Welcome to this month’s edition of Comp Medical News, an essential update series. Each update features stories from around the country, with special focus on medical treatment guidelines and emergent issues related to medical management in workers’ comp.
First, prescription opioids continue to receive attention from regulators and providers alike, as stakeholders see to limit the risk of addiction and other adverse outcomes:
Ohio Bureau of Workers’ Compensation Credits Formulary for Decline in Opioid Prescriptions
The Ohio BWC recently reported that injured workers in the state were prescribed 15.7 million fewer opiate doses in 2014 than in 2010, representing a 37 percent decrease. The BWC implemented a closed formulary in 2011 to “improve the efficiency and effectiveness of treatment, limit inappropriate uses of medications and lower prescription costs.” After implementing the formulary, the monopolistic state comp insurer began refining coverage for opiates as well as coverage of muscle relaxants and anti-ulcer agents, which are also commonly overprescribed and misused. Over that period of time, prescriptions for muscle relaxants and anti-ulcer medications decreased by 72 percent and 83 percent, respectively.
Read the full release from the Ohio BWC here.
The FDA Allowed Much-Maligned Opioid Opana Back on the Market
A joint investigation conducted by the Milwaukee Journal Sentinel and MedPage Today uncovered the strange re-approval saga of Numorphan, a painkiller known generically as oxymorphone, which was linked to abuse and death in the 1960s and 70s. According to the report, the FDA re-approved a slightly altered version of the drug called Opana in 2006 in both immediate-release and extended-release forms. Then in December 2011, the agency approved a new abuse-deterrent version, but the mechanism was fairly easily foiled, which is worrisome, as Opana is 10 times as potent as morphine when injected. Abuse of Opana by injection has been tied to a recent outbreak of HIV in rural Indiana, as well as a surge in hepatitis C infections in several Appalachian states. It also has been associated with a blood-clotting disorder and permanent organ damage, a problem that didn’t occur with injection abuse of generics and the earlier version of the drug.
Read the full story about Opana via MedPage Today here.
New Study Reveals that Addiction Treatment Therapy Should be Geared Toward Early Success
New research presented at the annual meeting of the American Psychiatric Association indicates that patients who do not achieve early success with prescription medication addiction treatment early on should switch methods. The findings come from a new analysis of the Prescription Opioid Addiction Treatment Study, from 2011, which assessed varying durations of treatment with buprenorphine/naloxone, combined with different counseling types and rigor. The study included 653 patients in the first phase, making it the largest ever study population for prescription opioid dependence. In statistical analysis, the researchers found that while the positive predictive value for abstinence in the first two weeks was fairly minimal, negative predictive value was significant. In sum, failing to stop using opioids during the first week turned out to be an excellent predictor of longer term treatment outcomes with a negative predictive value of 80 percent. That figure rose to 94 percent for patients who were not abstinent for the first two weeks.
Read more from MedPage Today here.
Next, two organizations, one federal and one private, offered guidance on the most significant current public health crises in the nation:
CDC Urges Public to Understand Antibiotic Misuse
Gregg Cognac at AMAXX Workers’ Comp Resource Center relayed the CDC’s goals with the antibiotic/antimicrobial resistance prevention program, which seeks to clarify the role of antibiotics and how taking them without cause contributes to serious, life-threatening conditions. Specifically, the CDC wants to encourage patients and providers to understand that antibiotics are not to be used for viral infections, for which they serve no purpose and can negatively impact an individual’s immune system by killing off “good” bacteria that naturally live in the human digestive tract. Increased unnecessary use of antibiotics (and in the production of livestock) in the past several decades has directly led to the rise of high-profile, drug resistant strains of “super germs” that require more, or more expensive, antibiotics to treat.
The AACE is Set to Offer New Evidence-Based Guidelines for Obese Patients
Three years after they officially declared obesity to be a disease, the American Association of Clinical Endocrinologists is expected to release new evidence-based guidelines for managing obesity, as well as a “toolkit” for clinicians, in the next few months. According to MedPage Today, the Association now relies on a “framework,” or algorithm, that clinicians can use to treat the disease, but it is not evidence-based. The new guidelines are expected to be comprehensive, with a new algorithm based on evidence, strategies for counseling patients, suggestions for setting up an office, and an obesity-focused review of systems.
Read further details about the anticipated guidance here.
Finally, a columnist addressed growing employer interest in integrating the management of workers’ comp, nonoccupational disability and employee absence:
Ceniceros: Employers Start to View Employee Health, Disability and Claims “Through One Lens”
Roberto Ceniceros, the workers’ comp columnist for Risk & Insurance, took a look at how the benefits integration trend is spreading from exclusively large employers to mid-size employers as well. Ceniceros explains that such employers “are growing increasingly interested in managing employee absences and medical costs — no matter if the cause is rooted in workers’ comp claims, nonoccupational disabilities, or leave laws like the FMLA. Recognizing the trend, brokers, third-party administrators and insurers are now offering products and services to middle market employers that want to link management of these areas.” Ceniceros notes the efficiency that can be garnered with integrated benefits, especially because many injured workers end up “crossing over” occupational and nonoccupational disability systems anyway.
Read the full column here.
Image Credit: A photo by Michael Hayman of The (Louisville) Courier-Journal as it appears in USA Today here.