[Vision2020] Pain Pills Add Cost and Delays to Job Injuries

[Art Deco]

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June 2, 2012
Pain Pills Add Cost and Delays to Job Injuries By BARRY
MEIER<http://topics.nytimes.com/top/reference/timestopics/people/m/barry_meier/index.html>

Workplace insurers are accustomed to making billions of dollars in payments
each year, with the biggest sums going to employees hurt in major
accidents, like those mangled by machines or crushed in building collapses.

Now they are dealing with another big and fast-growing cost — payouts to
workers with routine injuries who have been treated with strong
painkillers, including many who do not return to work for months, if ever.

Workplace insurers spend an estimated $1.4 billion annually on narcotic
painkillers, or opioids. But they are also finding that the medications, if
used too early in treatment, too frequently or for too long, can drive up
associated disability payouts and medical expenses by delaying an
employee’s return to work.

Workers who received high doses of opioid painkillers to treat injuries
like back strain stayed out of work three times longer than those with
similar injuries who took lower doses, a 2008 study of claims by the
California Workers Compensation Institute found. When medical care and
disability payments are combined, the cost of a workplace injury is nine
times higher when a strong narcotic like OxyContin is used than when a
narcotic is not used, according to a 2010 analysis by Accident Fund
Holdings, an insurer that operates in 18 states.

“What we see is an association between the greater use of opioids and
delayed recovery from workplace injuries,” said Alex Swedlow, the head of
research at the California Workers Compensation Institute.

The use of narcotics to treat occupational injuries is part of a broader
problem involving what many experts say is the excessive use of drugs like
OxyContin, Percocet and
Duragesic<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/duragesic_drug/index.html?inline=nyt-classifier>.
But workplace injuries are drawing particular interest because the drugs
are widely prescribed to treat common problems like back pain, even though
there is little evidence that they provide long-term benefits.

Along with causing
drowsiness<http://health.nytimes.com/health/guides/symptoms/drowsiness/overview.html?inline=nyt-classifier>and
lethargy<http://health.nytimes.com/health/guides/symptoms/fatigue/overview.html?inline=nyt-classifier>,
high doses of opioids can lead to addiction, and they can have other
serious side effects, including fatal overdoses.

Between 2001 and 2008, narcotics
prescriptions<http://health.nytimes.com/health/guides/specialtopic/getting-a-prescription-filled/overview.html?inline=nyt-classifier>as
a share of all drugs used to treat workplace injuries jumped 63
percent,
according to insurance industry data. Costs have also soared.

In California, for example, workplace insurers spent $252 million on
opioids in 2010, a figure that represented about 30 percent of all
prescription costs; in 2002, opioids accounted for 15 percent of drug
expenditures.

As a result, states are struggling to find ways to reverse the trend, and
some of them have issued new pain treatment guidelines, or are expected to
do so soon. These states include New York, Colorado, Texas and Washington.
Insurers are also trying to influence how physicians prescribe the drugs.

Doctors in four states — Louisiana, Massachusetts, New York and
Pennsylvania — appear to be the biggest prescribers of the drugs for
workers’ injuries, according to a review of data from 17 states by the
Workers Compensation Research Institute, a group in Cambridge, Mass.

Painkiller-related costs are also hitting taxpayers, who underwrite
coverage for public employees like police officers and firefighters,
experts say. In February, one major underwriter, the American International
Group, said that it would no longer sell backup coverage to workplace
insurers, citing rising pain treatment expenses as one reason.

There is little question that strong pain
medications<http://health.nytimes.com/health/guides/specialtopic/pain-medications/overview.html?inline=nyt-classifier>can
help some patients return to work and remain productive. But injured
workers who are put on high doses of the drugs can develop chronic pain and
face years of difficult treatments. It is not clear how, or if, the drugs
are involved in the process, but when pain becomes chronic, the cost of a
commonplace injury can equal a crippling one, experts said.

“Some of these claims look like someone who fell down an elevator shaft and
had multiple injuries,” said Dr. Edward J. Bernacki, the director of the
division of occupational and environmental medicine at Johns Hopkins
University in Baltimore.

For decades, workers’ compensation plans, which vary by state, have been
plagued by problems like lengthy legal battles over an injury’s financial
value. But it is in recent years that opioid painkillers have emerged as a
major driver of costs, experts said.

Accident Fund Holdings examined its claims and found that the cost of a
typical workplace injury — the sum of an employee’s medical expenses and
lost wage payments — was about $13,000. But when a worker was prescribed a
short-acting painkiller like Percocet, that cost tripled to $39,000 and
tripled again to $117,000 when a stronger longer-acting opioid like
OxyContin was prescribed, said Jeffrey Austin White, an executive with the
insurer, which is based in Lansing, Mich.

In a sense, insurers are experiencing the consequences of their own
policies. During the last decade, they readily reimbursed doctors for
prescribing painkillers while eliminating payments for treatments that did
not rely on drugs, like therapy.

Those policies may “have created a monster,” said Dr. Bernyce M. Peplowski,
the medical director of the State Compensation Insurance Fund of
California, a quasi-public agency.

For patients, such policies had consequences.

Dr. Eugenio Martinez, a physician in the Boston area who specializes in
rehabilitative medicine, said one patient, a former waitress who hurt her
back five years ago in a fall, recently won a court fight to force her
insurer to pay for physical
therapy<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/physicaltherapy/index.html?inline=nyt-classifier>.
The insurer had cut off those payments five years ago after a few sessions,
and the woman, now disabled, had no option but to take strong painkillers,
Dr. Martinez said. “It certainly did not help that she was cut off,” he
said.

Nationwide, data suggests that a vast majority of narcotic drugs used to
treat occupational injuries are prescribed by a tiny percentage of doctors
who treat injured workers; in California, for example, that figure is just
3 percent. Also, the bulk of such prescriptions go to a relatively small
percentage of injured workers, including those who might be addicted to the
drugs or those who sell them, experts said.

Several companies, like Accident Fund Holdings and Liberty Mutual, have set
up programs in which pain experts contact doctors identified as high
prescribers to discuss their practices. The State Compensation Insurance
Fund of California has also instituted a policy that requires approval for
a doctor to prescribe an opioid for over 60 days.

Insurers say they are making progress in reducing overuse of the drugs. But
their ability to influence physicians is limited because workers’
compensation plans can allow employees to see any doctor. So several states
have or will soon adopt new pain treatment guidelines for doctors who treat
workers.

In New York, one proposal would require a doctor to refer a patient who is
not improving to a pain specialist when an opioid dose exceeds a certain
level, said Dr. Elain Sobol Berger, the associate medical director of the
state’s workers’ compensation board. Washington State has already adopted
such a policy.

Dr. Sobol Berger added that the New York rules, which are expected to be
proposed this year, will also emphasize nondrug treatments for pain. “We
know that there is a significant problem with the management of chronic
pain and the use of opioids,” she said.

Some insurers, like the California state fund, have also started paying for
alternative approaches like specialized psychotherapy or are trying to get
addicted workers into treatment. Other companies are also checking on
long-disabled workers.

Mark Kulakowski, a 57-year-old former warehouse worker from Peabody, Mass.,
injured his back more than three decades ago while lifting a box. He has
not worked since 1995. Since his injury, he has taken narcotic painkillers
and has had a long list of failed treatments.

Recently, his insurer, Liberty Mutual, sought to have a nurse accompany him
to his next doctor’s appointment, a suggestion he welcomed if it could lead
to taking fewer painkillers.

“It just drains everything out of you,” he said.


-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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