4 Drug Regimens in Workers’ Compensation That Should Raise Red Flags
Drugs, even when prescribed by a physician, can be dangerous or even deadly when taken with other drugs that don’t mix well. While claims with dangerous drug regimens are infrequent, they can still pose risk for workers.
“We see these in fewer than one percent of all claims that have any prescriptions,” said Marcos Iglesias, vice president and chief medical director at Travelers.
“It’s a small number, but from a clinical point of view, the risk to the injured employee can be an issue and that’s why we’re concerned about them, why we flag them and why we intervene in these cases.”
Given how dangerous these combinations can be, even one claim is one too many.
“There are still too many claims with dangerous drug regimens,” said Mark Pew, senior vice president of product development and marketing at Preferred Medical.
“I started addressing the issue back in 2003, and back in that period of time, there were not a lot of people focused on the opioid issue but also not really looking necessarily at the polypharmacy issue. Most of the time I would see opioids along with benzodiazepines, which are very dangerous drugs. They’re not supposed to be mixed together.”
While Pew said that dangerous drug regimens in workers’ compensation “have diminished over time,” there are still plenty of regimens that employers and payers should be wary of.
1) Opioids and Drugs that Increase Euphoria:
No one in America needs to be reminded of the crippling effects opioid addiction has had on communities across the nation. Opioids caused 47,590 overdose deaths in 2018 and pharmaceutical companies have faced endless litigation over their role in creating what the media has dubbed a “man-made” epidemic.
Given the painful effects of opioid addiction, it seems like a no-brainer that prescribing opioids alongside drugs that increase euphoria would be a recipe for addiction and the disaster that follows. Unfortunately, these drugs are prescribed together all too frequently, said Pew.
Gabapentinoids, like Lyrica, and muscle relaxers, like Soma, are two common drugs that increase the euphoria of opioids and can lead to addiction.
“Gabapentin can accentuate the euphoria that comes from opioids. So they actually end up being drugs of abuse,” Pew said.
2) Gabapentinoids to Treat Chronic Pain
Gabapentinoids aren’t just dangerous when combined with opioids, however. They can also be dangerous for injured workers when used to treat long-term conditions, such as chronic pain, which are frequent in workers’ comp.
“If you look at the label for Lyrica, it’s very, very clear that there’s a higher likelihood of suicidal ideation in the use of long-term Lyrica, especially at higher dosages,” Pew said.
In addition to increasing the risk of suicidal ideations, long-term use of gabapentinoids can create ulcers and gastro-intestinal issues that affect the liver and the kidneys.
“From a long-term standpoint, there are certain things that you need to look at very, very carefully with gabapentinoids,” Pew said.
3) Opioids and Benzodiazepines
No one should be taking opioids and benzodiazepines at the same time. Since drugs depress the central nervous system, the result of taking them in conjunction can be deadly.
“The more that you depress the central nervous system, the more the central nervous system forgets to automatically do things, like breathe,” Pew said.
“Oftentimes, when people die from opioids, it’s from asphyxiation.”
These two drugs are such a dangerous combination that even the CDC recommends patients do not take opioids and benzodiazepines in conjunction.
When combined with skeletal muscle relaxants, opioids and benzodiazepines become even more dangerous because all three drugs repress the central nervous system. These drugs are sometimes mixed together in a recreational drug called a “Las Vegas Cocktail,” according to Iglesias.
“When you combine all three, that’s when you can put someone’s health and life at risk,” Iglesias said. “Because it can be misused and abused; it also has a high street value, so we need to be on the lookout for combinations of drugs like that.”
4) Central Nervous System Depressant and Some Over the Counter Drugs
On their own, benzodiazepines and other drugs that affect the central nervous system can be dangerous when used alongside some over the counter drugs or alcohol.
“Things like over the counter drugs and alcohol, which is a strong central nervous system depressant, are big concerns,” Iglesias said.
“Anytime you mix those drugs together with other central nervous system depressants, you’re going to have impaired motor control, increased risk of addiction and other side effects like drowsiness, confusion, nausea, vomiting, and then the biggest threat, which is the risk of a life-threatening overdose.”
How to Reduce Dangerous Drug Regimens in Workers’ Comp
While dangerous drug regimens are still seen too frequently in workers’ compensation patients, payers can take action to help reduce them.
“We’ve been moving away from being willing to pay for opioids and other dangerous prescription drugs,” Pew said.
“It’s about educating payers to be willing and open to pay for cognitive behavioral therapy, be willing and open to pay for acupuncture, to be willing and able to pay for virtual reality or a nutritionist or access to a functional restoration program.”
Education doesn’t stop with payers, however. Prescribers, pharmacists and even injured workers themselves need to know that many drugs can be dangerous.
“As a society over the last few years, we have greatly focused on reducing opioids. As a society, we also need to focus on educating the public about the dangers of different combinations of drugs, whether they’re prescribed or not,” Iglesias said.
“We need to focus on educating the public that if you’re a patient, you need to let your doctor know what medications you’re on, what drugs you’re using, what over the counter medications you’re using, because they can have a serious effect not only on your function but also on the risk of death.”
Pew echoed the need for education about dangerous drug regimens: “It really boils down to education, because education creates the opportunity for better choices,” he said. &