Opioids are Just One Pharmaceutical Issue Facing Workers' Comp Programs

Sarasota, FL (WorkersCompensation.com) - Opioids, the class of powerful pain-relieving drugs including oxycodone, hydrocodone, codeine and morphine, have dominated headlines in recent years as the United States has seen a rapid increase in problems associated with both their prescription and non-prescription use.

There are, however, other significant pharmaceutical issues in workers’ compensation that have been getting far less attention than opioids.

First, a look at how the opioid issue developed:

It was within the workers’ compensation arena that the problem of opioid addiction began to surface, according to Joe Paduda, president of CompPharma. CompPharma works with pharmacy benefit managers (PBMs) within workers’ compensation programs to find cost-effective solutions to pharmaceutical issues.

Paduda told WorkersCompensation.com that problems with opioid use — specifically, that the drugs had become at least as much of a medical issue as the underlying injury — were first noticed within workers’ compensation programs more than a decade ago.

In the years since, Paduda said, workers’ compensation programs have come to rely on PBMs to alert claims handlers to opioid issues. In addition, Paduda said, PBMs have set up formularies — lists of approved medications — that provide alternatives to opioids.

PBMs have also set up approval processes for the use of opioids, according to Paduda.

All of that work has been valuable, Paduda said, in “just preventing the initial prescribing” of opioids.

Recently, pain management strategies have been moving away from drugs toward physical therapy and other approaches, including acupuncture and even meditation, Paduda said.

There is a long way to go before those strategies become the dominant treatment paradigm.

“We’re definitely in the early stages,” Paduda said. “These are by no means the dominant way of doing things.”

“It’s a daily fight,” he said, that pits alternative therapies against the power and influence of pharmaceutical companies.

Opioids may be getting the headlines, but they are by no means the only drugs that can be problematic within workers’ compensation scenarios.

Mark Pew, senior vice president of PRIUM, told WorkersCompensation.com via email that a number of drugs can create serious issues. PRIUM is a provider of workers' compensation medical peer review services

Among those other drugs, Pew wrote, are benzodiazepines, which carry brand names like Xanax and Valium. Used primarily for treating anxiety, benzodiazepines — which act on the body’s central nervous system — also are used to treat seizures, and for muscle relaxation.

According to Pew, benzodiazepines “are highly addictive, complicated and lengthy to wean [and] … risky to use long-term.”

Benzodiazepines can “really complicate things when mixed with an opioid,” Pew added. 

Other problematic drugs, Pew wrote, include carisoprodol, marketed under the brand name Soma, a muscle relaxant that works by blocking pain sensations. Like benzodiazepines, carisoprodol is “very addictive, requires weaning and doesn’t mix with opioids,” according to Pew.

Beyond those drugs, even things like NSAIDs — non-steroidal anti-inflammatory drugs, including common pain relief medications like aspirin, ibuprofen, Celebrex and Aleve — have the potential to cause kidney and/or liver issues over the long term, Pew noted.

And interestingly, according to Pew, cannabis — better known as marijuana — is becoming an issue in terms of workers’ compensation-related medical treatment.

“Regardless of what advocates say, cannabis is addictive and is increasingly being considered as medical treatment (and reimbursed as such) in workers’ compensation,” Pew contended.

According to Sherri Hickey, assistant vice president for medical management at Safety National, a provider of alternative risk funding products, workers’ compensation programs and other providers find themselves dealing with cost issues associated with the regular introduction of new drugs into the marketplace.

As just one relatively recent example, Hickey pointed to Duexis, a proprietary single-tablet combination of the common and inexpensive over-the-counter drugs ibuprofen, a pain reliever, and famotidene, an acid reflux drug.

According to Matrix Healthcare Services, a pharmacy benefits management company, when Duexis was introduced in 2011, its average wholesale price was $1.86 per tablet. As of 2015, that average had climbed to $18.65 per tablet.

Hickey noted that both of the drugs in Duexis are available separately, as generic medications, at a substantially lower price. Today, ibuprofen’s average wholesale price is 30 cents per tablet while famotidene is available at approximately $4 per tablet. 

To read more WorkersCompensation.com coverage on compound medications, click here.

And Duexis is not an isolated case, Hickey said.

“Several drugs are driving us crazy,” Hickey told WorkersCompensation.com.

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