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Winter 2019   Volume 29, Number 1        

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Opioid Update:

There is progress in efforts to reduce opioid use in workers, despite the hurdles.

Opioid Prescriptions for Workers Down 6 percent

Overall, the use of opioids in prescriptions for injured workers dropped from 51.3 percent in January to 45.3 percent in June, a drop of 6 percent, according to the database maintained by Optum, a pharmacy benefits management firm.

In addition, the total amount of workers comp dollars spent on opioids dropped from 28.6 percent to 25.4 percent in the first six months of 2018, according to the report. Opioids as a percentage of total prescriptions also dipped from 29.8 percent to 27.3 percent, the report states.

Alternative therapies such as acupuncture, as we reported in this issue's "This Just In" article, are helping. So are topical creams to some extent. Still, challenges remain.

Use of Topical Creams Results in Significant Opioid Use Reduction

The benefit of topical creams has been considered problematic in the past, according to some experts. Many complained that a 2010 analysis published in the Journal of Pain Research had sample sizes that were too small and that among the control groups there had not been a systematic review of every drug class, which made it difficult to assess how well the creams worked.

In a new study though, use of topical creams after three- and six-month periods were reported to produce significant results in reducing opioid use among a group of chronic pain sufferers, according to a study published in the medical journal Postgraduate Medicine in January 2018: "Reduction of Opioid Use and Improvement in Chronic Pain in Opioid-Experienced Patients after Topical Analgesic Treatment: An Exploratory Analysis."

Almost half of patients (49 percent) in the three-month group and over half (56 percent) in the six-month group reported they completely discontinued their opioid use. More than half of those who discontinued opioid use said they were no longer taking any pain medication.

The only problem with topical creams is the cost in some instances, according to critics. While over-the-counter creams like Bengay and Icy Hot are inexpensive, their prescription counterparts can cost patients $1000 to $5000, depending on how much the insurers are willing to pay.

Another problem with topical creams is that some states have implemented formularies to restrict compound medications, according to Ben Roberts, vice president of compliance at Wayne, Pennsylvania-based managed care services company Genex Services L.L.C, when interviewed by Business Insurance. Plus, says Roberts, compound drugs are not approved by the U.S. Food and Drug Administration.

Still, the January 2018 Postgraduate Medicine study is good news for the campaign to reduce opioid use.

OSHA Seen Working Against Employers in the Battle against Opioids

The workers comp community is well aware of the lethal effects of opioid pain relievers and employers, workers' comp professionals, physicians and even patients themselves have been taking steps to reduce their use. However, many in the community complain that the U.S. Occupational Safety and Health Administration is hamstringing efforts to further reduce use.

OSHA's electronic record-keeping rule still discourages employers from mandating post-incident drug testing. OSHA is concerned that employers will use drug-testing as a way to retaliate against employees who report an injury or illness.

"Employers have really struggled with that because there's so much drug use in the workplace," said Fiona W. Ong, a partner with Shawe Rosenthal L.L.P. in Baltimore, to Business Insurance. "I know of one employer who said, 'I don't care what OSHA says because when we do the post-accident testing, 90 percent of our people are coming up positive, so we're going to continue to test.' And they may be able to argue that before OSHA because they have such a high incidence of use … but who knows whether OSHA would agree."

"We know this drug crisis is invading the workplace, and yet OSHA is out there pushing rules that scare employers away from drug testing," said Eric Conn, founding partner of Washington-based Conn Maciel Carey L.L.P. "I could not write a more backwards safety and health policy if I tried."

If you have questions about your efforts to reduce workers comp drug dependency, please contact us.

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In this issue:

Risk Tip

Do You Need Professional Liability Insurance?

Opioid Update:

Marijuana Use Linked to Increased Car Crashes

What's a "Reasonable Accommodation"?



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