Opioid Scripts Down, Alternative Pain Med Use Increases, in Latest Coventry Report

Sarasota, FL (WorkersCompensation.com) - Understanding the types of medications associated with the ages of claims can lead to better outcomes and improved return-to-work rates, according to Coventry. In a new video, the company compares the top therapeutic classes for claims of a year or less, and those two years or older.

“Overall, claims that remain open longer are generally associated with greater medical severity compared with claims that fall within the one year or younger bracket,” said Nikki Wilson, director of Pharmacy Product Development at Coventry, “and in older claims it is not uncommon to see a number of different medications tried over the course of two-plus years to find the best treatment option for these patients while minimizing negative outcomes.”

Nonsteroidal anti-inflammatory drugs — NSAIDs — are increasingly being used to treat injured workers, while opioids, especially long-acting ones have decreased in use. NSAIDs, such as ibuprofen, naproxen and meloxicam comprised 26.7 percent of total prescriptions for younger claims in 2018.

Short acting opioids and muscle relaxants, such as backlofen, tizanidine and cyclobenzaprine accounted for the next two drug classes used for claims of one year or less.

“Notably, proportionate use of short acting opioids like morphine, hydrocodone with acetaminophen, and oxycodone products decreased from 2017 to 2018 and was offset by slight increases in other first line treatments that can be used for pain,” Wilson said.

Older Claims

Longer term claims of two years or more saw a “proportionate decrease in opioid scripts from 2017 to 2018 for both short acting and sustained release opioids,” Wilson said. “The apparent shift toward increased use of first line or opioid alternative medications that can be used for pain management  follows evidence based treatment recommendations  and mirrors the FDA’s long-acting, extended-release opioid labeling which states that these types of medications should be reserved for use in patients for whom alternative treatment options such as non-opioid analgesics or immediate-release opioids are ineffective, not tolerated, or would otherwise be inadequate to provide efficient management of pain.”

In addition to NSAIDs, anticonvulsants have gained in popularity for injured workers. While they were designed to treat seizures, they’ve also been shown to help manage chronic and neuropathic pain.

Medications to manage the side effects of other drugs are more widely used in longer term claims. Anti-ulcer medications, for example help manage the effects of long-term use of drugs such as NSAIDs. Drugs to treat depression are also more common among workers with longer term claims.

The use of topical drugs increased for both younger and older claims, and were used almost equally — 4.6 percent for shorter term claims and 4 percent for longer claims. They include products such as gels, patches and solutions of NSAIDs; lidocaine patches, creams and ointments; and “several nonprescription products including costly private label topical analgesics,’ Wilson said.

The video comes as the company also released information on its latest drug trends in workers’ compensation. The first ‘infographic’ showed retail and mail-order pharmacy trends for 2018 included:

• Decreases in the use of opioids for five consecutive years
• The largest reduction in the average morphine equivalent dose in five years
• Increases in specialty medication. “While specialty medications have low utilization, they are of particular interest due to their significant costs,” the infographic states.

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