30-Year Hydrocodone Treatment Fails to Meet Kentucky Standards for Pain Management

Case File

Although she had been using it for 30 years, a school worker's use of hydrocodone was non-compensable for treatment of her work-related injury. Simply Research subscribers have access to the full text of the decision.

Case

Howell v. Floyd County Board of Education, No. 2024-SC-0504-WC (Ky. 09/18/25)

What Happened

A worker for a Kentucky school district was injured on the job in 1993 and was awarded workers' compensation benefits, including future medical benefits.

After nearly 30 years of the worker's using hydrocodone, as prescribed by her physician, the district initiated a medical fee dispute to contest the compensability of the medication.

An administrative law judge agreed with the district that the prescription was non-compensable. The ALJ's decision was upheld by the Workers' Compensation Board and also in court.

The worker appealed to the Kentucky Supreme Court.

Rule of Law

Under the Official Disability Guidelines, which Kentucky uses to assess the compensability of an injured worker's treatment and prescription medication, hydrocodone is "not recommended" short of circumstances that reasonably preclude other recommended or approved treatment options. The guidelines create a presumption that may be rebutted by presentation of contrary evidence supporting long-term use of hyrdrocodone.

What the Kentucky Supreme Court Said

Reasoning that opioids are commonly used for less than six weeks and pointing out that there are alternatives to opioids that can be used, the Kentucky Supreme Court determined that the ALJ did not err in deeming hydrocodone non-compensable.

In particularly, the court highlight that of the three medical reports in the record, two supported non-compensability, noting that the worker still reported high levels of pain as evidence of an "inconclusive benefit, lack of benefit, or potential harm."

These reports constituted substantial evidence, and the worker did not demonstrate that evidence in her favor "was so overwhelming to compel a favorable finding," meaning that the ALJ did not err.

Verdict: The Kentucky Supreme Court affirmed the Court of Appeals' ruling and upheld the ALJ's determination that the worker's hydrocodone prescription was non-compensable.

Takeaway

In Kentucky, guidelines advise that long-term use of opioids isn't recommended as a reasonable and necessary treatment for pain.

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