A récent Los Angeles Times article on prescription drug abuse is worth noting.
The article, “Drug Deaths Now Outnumber Traffic Fatalities in the U.S.”, by Lisa Giron, Scott Glover and Doug Smith, is likely to add further weight to concerns about the expanded use of opioids in the workers’ comp system.
The authors charge that:
“Public health experts have used the comparison to draw attention to the nation’s growing prescription drug problem, which they characterize as an epidemic. This is the first time that drugs have accounted for more fatalities than traffic accidents since the government started tracking drug-induced deaths in 1979.”
“Fueling the surge in deaths are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol. Among the most commonly abused are OxyContin, Vicodin, Xanax and Soma. One relative newcomer to the scene is Fentanyl, a painkiller that comes in the form of patches and lollipops and is 100 times more powerful than morphine.”
“Such drugs now cause more deaths than heroin and cocaine combined.”
A link to the full article is at the bottom of this post.
Expanded use of opioids followed a paradigm change in the way pain was treated. Within the past several decades more aggressive pain treatment protocols have become popular.
Some pain meds that are often used for end stage cancer are used in the workers’ comp system for orthopedic injuries.
After writing a post about this some months ago I received a handful of e-mails from injured workers concerned that I was criticizing them and the treatment that they say works for them. In response, I noted that I was not implying that their pain was not real or that the meds weren’t indicated for their particular situation. Nor was I implying that they were abusing.
On the other hand, I noted that in the past I had had clients who overdosed and a client who was found to have been diverting narcotics for sale. So on an anecdotal level, I had some familiarity with concerns being raised by other journalists and researchers.
These issues are not confined to California. Florida’s workers’ compensation system has developed a reputation as a “pill mill”.
Have medical treatment guidelines and limits on physical therapy actually encouraged doctors to default to a pharmaceutical approach faster? Are pain management doctors being chosen as primary treaters earlier in the process before other approaches are sorted out? What role do MPNs or attempts to escape from MPNs (especially in the Southlland) play in this?
Should California adopt a new algorithm that must be followed where doctors want to start workers on opioids? Should other controls be put in place? Should we make the process easier for doctors to get authorization for a detox program? Does in-office dispensing by physicians have a role in all of this, and how to control the “bad actors” without penalizing careful prescribers?
It’s a complicated problem and at the moment I see little consensus on practical solutions. Although there is already research data from CWCI and CHSWC analysis data on medical treatment, moving forward with new regs or bill language to make some changes will not be easy.
Here is the L.A. Times article:
http://www.latimes.com/news/local/la-me … full.story
Here is a link to an ear