Monday, January 9, 2012

Opioid over-utilization and WC death benefits

There is a massive amount of unintended consequences from treating the symptoms of pain and not necessarily the source of pain.  The most obvious is cost – to the Payer, to the medical delivery system, and to society (the National Drug Intelligence Center estimates that drug abuse costs the U.S. more than $120B in lost productivity each year).  The clinical consequences may be even greater, and ultimately more costly.  From the unmet expectations by the patient of total pain control, to dealing with subjective rather than objective complaints, to masking other illnesses whose symptoms cannot be identified due to sedation, to drug side effects that often require other drugs and often create co-morbidities, to over-sedation that turns them into zombies … they all have a negative effect on a patient, their family and friends and their treating physician.  However, recent reports indicate the ultimate cost, death, is gaining momentum.
First, the statistics: Research from the CDC’s Morbidity and Mortality Weekly Report from 11/1/11 (Volume 60) showed that the death rate from drug overdoses in the U.S. has tripled from 1991 to 2007.  Per their research, the death rate in 2007 was 11.8 per 100,000 (or almost 100 people per day), and prescription drugs have accounted for most of that increase.  In 2009, 1.2M emergency department visits (an increase of 98.4% from 2004) were related to misuse or abuse of pharmaceuticals (compared to 1.0M visits due to illicit drugs).  The biggest driver of these increases was due to opioid pain relievers.  In 2008, drug overdoses were responsible for 36,540 deaths.  Opioids were involved in 14,800 deaths, or 73.8% of the total 20,044 overdoses related to overdoses that included one or more prescription drug.  Just think what 14,800 people means – 40 per day, or the entire city of Taos NM.
And then the effect: Recent court decisions indicate this is a burgeoning problem for Work Comp.  On 11/30/11 the Tennessee Supreme Court Special Workers’ Compensation Appeals Panel ruled that death benefits should be allowed for a claimant who overdosed on oxycodone.  The Commonwealth Court of Pennsylvania confirmed on 12/2/11 that a claimant’s fatal overdose from fentanyl was compensable because even though a Utilization Review report concluded the drugs were not reasonable and the Payer refused to fill the prescriptions, the claimant’s treating physician prescribed them anyway.  The North Carolina Court of Appeals affirmed on 12/20/11 that the widow of a claimant is due death benefits because her husband died from a methadone overdose that was part of his WC treatment regimen.
Our industry, and society in general, has created zombies who are unfortunately marching to their graves.  That is a trend we need to reverse.
In this together – Mark Pew

On Twitter @PRIUM1

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