When Mental Health and Pain Management Collide: Navigating the Rx Maze

Find out more about psychotropic drugs, their off-label use, and how the COVID-19 pandemic can teach workers’ comp professionals more about the injured worker experience.
By: | March 22, 2021

The classic “don’t buy the psych claim” mentality isn’t entirely a thing of the past, but one could argue that it’s moot.

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Regardless of whether the psych component is compensable, the presence of psychotropic drugs is high and will have an impact on both direct drug costs as well as outcomes.

Approximately 39 million adults in the United States have been diagnosed with a mental health disorder. Mental health conditions — and the drugs used to treat them — are an important part of the workers’ comp conversation.

You can join in on April 14, during a National Comp digital session entitled “Navigating the Intersection of Pain Management and Psychotropic Drugs.”

In this presentation, experts in the pharmaceutical space will discuss psychotropic drugs, their off-label use, and how the COVID-19 pandemic can teach workers’ compensation professionals about the injured worker experience.

Marcos Iglesias, chief medical director at Travelers and Constitution State Services, and Phil Walls, RPh, chief clinical officer for myMatrixx, will home in on the intricacies of mental health disorders and the drugs used to treat them, especially in terms of pain management following work injuries.

“Our parent company Express Scripts did a report early last year called America’s State of Mind in which they looked at use of mental health drugs in quarantine. When I looked at that my first thought was, ‘What is the quarantine doing to injured workers?’ ” Walls said.

Marcos Iglesias, chief medical director, Travelers and Constitution State Services

The report, which was released in April of 2020, “shows that the number of prescriptions filled per week for antidepressant, anti-anxiety and anti-insomnia medications increased 21 percent between February 16th and March 15th, peaking the week ending March 15th, when COVID-19 was declared a pandemic.”

If we extrapolate these numbers, it becomes clear that regardless of whether the psych component is compensable, the presence of psychotropic drugs is high and will have an impact on both direct drug costs as well as outcomes.

“We’re focusing on the fact that most Americans are now working from home, those that are still employed, that combination of those events led to the use of psychotropic drugs, but what about the injured worker?” Walls asked.

“Aside from the pandemic and the quarantine, any time a worker experiences a serious injury, they go into their own personal quarantine. Many of them are homebound, isolated, in fear of losing their job, or perhaps their job has been eliminated while they were out for injury.

“So we decided to look at the data not based on when quarantine started, but based on the date of injury, as we saw a similar pattern in terms of increased use of psychotropic drugs. That was the impetus to look into it further.”

Upon looking further into the data, Walls discovered some confounding variables, which added additional value to the enterprise and would be of interest to attendees.

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“There’s a complicating factor which I’ll share with the audience. With an injured worker, especially if they’re still employed and have group health insurance, there’s the possibility that certain drugs may still be dispensed through the group health care system,” Walls explained.

“Because of HIPAA and contractual firewalls, that data is not usually available when doing research of this type, which is what we experienced. The use of these drugs then could actually then be much higher, it could just be paid through another venue.”

This isn’t the only interesting limitation that many claims handlers may not have considered.

“The other complicating factor is that in pharmacy in general, pharmacists do not necessarily know why a physician prescribes a certain drug,” Walls continued.

“Antidepressants are a great example. We cannot assume when we dispense antidepressants that the patient is depressed. So many antidepressants are used off label in pain management.”

Phil Walls, chief clinical officer, myMatrixx

This is when Walls decided to reach out to Dr. Marcos Iglesias to develop the session further.

“Dr. Iglesias has done his own research into off label use, and I’ll hand it over to him to discuss off label use,” he said.

“He and I both agree that off label use is neither inherently good nor bad, it all depends on whether or not there’s evidence to support that use.”

In terms of key takeaways for National Comp attendees, Walls sees a myriad of potential.

“So much attention is being paid to the pandemic and quarantine, injured workers have been going through this for a long time, we’ve just never recognized the impact that the isolation can have on mental health,” he said.

“Also, HIPAA and things of this nature, although created for all of the right reasons, and I fully support patient privacy, at the same time, it has made it difficult to look at the whole patient. I don’t know if folks thought about that — one individual with multiple sources of coverage.”

The session, Navigating the Intersection of Pain Management and Psychotropic Drugs, will be presented April 14th at 2 PM ET, and will be available on-demand after the broadcast. Registration information can be found here&

Nina Luckman is a business journalist based in New Orleans, focusing primarily on the workers' compensation industry. Over the last several years, Nina has served as Editor of Louisiana Comp Blog, a news site she started in 2014 under the auspices of a group self-insurance fund. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]