Work Comp Central has published We’re Beating Back Opioids – Now What? , written by columnist Peter Rousmaniere in cooperation with CompPharma, a consortium of workers’ compensation Pharmacy Benefit Managers.
To say the Mr. Rousmaniere is a “workers’ compensation thought leader” is a little like saying Ted Williams was a pretty good baseball player. In this provocative analysis he expertly chronicles the increasingly alarming rise in opioid usage to treat work injuries from the early 1990s through the first decade of this century, what he calls “the twenty year crisis.” He describes how Purdue Pharma’s introduction and heavy-handed marketing of Oxycontin in 1996 lit the fuse of the opioid rocket ride to the moon, setting off a series of cataclysmically destructive personal odysseys on a grand scale. Lives ruined, families torn apart. And he documents the myriad counterattacks mounted by responsible parties around the country, most notably Dr. Gary Franklin, the neurologist and medical director for the Washington State Department of Labor & Industries, who, by anyone’s standard has been a torchbearer in the battle.
Rousmaniere describes how the responsible physician community, recognizing that things were getting more than a little out of control, began to question the effectiveness of opioids in treating pain:
In 2013, the American Medical Association published a review of pain medications, in which it concluded that “Narcotics provide little to no benefit in acute back pain, they have no proven efficacy in chronic back pain, and 43% of patients have concurrent substance abuse disorders, with aberrant medication-taking disorders [in] as high as 24% of cases of chronic back pain.” The “no evidence” concept has been stretched to raise more questions, as in this conclusion published in early 2015: “There is no evidence that opioids improve return to work or reduce the use of other treatments. They may even limit the effectiveness of other treatments.”
Finally, he tells the story of how the federal government as well as almost all the states, the insurance industry, the American Medical Association and workers’ comp pharmacy benefit managers took definitive action to bend the opioid curve to the point where all of the leading indicators have been significantly slowed or reversed.
But Peter Rousmaniere’s report up to this point, the halfway mark, is merely preamble to the real thrust of We’re Beating Back Opioids – Now What? It’s the “Now What?” that concerns Mr. Rousmaniere. The “baby and the bathwater” question. He writes:
The workers’ comp industry was victimized by opioids and their well-resourced purveyors and ardent advocates. But it also made a costly, unforced strategic error. It paid more attention to wrestling with this flawed solution than to the underlying problem: chronic pain.
In short, Rousmaniere says, “We have equated pain management with drug use.” He isn’t shy about making his point:
Too much attention was diverted to fighting the opioid threat. For example, when states introduce hard hitting formularies, such as Texas did and others are doing, hardly any thought is given to making sure patients and physicians have access to a balanced array of non-opioid treatment. This needs to change – now.
Well, chronic pain is real. So, if not with opioids, how should the medical community be treating it?
Rousmaniere’s prescription is an elastic version of conservative care. He describes the approach of California’s second largest private employer, Albertsons / Safeway / Vons, who “learned through experience” that every injured person is a unique individual and that new ideas need to be brought to the recovery process.
For example, it’s almost a cliche to say that chronic pain sufferers tend to depression as well as other mental and behavioral health issues. Consequently, Cognitive Behavioral Therapy, an underused treatment because of its perceived fuzziness, is gaining traction within the world of claims management. As is the idea of treating injured workers in a biopsychosocial way. And, because opioid treatment is still an option, many in the medical community are saying that before any injured workers receive opioid prescriptions they should be screened for depression.
Rousmaniere argues persuasively that “one size fits all” treatment just doesn’t work for many people and that the solution to this thorniest of workers’ comp problems will take a heretofore unheard of level of cooperation and coordination among and between the industry’s disparate factions. He even goes so far as to compare the effort required to the largest single public infrastructure project in the nation’s history, Boston’s Big Dig. Although, having lived through the Big Dig and its daily remapping of Boston’s streets, that’s a bit of a long pull for me. But I get his point:
The goal of the Big Dig was to improve the livelihood of the Boston metropolis – more than reworking traffic flow. The goal of a chronic pain initiative is to keep workers productive – more than managing drugs.
Peter Rousmaniere’s We’re Beating Back Opioids – Now What? is a compelling, stimulating and thought provoking work by a person with 30 years in the workers’ comp trenches and the scars to prove it. It should be required reading for anyone whose job it is to help injured workers return to the productive future each deserves.