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Note: this post includes a correction to an earlier version of this post;;;

I’m not surprised that I received some response to my recent post, “The Outliers”, which focused on a recently released study of opioid prescribing practices in California workers’ comp.

That study, by the insurance industry’s California Workers” Compensation Institute, has been picked up in scads of articles in various media outlets.

But in the interest of fairness, I’ll share some comments from readers who present different perspectives on the issue.

I offer their comments to further stimulate debate, realizing that on the one hand anything that comes between workers’ and doctors is anathema to some, while on the other hand some in the employer community would be happy to place further limits on treatment access.

One injured worker writes to point out that not all workers on opiates for chronic pain are “dope fiends”. Reacting to the perceived vilification of workers treating for chronic pain, he notes that
“‘I’ve been on Opiates for 5-6 years now, since they’re the only medication that works for me, a chronic pain patient.
My Doctor sees me once a month, writes me a prescription, and I take it to the pharmacy.
The article you posted about Doctors making money off of handing out them doesn’t apply in my case, and I use my medication judiciously and as prescribed.
Please mention in your Blog that all truly injured workers aren’t dope fiends who use drugs for fun. If I didn’t have mine I wouldn’t be able to use my hands or arms.”

A friend forwards me a reaction to my post and the CWCI study sent to him from a medical staffer at California workers’ comp insurer:
“As to this study, there is no doubt that there is a lot of abuse in prescribing psychotropic and pain medications. Duh. However, it is not surprising that 3% of the doctors write the bulk of these prescriptions. I would surmise that these are the pain management guys who, for all their other faults, end up with the worst patients and therefore their prescribing patterns are not necessarily abusive. Its like saying that the top trauma hospital has a higher death rate per admission than Podunk Community. It’s a good bet that the top trauma hospital has a much sicker patient population than Podunk Community. Similarly, neurosurgeons pay a higher malpractice rate than chiropractors or weight-loss doctors.

Note correction: an earlier version of this post included a critique passed on to me from a commentator which misstated authorship of the CWCI opioid study. CWCI study co-author Alex Swedlow has kindly noted that the sole authors of the study were himself, John Ireland of CWCI and Gregory Johnson, Ph.D, an independent consultant specializing in insurance and healthcare issues. Arnold Milstein was not involved with this study. My apologies to the CWCI authors and Dr. Milstein for this error.

This industry doctor goes on to argue his point, which I’ll share here even though I’m not vouching for his views:
“Not to say that abuse by the pain management doctors is not a problem. It is. However, the solution to this problem is not simply going after the prescribing patterns, but rather the whole paradigm that has accepted this whole notion of “chronic pain management” as a validated medical treatment program that should be available to anyone who has pain that doesn’t get better with standard treatments. This is a shortcoming of the ACOEM Guides, the ODG Guidelines and the Labor Code and needs to be addressed with honest outcome studies. The reason this practice flourishes in the workers’ comp system is because it is predicated on the false notion that these programs actually get people back to work. It’s the same argument that has allowed spinal fusion and other devices of medieval torture to become a standard of care for so long, the lack of meaningful studies to the contrary.”

But wait. There’s more.

My friend forwards an article from the March 6,2011 New York Times, by Gardiner Harris entitled, “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy”:
http://www.nytimes.com/2011/03/06/healt … inerharris

Making his point, my friend notes that in our society we have trended toward a pharmaceutical fix to problems. Psychiatrists generally can’t make it by doing on the couch counseling and analysis. Even the state-adopted treatment guidelines seem to favor medications over physical therapy, gym memberships and such modalities. Whollistic approaches and Eastern medicine type approaches aren’t often allowed. So is the system reaping what it has sowed?

Three different approaches. All food for thought.

Julius Young
www.workerscompzone.com
www.boxerlaw.com
www.thecompguys.org

Category: Medical treatment under WC

Julius Young

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