Archive for the ‘Drugs’ Category

Opioids: the Gateway to Heroin

Wednesday, February 12th, 2014

The surprising overdose death of acclaimed actor Philip Seymour Hoffman has put a spotlight on a national epidemic: prescription drug abuse. In workers’ comp, prescription drugs have been an area of great concern for a number of years; so too in the public health and policy arena. But has the message — and the necessary education — filtered to the general public? It would seem not: According to the CDC, prescription painkiller overdoses nearly quadrupled in the decade from 1999 to 2008.
This past week, the New York Times framed the new reality: Prescription Painkillers Seen as a Gateway to Heroin

“Dr. Jason Jerry, an addiction specialist at the Cleveland Clinic’s Alcohol and Drug Recovery Center, estimates that half of the 200 or so heroin addicts the clinic sees every month started on prescription opiates.

“Often it’s a legitimate prescription, but next thing they know, they’re obtaining the pills illicitly,” Dr. Jerry said.

In many parts of the country, heroin is much cheaper than prescription opiates. “So people eventually say, ‘Why am I paying $1 per milligram for oxy when for a tenth of the price I can get an equivalent dose of heroin?’ ” Dr. Jerry said.

In many parts of the country, heroin is much cheaper than prescription opiates. “So people eventually say, ‘Why am I paying $1 per milligram for oxy when for a tenth of the price I can get an equivalent dose of heroin?’ ” Dr. Jerry said.”

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Oklahoma: One state’s experience
The investigative journalism non-profit Oklahoma Watch recently published a report on the state’s addiction: As Drug Deaths Rise, Millions of Narcotic Prescriptions Filled
According to this report, Once occupying the ignominious position of first in the list of states with prescription drug abuse, Oklahoma is now #8 on the list. In 2012, 844 Oklahomans were killed by overdoses, eclipsing the year’s 708 traffic fatalities. The state has a real-time Prescription Monitoring Program that is reported to be one of the best in the nation, but doctors are not required by law to check the database before prescribing controlled dangerous substances. There was an average of 68 prescriptions per patient.
Oklahoma is also seeing a steep rise in heroin use, echoing the concept and experience that opioids are the gateway drug.

“Hal Vorse, a physician who treats habitual drug users and teaches new doctors about addiction at the University of Oklahoma Health Sciences Center, said he’s seen the phenomenon in his own practice.

“We’re seeing a big surge in heroin, and 85 percent of those people started on prescription opiates,” said Vorse. “The cost of their addiction got so high that they switched to heroin because it’s cheaper.”

Vorse said the price on the street for OxyContin has risen to $1 to $1.50 per milligram. Addicts typically use 200 to 300 milligrams per day, he said. “They find out they can get an equivalent dose of heroin for a third of what it costs for Oxys,” Vorse said.”

On the Workers Comp front
Meanwhile, in workers’ comp’s battle against opioids, Joe Paduda says that Opioid guidelines are about to get a whole lot better with the anticipated upcoming release of guidelines by ACOEM. He’s has a sneak peek and finds them to be “comprehensive, extremely well-researched and well-documented, and desperately needed.”
But he also points out that more progress is needed: Why don’t workers’ comp payers have pharmacists on staff?.

“I’m only aware of three major work comp insurers (Travelers, BWC-Ohio, Washington L&I) that have pharmacists on staff; the North Dakota State Fund does as well.

With pharmacy costs accounting for somewhere around 15% of total medical spend, that seems like a “miss”. Yes, pharmacy costs have been flat in recent years, but the impact of drugs on work comp claim duration and the medical and indemnity expense associated with long-term drug use is quite significant.

by-state
Resources:
The National Conference of State Legislatures offers an overview of state laws
CDC on the Drug Overdose issue
Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999–2008
Prescription Drug Overdose: State Laws

Opioids: Altered Minds and Bottom Lines

Wednesday, August 29th, 2012

In this era of data mining and predictive analytics, it’s really not that difficult to project which comp claims are headed for “catastrophic” levels. Just follow the meds. A new study entitled “The Effects of Opioid Use on Workers Compensation Claims Cost in Michigan” establishes a direct link between long-acting medications and the eventual magnitude of the claim. Where short-acting opioids are involved, the claim is 1.76 times more likely to break the $100K barrier; with long-acting medications, the likelihood increases to a whopping 3.94. The researchers, including Jeffrey Austin White and Jack Tower of Accident Fund Holdings in Lansing MI, demonstrate what has been long known anecdotally: the use of opioids is an “independent risk factor for development of catastrophic claims.”
The study examined over 12,000 claims that opened and closed between January 2006 and February 2010. (Had they included claims that were still open, the numbers may have been even more dramatic.) In an effort to isolate just how much opioids drove up the costs, the study accounted for other risk factors including sex, age, attorney involvement, the number of medical treatments and claim duration.
Pain and Dr. Sajedi
There is a relatively simple logic at work: injuries cause pain and opioids alleviate extreme pain. The question, naturally, is which injuries require extreme pain relief and which could be managed with lesser medications. Far too many doctors are too quick to prescribe narcotics, even as they fail to implement the most elementary safeguards to ensure that the drugs are used properly and for as short a duration as possible. (A comparable problem exists with the overuse of antibiotics; doctor training clearly needs more emphasis on pharmacology.)
Which brings us to Dr. Ebrahim Sajedi, 46, an internal medicine specialist in California who gets good reviews from his patients. Trained at the Rochester School of Medicine, Sajedi was busted on 12 felony counts of prescribing medications without a legitimate purpose. He provided scripts for Vicodin, Adderall, Klonopin and similar drugs to four undercover police officers without examining them and for no medical purpose. Why buy drugs on the street when you can get the good stuff from a certified specialist?
Bottom Lines
The prevalence of strong drugs in the comp system should come as no surprise. We live in a culture where we are supposed to live pain free, virtually forever, stimulated and distracted in every waking moment. We can hardly fathom the pain that mankind endured in every generation up until recent times. There is a complex, perhaps ultimately incomprehensible alchemy that takes place when pain relievers are introduced into the body. But this relief comes at great cost and even greater risk.
In workers comp, the cost is borne by the employer. The quick pain fix of opioids inevitably finds its way to the employer’s bottom line in the form of prolonged absence from work, higher costs, higher experience mods and bigger insurance premiums. We have long suspected that injured workers on opioids stay out of work far longer than is medically necessary and often find themselves in the downward spiral toward a permanent disability lifestyle. With this Michigan study, we have further documentation that the promiscuous use of drugs undermines the recovery of injured workers and the financial stability of their employers.