State: Pain meds contributing to workers’ comp costs

March 27--State officials and legislators are increasingly concerned with the over-prescription of opiates and other controlled substances for pain management in the workers' compensation program.

A bill pending in the state House, HB 370, would put sideboards, or limits, on long-term prescriptions by physicians of drugs like Oxycodone that can lead to addiction, inability of workers to return to jobs, and extra workers' compensation costs paid by employers.

"In 2011, prescription drugs comprised nearly 20 percent of medical costs in workers' compensation claims in Alaska," said Rep. Kurt Olson, R-Soldotna, in a statement. "In cases where the (workers' compensation) claimant has been prescribed a controlled substance for more than 90 days, the long-term costs to the employer are estimated to range from $1,000 to $12,000 monthly."

The bill is sponsored by the House Labor and Commerce Committee, which Olson chairs. It was introduced March 4 and is now being reviewed by the House committee.

The problem seems to be that physicians are too liberal in prescribing the drugs for long periods, up to 90 days.

"Once you're on these drugs for an extended period of time, you're not going back to work," Olson said during a hearing on the bill March 19.

Mike Monagle, director of the state Division of Workers' Compensation, agreed with Olson's assessment.

"In workers' compensation, the longer you're on these pain medications the longer you're going to miss work," and the less likely there will be a successful return to employment, Monagle said at the March 19 hearing.

Lori Wing-Heier, the newly-appointed director of the Division of Insurance, said the statistics are staggering on the widespread prescription of opiates.

"Historical data shows that for every 100,000 workers there will be 4,800 workers' compensation claims," she told the committee. "One thousand four hundred of these will wind up being long-term claims. On average, each long-term claimant is prescribed six different prescriptions for an injury.

"Of the top 10 drugs prescribed for an injury, 25 percent are Oxycodone."

Rep. Andy Josephson, D-Anchorage, a member of the Labor and Commerce Committee, asked Wing-Heier if she felt physicians were complicit in the over-prescribing of the drugs.

"I would not disagree with that," she said.

The reasons why physicians are so quick with long-term prescriptions are not clear, however.

"It seems to be just for convenience," Wing-Heie said. "I am aware of prescriptions for 90 days to 120 days."

Alaska Medical Association Executive Director Michael Haugen said the AMA has not yet taken a position on the bill.

"This is one among a long list of bills affecting the medical community that are pending in Juneau and that we are watching," he said.

The legislation would restrict the prescription of long-term opioids to a 30-day supply. Opioids are synthetic versions of opium-derived drugs.

Another big worry for legislators is that some of the prescribed controlled substances are not being taken by the workers' comp claimants, and some are being sold.

"A national report on 939,000 screenings of workers' compensation claimants by Lockton Companies, published in 2012, shows that 71 percent of workers' compensation claimants on chronic opioid therapy greater than three months are not taking their pain medication as prescribed due to misuse or abuse," said Anna Latham, a staff assistant to Olson, in a presentation on the bill to the House committee.

Drug testing of the patients showed that, "38 percent of claimants (to whom the drugs had been prescribed) were found to have no detectable level of prescription medication," Latham said, which raised questions as to what is being done with the medication not taken.

"Prescription opioids are presently the No. 1 workers' compensation problem in terms of controlling the ultimate costs of indemnity losses," Lockton wrote in its 2012 report.

Along with limiting prescriptions for long-term opioids to 30 days, HB 370 would also allow employers to require drug testing of workers' compensation claimants who have been prescribed the drugs for more than 90 to ensure the medications are being properly taken.

"Statistics show that one in four prescriptions is being used by someone that has not been prescribed the medication. This is medication that an employer is paying for either directly, or through insurer premiums," Lathan said in her presentation.

House Speaker Mike Chenault, R-Nikiski, who is a member of the Labor and Commerce Committee, said he is concerned that a lot of these drugs are going on the street.

"This is a problem now in my community. I think the docs are writing too many prescriptions," Chenault said.

Monagle, of the workers' compensation division, suggested that Alaska adopt a system being used in several other states where a physician and a workers' compensation claimant are required to have a plan for a "step down" on the use of stronger drugs.

"The intent is to wean them off these, with a step-down plan and pain management clinics. These drugs are not intended to be used long-term," Monagle said.

Josephson is a critic of the bill, however.

"I object to giving employers the discretion to order drug tests. The proponents of the bill seem to be arguing that the drugs are underused and that people are peddling the drugs," he said.

House Minority Leader Rep. Chris Tuck, D-Anchorage, said he was once injured on the job and was prescribed medication for pain, which he resisted taking for fear of addiction. Others advised him that he should take the medication so that he could heal, he said at March 25 briefing by House Democrats.

"I want to have the option to take the medication. I don't want to be penalized for not taking them," Tuck said.

Tim Bradner can be reached at tim.bradner@alaskajournal.com.

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