Friday, March 22, 2013

Controlling Opioid Roaches

While health care expert and noted blogger Joe Paduda told the audience at the annual California Workers' Compensation Institute's (CWCI) meeting in San Francisco yesterday that opioids are the biggest problem facing the industry today, Georgia lawmakers were passing a bill that they hope will take the "roach" element out of the state.

First, Paduda: “This is such an inherently huge problem,” he said. “It’s the biggest problem facing the industry today. If we don’t get our arms around it, it is going to eat the industry alive.”

CWCI's new president, Alex Swedlow, said that the organization's research into opioids occurred because it was the number two cost driver after attorney involvement.

The reason, as Paduda explained, is because after six months of opioid use there is addiction, declination of functioning, destruction of health, extension of disability, and ultimately death.

Paduda cited an Appalachian community school where 13 kids were left parentless last year because of opioid deaths. There are only 110 kids in the entire school...

“We’ve become the addiction-creation industry,” Paduda said. “That’s our fault. We’re the ones enabling the physicians to prescribe the wrong drugs. We’re paying for them.”

Georgia has decided that it isn't going to pay for them anymore. Or at least is going to slow down the process.

House, HB 178 will require the Georgia Composite Medical Board – the agency that licenses Georgia doctors – to begin licensing pain clinics on July 1, 2013.

The bill would apply to any medical practice that advertises the treatment of pain, uses pain in the name of the clinic or treats more than 50% of non-terminal patients with drugs on Schedules II and III of the U.S. Drug Enforcement Administration's controlled substances list.

The bill "grandfathers in" clinics that are operating by July 1 and are at least partly owned by Georgia-licensed physicians.

Bill supporters say Georgia became a haven for pill mills that moved north when the Florida Legislature passed its own pain clinic bill in 2011. The Florida legislation imposed tough licensing standards on pain clinics and banned physicians from dispensing of Schedule II and III drugs, except in limited instances.

Georgia Senate Health and Human Services Committee Chairwoman Renee Unterman, R-Buford, a prime sponsor of the pill-mill bill, told the Senate on Thursday the number of pain clinics in Georgia jumped from 10 in 2010 to more than 140 last year because of the northward migration from Florida.

"There are a lot of bad apples in these pain clinics. They fled like roaches from Florida, and, when they heard that we were going to come in and start regulating them, the clinics started shutting down and moving to another state," Unterman said.

"Millions and millions of dollars can be made at these pain clinics because they keep people addicted to drugs."

Unterman has the issue firmly in grasp - the addiction model of opioids creates a nice recurring revenue stream for the purveyors of the drugs. In the meantime the costs to workers' compensation claims is exponentially increased, as reflected by CWCI's data.

Paduda says the work comp industry has an obligation to do something about opioids - and I agree. The issue that we face in work comp is the liberal requirement to provide virtually any medical treatment requested by or on behalf of an injured worker (more likely than not, on behalf of...). States are now giving tools to the industry to "just say no" (thanks Nancy Reagan!) with treatment guidelines, control via networks, etc.

Insurance companies, such as California's State Fund, are taking initiatives by telling their network doctors that strict adherence to treatment guidelines when it comes to prescriptive medication must be followed and that failure to do so, or offer a medically sound reason for not doing so, will result in non-payment and/or elimination from the network.

That kind of financial hard talk works. CWCI's data shows that California's share of the opioid problem is leveling off.

Can the industry do more? Sure - California needs to see a declination in opioid usage, not just a flattening of the trend. But the tools start with the laws that provide the underlying structure.

Christine Baker told the CWCI audience that the administration will address opioid abuse with treatment guidelines. Division of Workers’ Compensation Medical Director Dr. Rupali Das and the Commission on Health and Safety and Workers’ Compensation are both working on opioid treatment guidelines, she said.

To be sure, California has its issues. We're a big state, lots of people, lots of money, lots of problems.

Paduda commented that we in California think we have problems, but he said it is nothing like Florida, where the legislature has been struggling to get something done about physician dispensed repackaged drugs for many sessions.

He said that he was asked by a Florida legislator where he got his data from concerning the social and business costs of prescription medication - CWCI was Paduda's answer. The legislator asked why he was using California data - the response from Paduda: because Florida doesn't have a CWCI...


  1. So does the new Georgia law simply put a time limit on opiod payment? Say a worker falls on a construction site and badly injures his back. Wil the new law let him lay in agony instead of treating his pain?
    If there is a time limit, what is it?

    1. No - pain management clinics would be subject to independent licensing beginning 7/1/13 and must go through the process every 2 years. Bill is here:

  2. So pain clinics will start their licensing as of early next week - Georgia is still really struggling with this - we've seen a couple clinics close down - but more seem to pop up and many have gone mobile - will be interesting to see if the new law helps - many have their doubts!