Thursday, August 25, 2011

Paduda Answers Questions Relevant to Upcoming Webinar

WorkCompCentral Education is hosting the first of what is planned to be a monthly series of educational webinars, free to the public, on Thursday September 1st.

This first webinar is presented by Joe Paduda, well known for his blog on the medical and work comp industry, "Managed Care Matters" and principal of Health Strategy Associates, a national consulting firm specializing in managed care for workers’ compensation and group health. 

In preparation for the webinar I asked Joe some questions about the upcoming webinar topic, Prescription Drug Abuse in Workers' Comp:

Q   The title of your upcoming webinar makes a pretty strong statement. What about this rises to the level of Rx abuse?

There's ample evidence of overuse of drugs in workers comp, especially narcotics.  About a quarter of the dollars spent on drugs are for narcotics, the majority of that is for opioids such as OxyContin and other powerful painkillers.  Yet there's very little evidence that opioids are useful in treating chronic musculoskeletal pain and some evidence they are not helpful. If drugs are being prescribed, and dispensed, and used, and paid for, yet aren't effective, then something's very wrong.

Q.  Has anybody sounded an alarm about narcotics for chronic pain, or is this a silent problem in the states?

I'd have to say the alarm has been sounded multiple times by various individuals and organizations.  NCCI's December 2009 report, the analyses and studies done by Alex Swedlow et al at CWCI, especially earlier this year, and the seminal work of Gary Franklin MD and Lee Glass MD in Washington State have all brought much-needed attention to this issue.

Q:   Do you see any way to fix the "abuse" of painkillers for treatment injured workers? 

Absolutely.  A combination of regulatory authority to ensure the appropriate use of narcotics is allowed and inappropriate use limited; education of stakeholders especially claims personnel and treating physicians, implementation of strong Prescription Drug Monitoring Programs with interstate reach, and proactive efforts to identify and treat claimants at high risk for addiction or dependence will all help reduce abuse.  These steps will also reduce claim duration and claim cost as well. 

Q:   What downsides have been documented with long-term narcotic use for chronic pain? 

Gary Franklin and others have reported increased risk of death associated with long term use of narcotics in workers comp.  Other studies have shown most patients don't see an improvement in functionality or pain levels over time.  Many patients require several other drugs to address the side effects of opioids, such as constipation, sleeplessness, sexual dysfunction.  That's not to say some patients don't do very well with appropriate long term use of narcotics, however that does not appear to be the norm.

Q:   Can workers' comp carriers and employers implement their own policies to prevent Rx drug abuse on claims?

Yes, and some are.  Working with their PBMs, payers can develop methods to track and identify potentially problematic situations involving specific claimants, pharmacies, or physicians.  Data mining enables payers to find patterns that may indicate elevated risk of abuse, diversion, or inappropriate prescribing or dispensing.  Promoting the use of narcotic 'contracts' between physicians and their patients taking narcotics can help establish expectations and ground rules, especially if they include random urine drug testing.  Data mining to identify claimants with elevated risk for addiction or dependence can also be quite helpful, but only if it is tied to treatment and follow up.

Finally, payers need to understand addiction is a disease - not a failure of will or character flaw.  Payers also need to understand that there are well-documented, proven methods of weaning claimants off opioids and other narcotics, thereby dramatically improving the claimant's quality of life and reducing medical spend - and reserves.


To register for the free webinar go to, or call 805-484-0333 x113 or x133. 1 hour CLE is available for attending this webinar for legal and claims professionals. Enrollment is limited to 100.

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