Patterns in Narcotics Prescribing

Tuesday, November 1, 2011
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A new report that compares the use of pain medications among injured workers in 17 large states points to the wide variations in the use of narcotics -- and coincides with one state's new rules that may help solve some of the growing concerns about opioid use in the workers' comp system.

"I think this study is one of the more important ones," says Richard A. Victor, executive director of the Workers Compensation Research Institute in Cambridge, Mass., which produced the report entitled Interstate Variations in Use of Narcotics. "It shows there are some large opportunities to manage better."

Nearly one in six injured workers who received any narcotics in Louisiana were identified as longer-term users of narcotics, compared to one in 20 in the typical state. Other states with higher numbers of long-term narcotics users were New York, Pennsylvania, Texas, California, Massachusetts and North Carolina.

The amount of narcotics per claim also varied substantially. The average injured worker in New York received more than 4,000 milligrams of morphine equivalent narcotics per claim. Also high were Louisiana, Massachusetts and Pennsylvania.

Tied in with the amount of narcotics per claim was the type of narcotics prescribed. Injured workers in Massachusetts, New Jersey, Maryland, Minnesota, North Carolina, Pennsylvania and Wisconsin were more likely to have stronger, Schedule II narcotics prescribed.

The report notes that most experts recommend careful screening of patients for chronic opioid therapy as well as close monitoring and management.

However, "few ... longer-term users of narcotics received those recommended services," the report states.

"Only 7 percent of the longer-term users in the median state had urine drug-screening tests... . Similarly, few longer term users of narcotics had the psychological evaluation and treatment recommended by guidelines," it states.

The authors note that more frequent prescribing of Schedule II narcotics did not always imply an overuse of narcotics.

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In Wisconsin and Minnesota, even though physicians were more likely to prescribe Schedule II narcotics, the average morphine equivalent amount of narcotics per claim was lower than the 17-state median.

The results signal the need for further research, according to the authors, who also hope the findings spark action among:

* Injured workers. If a physician tells an injured worker that he has a "one-in-six chance of being on them six months from now, I'd think long and hard," Victor says.

* Physicians. "If I'm a clinician ... in ... states where I have a preference for prescribing Schedule II narcotics, I'd want to know whether my counterparts in states that have a preference for Schedule III narcotics are getting good outcomes," Victor says.

* Employers and insurers. In higher prescription states, "I'd want to focus my utilization management there," he says.

* Elected representatives and public-sector action. "I'd want to take a look at the effectiveness of public policies in place and look at what other states do to see if they get different results," Victor says.

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