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Risk Insider: Debbie Michel
Where’s Your Bottle of Painkillers?
Debbie Michel is President of Helmsman Management Services, the wholly owned third party administrator of Liberty Mutual Insurance. She can be reached at [email protected].
Medical care providers inconsistently prescribe powerful – and highly addictive – narcotic painkillers across the country, according to a recent study by the federal Centers for Disease Control and Prevention (CDC) and data from Liberty Mutual Insurance.
This variation needlessly endangers patients, drives up workers compensation costs and may not provide a healing benefit to injured workers.
This is largely a problem that shouldn’t exist, since the American College of Occupational and Environmental Medicine (ACOEM) “Guidelines for the Chronic Use of Opioids” provide clear best medical practices for prescribing powerful narcotic painkillers — and advise that they be used only for select patients.
And yet the recent CDC study found tremendous variability in the rates of narcotic prescriptions between states.
For example, in 2012, health care providers in Tennessee wrote 143 pain killer prescriptions per 100 people, while doctors in California issued 57 prescriptions per 100 people.
Shockingly, health care providers across the U.S. wrote 259 million prescriptions for painkillers in 2012, enough for every adult American to have a bottle, according to the study.
A Liberty Mutual study published in 2009 found similar interstate variation in opioid prescriptions for acute work-related lower back pain. In fact, almost eight times as many opioid prescriptions were written in South Carolina for acute lower back pain than in Massachusetts during the study’s time frame.
The problem is clear. So is the solution.
Here are four steps every risk manager should take to help protect injured employees and the bottom line:
• Get informed — Understand if the states where your company operates have high rates of opioid prescribing, and to what extent the workers compensation systems in those states require treating physicians follow the ACOEM guidelines.
Providers treating injured workers in some states are mandated to follow these guidelines, while they are mere suggestions in other states.
• Get involved — Help your regulators and legislators understand the problems associated with narcotic over prescription, for both individuals and employers.
Work with them to appreciate the value of evidence-based medicine, such as the ACOEM guidelines.
• Use the right medical care provider — Having the injured worker treated by a provider experienced in occupational injuries will usually help the worker recover sooner and make the use of narcotics much less likely.
Even in states where employers cannot direct the care of injured workers, they can help employees understand the potential dangers of powerful narcotic pain killers.
• Spot problems early — Closely monitor claims. Use specialized resources to quickly identify the inappropriate use of narcotics and the early warning signs of potential abuse, such as use of multiple pharmacies or physicians, depression and addictive behaviors.
While not everyone has a bottle of painkillers, some have several. And it may be costing those individuals — and their employers — dearly. Get involved to help end this tremendous human and financial waste.
