Better Prescribing Through Technology
Doctors are increasingly turning to the genetic testing of workers’ compensation claimants to evaluate their tolerance for prescription medications such as opioid pain relievers, observers say.
Pharmacogenetics, or the study of genetic variations among individuals, has found broader use to test how patients suffering from cancer and other diseases metabolize prescription drugs and whether they are likely to derive therapeutic benefits or are at higher risk of suffering harmful side effects.
Now, more physicians are turning to pharmacogenetics to similarly evaluate how workers’ comp claimants will respond to prescription drugs based on a patient’s genetic makeup.
It is not yet a mainstream practice for workers’ comp claims, nor is it appropriate for all claims, said Candy Raphan, director of medical services for Broadspire, a third party administrator.
But the practice is taking hold, and a recent review of injured worker claims managed by Broadspire revealed “quite a few incidences where this was used in the last year,” Raphan added.
Doctors turning to pharmacogenetics are doing so to determine how workers’ comp patients might metabolize opioids and other pharmaceuticals used for “adjunct pain management,” Raphan said. They are looking to identify patients that may not respond positively to certain drugs or experience a “heightened response,” placing them at a high risk for an adverse drug reaction, such as overdose and death.
Physicians may also use it — by taking a swab from inside a patient’s cheek — as a tool for learning why patients may not respond to the “pain-relief intention” of a drug, despite dose escalation, Raphan said.
“If you are giving someone a medication and they keep saying, ‘I took twice as much because I didn’t get pain relief,’ it may be as a result of them not having one of those [genetic] factors so they can break that drug down to get that therapeutic benefit,” she elaborated.
Advocates say pharmacogenetics could shorten injury and disability durations among workers’ comp claimants by eliminating common trial-and-error doctor attempts to find which prescriptions will benefit patients most.
It can also reduce treatment durations by eliminating harm caused when providing drugs a patient will not tolerate well, they add.
“We have seen providers say, ‘Let’s do some genetic testing to identify which drugs you are more likely to have side effects from, or are least likely to respond to or to tolerate, and let’s use that as a roadmap to guide our therapy,’ ” said Jennifer Strickland, VP and pharmacogenetics business leader for Millennium Laboratories L.L.C.
San Diego-based Millennium launched in 2007, providing urine-drug testing services for patients suffering from pain. The company moved into pharmacogenetics testing about two years ago.
There is interest in applying pharmacogenetics in worker’s comp cases because doctors are often attempting to address pain, which is a “very subjective condition,” Strickland said. It is difficult for them to find the right drug, especially while trying to meet the goal of returning employees to the job as soon as possible.
Most requests for testing are now coming from doctors, but Millennium has also held discussions with pharmacy benefit managers evaluating the practice and considering its application for cases where patients have not responded to medications prescribed to them, Strickland said.
For now, plenty of doctors remain hesitant about using a new technology.
But as the technology enters the mainstream, Raphan said she expects to see more doctors turn to it, “as long as the costs and the benefits align.”