WCRI released a new study: Interstate Variations in Dispensing of Opioids, 5th Edition, which assesses claims data from 27 states, including Louisiana, from October 2011 to March 2018. The study finds that, in all states studied, fewer injured workers received opioids recently as compared with previous years. Injured workers continue to be treated for pain with NSAIDs, which increased modestly, and other interventions.
Louisiana, though it saw declines in opioid prescriptions, was well outside of WCRI's median decline in opioid dispensing. Key conclusions about Louisiana opioid prescriptions included:
50 to 60 percent of injured workers with prescriptions received at least one opioid prescription in a majority of states. A higher proportion of injured workers with prescriptions in Arkansas and Louisiana (70 percent) received opioids.
On average there were 6.2 prescriptions for opioids in Louisiana, totaling 381 opioid pills per claim, compared with 2.8 prescriptions and 131 pills per claim for opioids in the median state.
The percentage of injured workers with prescriptions who received two or more opioid prescriptions was 48 percent in Louisiana – 22 percent higher than the median state and nearly four times as frequent as the rate in one of the lowest prescribing states, New Jersey (13 percent).
WCRI focused on claims without major surgery. The average amount of opioids per claim exceeded 3,200 milligrams of morphine equivalents in Louisiana nonsurgical claims, which was triple the median state.
Louisiana workers received opioids for 115 days, on average, compared with 36 days in the 22-state median.
In a written statement from the OWCA, Assistant Secretary Sheral Kellar stressed that context is needed to understand Louisiana's comparatively high rate of opioid prescribing, emphasizing that reforms have been made under Governor John Bel Edwards' administration.
The statement is below, edited for brevity:
“The report concludes that opioid prescribing declined substantially in most of the 27 states studied, including Louisiana. Despite the decline in both the number of opioid prescriptions per claim and the number of morphine milligram equivalents prescribed per claim, Louisiana is still on the high end of both when compared to the other states studied. One reason for this may be that while the frequency of claims is down in Louisiana, the severity of claims is up. More severe claims require appropriate pain relief medication, even in cases of nonsurgical injuries.
It is refreshing to see that the use of opioids in Louisiana is on the decline, even though the severity of reported claims is increasing. John Bel Edwards' aggressive approach to addressing the opioid crisis directly correlates to the decline in the number of opioids dispensed in both general health and workers' compensation. Act 82, provided for a seven day limitation on the prescribing of opioids to an adult patient with an acute condition. Act 76 requires a prescriber of opioids to possess a controlled dangerous substance license issued by the Board of Pharmacy prior to dispensing opioids, to be registered as a participant in the Prescription Drug Monitoring Program (PDMP), and to access and review the PDMP at least every ninety days and to successfully complete a requisite number of continuing education credits as a condition of continued licensure. Act 88 established the Advisory Council on Heroin and Opioid Prevention and Education. There were other legislative changes implemented to address the opioid crisis, as well. While legislative changes are slow to reverse the tide, the WCRI report does reflect that legislation is having a positive impact, although nominal.
The opioid crisis didn't appear overnight and it will not be mitigated in a single legislative session or even two. All stakeholders, prescribers, payors, injured workers, administrators and others must work together to effect major changes to curb the tide of opioid abuse. LWC will continue to work with stakeholders to address this issue and any option suggested by stakeholders will be given serious consideration by the administration.”
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