Physicians Failing to Treat Narcotics Abuse by Injured Workers: Study

Nearly 1 in 12 injured workers given narcotics are still on them 3 to 6 months later as few doctors appear to be following recommended treatment guidelines to prevent abuse, according to new research.

This report, “Longer-Term Use of Opioids,” by the Workers Compensation Research Institute (WCRI) examined longer-term use of narcotics (or opioids) in 21 states and how often recommended treatment guidelines for monitoring injured workers with longer-term use were followed by physicians. The monitoring includes services, such as drug testing and psychological evaluations, which can help prevent opioid misuse by injured workers that could result in overdose deaths, addiction, and diversion.

The study found relatively low compliance with the medical treatment guidelines in most states. Among the study’s findings:

• More frequent and longer-term use of narcotics may lead to addiction and increased disability or work loss. Nearly 1 in 12 injured workers who started narcotics were still using them 3-6 months later.

• Drug testing was used less frequently than recommended by medical treatment guidelines. Among claims with longer-term use of narcotics, 18-30 percent received drug testing in most states studied, with the 21-state median at 24 percent. Over the study period, the percentage of workers with longer-term use of narcotics who received at least one drug test increased from 14 to 24 percent in the median state.

• Use of psychological evaluation and treatment services continued to be low. Only 4–7 percent of the injured workers with longer-term narcotic use received these services in the median state. Even in the state with the highest use of these services, only 1 in 4 injured workers with longer-term narcotic use had psychological evaluation and 1 in 6 received psychological treatment. Little change was seen in the frequency of use of these services.

“This study addressed a very serious issue: how often doctors followed recommended treatment guidelines for monitoring injured workers under their care, who are longer-term users of narcotics,” said Dr. Richard Victor, WCRI executive director.

Victor said the study should help public officials, employers, and others balance providing appropriate care to injured workers while reducing unnecessary risks to patients and costs to employers.

The study is based on nearly 300,000 workers compensation claims and 1.1 million prescriptions associated with those claims from 21 states. The claims represent injuries arising from October 1, 2006 to September 30, 2009, with prescriptions filled up to March 31, 2011. The underlying data reflect an average of 24 months of experience. The states included in this study are: Arkansas, Arizona, California, Connecticut, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

Research by the California Workers’ Compensation Institute last year found that a small percentage of medical providers are responsible for writing narcotic prescriptions for workers’ compensation patients.

A 2009 study by the insurance industry’s National Council on Compensation Insurance (NCC() found that narcotics account for nearly one quarter of all workers compensation Rx costs.

A report by the National Center on Addiction and Substance Abuse at Columbia University found that 15.1 million Americans — more than 6 percent of the country’s adult population — admit to abusing prescription drugs.

WCRI is a not-for-profit research organization. Its members include employers, insurers, governmental entities, managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies.