Pharma’s New Goal: Non-Addictive Pain Meds
Pharmaceutical companies are developing new classes of painkillers that purportedly would be non-addictive, lessening the use of addictive opioids that are causing workers compensation claims to skyrocket.
Indeed, the use of opioids — a $57 billion global market — represents on average nearly 40 percent of workers’ comp medication costs, averaging 15 percent in the first year of the claim to 35 percent in the fifth year, according to Integrated Prescription Solutions in Costa Mesa, Calif.
The main reason is the highly addictive nature of opioids, experts say. In the 2014 report, “A Nation in Pain,” St. Louis-based Express Scripts found that nearly half of those who took opioid medications for more than a month in their first year of treatment then refilled their prescriptions for three years or longer.
Addictions can also lead to death: the number of overdose deaths from prescription painkillers in 2013 roughly quadrupled from 1999, to 16,000, according to the U.S. Centers for Disease Control and Prevention.
But new classes of non-addictive medications could lessen those punches. A Wall Street Journal article last month reported on the development of experimental non-addictive painkillers by such firms as Pfizer Inc. in San Diego, Biogen Idec Inc. in Cambridge, Mass., Nektar Therapeutics in San Francisco, and Cara Therapeutics Inc. in Shelton, Conn. The new painkillers purportedly work differently than traditional opioid medications by alleviating pain without the commensurate euphoria, and hence, theoretically reducing the chance that a person would become addicted to the drugs.
“[Opioids] are lousy drugs when used long-term for most patients with chronic pain,” — Andrew Kolodny, chief medical officer, Phoenix House
Robin Hendrickson, senior vice president, workers’ compensation claims at ABD Insurance & Financial Services in San Mateo, Calif., said she supports the development of such painkillers “100 percent,” as increased use of opioid medications in the treatment of work-related injuries such as back strains or for post-surgical pain have resulted in longer recoveries, more time off work and increased claim costs. In California, the medical portion of a workers’ compensation claim can be as high as 60 to 70 percent. If narcotics are being prescribed long-term, these costs can be further escalated.
“One of the most apparent risk factors to consider is the employee’s safety if the narcotics become habit forming and may impede one’s ability to be mentally alert, especially if they are in critical positions such as a driver, operating machinery or in a public safety position,” Hendrickson said. “Bravo to the pharmaceutical companies that are looking to develop alternative pain relievers that can help an injured worker reduce their level of pain, recover from the injury and safely return to work.”
Some experts are skeptical about the new classes of painkillers.
“It may not be possible to separate the euphoric effects from the analgesic effects, but even if we could produce an opioid that lacked the risk of addiction or abuse, it wouldn’t change the efficacy side of the equation,” said Andrew Kolodny, chief medical officer at New York City-based Phoenix House substance abuse treatment centers.
While opioids are “essential” for short-term severe pain, such as after surgery, or end-of-life care, “they are lousy drugs when used long-term for most patients with chronic pain,” Kolodny said.
Medical practitioners should stop searching for a “magic bullet,” and instead employ alternative medications and non-pharmalogical treatments to lessen long-term chronic pain, he said. Current effective non-addictive medications for pain include nonsteroidal anti-inflammatory drugs such as aspirins; ibuprofens such as Motrin and Advil and naproxens such as Aleve; as well as acetaminophens such as Tylenol.
“Hopefully there will be more education on the problem of opioids so the medical community can return to the days of using safer pain medications that are more effective for long-term chronic pain,” Kolodny said.
Use of opioids in workers’ comp claims may not only exacerbate disability, but actually initiate disability, said Gary M. Franklin, research professor in the Department of Environmental and Occupational Health Sciences at the University of Washington in Seattle, who published a research study on the topic last year in the American Journal of Industrial Medicine.
“My advice would be for workers not to use opioids at all for such things as non-specific lower back pain or headaches,” Franklin said. “If used, only short-acting opioids should be used, and not for more than a few days. By avoiding use, they can avoid dependence, which is going to happen in every single patient.”
In addition to using alternative medications such as acetaminophens and nonsteroidal anti-inflammatory drugs, injured workers can also lessen their pain through graded exercise and cognitive behavioral therapy, which can include “reactivation” programs to gradually build up both physical and mental stamina, and activity coaching, he said.
“Activity coaching is focused on overcoming psychosocial barriers such as fear avoidance or low return-to-work expectations, specifically aimed at improving worker self-efficacy — helping workers to actually help themselves,” Franklin said. “It’s a very powerful method.”