Chronic Pain Health — 12 July 2012

The use of powerful opioid painkillers such as oxycodone by injured California workers has dropped to its lowest level since 2007, according to a new study. Researchers say the data suggests that insurers may be making the drugs more difficult to obtain.

The study by the California Workers Compensation Institute (CWCI) found that Schedule II opioid use fell from a peak of 5.8% of workers comp prescriptions in 2010 to 3.4% in the fourth quarter of 2011. Use of Schedule III pain relievers, such as Vicodin, remained relatively stable over the past decade. The Institute based its study on a review of over nine million prescriptions dispensed to California claimants from 2002 through 2011.

Schedule II drugs, which include oxycodone, fentanyl, morphine and methadone, have high potential for abuse and addiction.

“The sudden decline in Schedule II opioid utilization and cost that began in the second half of 2010 and continued through 2011 was not associated with any significant or explicit changes in workers’ compensation legislation or regulations pertaining to opioids, which suggests that stepped up efforts by the payor community (workers’ compensation insurers and self-insured employers) to modify medical cost containment oversight and tighten controls over the use of Schedule II painkillers may be having an impact,” the CWCI said in a statement .

Insurers across the country are taking steps to restrict access to opioids. This month, Blue Cross Blue Shield of Massachusetts adopted one of the most restrictive policies in the nation. Payments for Schedule II drugs will not be allowed without prior authorization from the insurer and refills after 30 days for Schedule III painkillers will trigger an automatic review. Cancer patients and those with terminal illnesses are exempt from the rules.

The state of California has also taken steps to limit the abuse and misuse of opioids. In 2009, it began to electronically track the distribution of Schedule II and III drugs. In that same year, the California Division of Workers’ Compensation adopted new guidelines for chronic pain management. However, according to the CWCI, the effectiveness of both programs has been undermined by a lack of funding and a vague definition of what constitutes chronic pain. The Institute believes public awareness may be playing a more decisive role in the declining use of Schedule II opioids.

“The strong spotlight of publicity and the growing awareness of the problems associated with Schedule II opioids also (could be) making doctors and their patients more cautious in regard to the use of these drugs, and perhaps more willing to seek alternatives for managing pain,” the CWCI said.

While the use of powerful pain relievers may be declining, the number and cost of drug screens to detect their use is soaring. In May, a report by the CWCI found that insurers and employers in California paid nearly $100 million for drug tests in 2011, almost 200 times what they paid eight years earlier. The annual cost of drug testing in the state’s work comp system is expected to approach $150 million this year.

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Pat Anson, Editor

Pat is Editor in Chief of American News Report. He is a veteran journalist and a former correspondent and producer for HealthWeek (PBS), Nightly Business Report (PBS) and other nationally syndicated shows. Pat has won numerous journalism awards, including a Golden Mike award for investigative reporting.

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