserved for cancer, end-of-life or postoperative care has hindered the recoveries of untold numbers of workers in Ohio and elsewhere, resulting in dependence, addiction and fatal overdoses.
“I am 100 percent sure that opioids have contributed to long-term disability in the workers’ comp system,” said Dr. Gary Franklin, medical director at the Washington State Department of Labor & Industries. “People are losing their lives because we haven’t figured out how to take good care of people in pain.”
Franklin spoke during the bureau’s medical and health symposium last month, along with Dr. Jane Ballantyne, a pain expert at the University of Washington.
“The reason opiates don’t work very well long term is because of tolerance and dependence,” she said, so many patients don’t wind up with good pain relief anyway. “Probably 90 percent of pain that’s treated with opiates shouldn’t be.”
Dr. Stephen Woods, medical director for the Ohio Bureau of Workers’ Compensation, said officials have made the most progress curbing excessive prescribing during the acute phase of an injured workers’ case, or when injuries are relatively minor.
“What’s more challenging is the people who have been on opioids long term,” he said.
Hanna expects plenty of discussion as the proposal moves to the bureau’s board of directors and on to a bipartisan legislative panel for review. Officials are open to adjustments but committed to change.
“You’ll never mop your way out of it,” Hanna said, “if you don’t shut off the water.”
