WCRI 2017 Conference Afternoon Sessions – Blogging Live
Please note I only input the trends and not the exact numbers from some of the studies. These studies are still in their preliminary phases.
WCRI OPIOID RESEARCH & HOW STATES ARE COMBATING THE OPIOID EPIDEMIC
This is the start of the WCRI 2017 Conference afternoon sessions. Join us as we learn about WCRI’s latest research on interstate variations and trends in the use of opioids for workplace injuries across 25 states.
We will also feature policymakers from different states who will share their initiatives to combat the opioid epidemic, to prevent inappropriate opioid use, and to provide help for those battling addiction.
Dr. Vennela Thumula, WCRI
Judge Omar Hernandez, Massachusetts Department of Industrial Accidents
Mr. William Emrick, Acting Commissioner, Kentucky Labor Cabinet
More Than 70% of injured workers with pain meds are still receiving an opioid
Cannot live blog exact studies – preliminary
Positive Results
- Arkansas had 83% of injured workers with pain meds prescribed had an opioid
- Kentucky and New York had largest reductions in opioid use
- Michigan and Maryland had over 35% reductions in opioid use
- Kentucky and NY had PDMP requirements with the best results
- New York introduced Chronic Opioid Guidelines
- Quantity limits introduced in KY, -, –
- Kentucky shifted a large amount of pain prescriptions from opioid to non-opioid
Negative Results
- Louisiana and Pennsylvania have highest amount of opioids per claim
- Massachusetts and Wisconsin have the highest amount of mixing opioids with benzodiazepines
- Louisiana and Florida have highest amount of mixing opioids and CNS Depressants
Kentucky’s Battle with Opioids
- Kentucky, West Virginia , and West Virginia had an extremely high opioid epidemic
- Senate Bill 176 was introduced in 2005 to created a PDMP
- SB 176 was turned away
- HB 1 introduced in 2012 – pill mill bill – not just Workers Comp claimants, general public
- KASPER – electronic reporting of all schedule prescriptions
- KASPER has to be checked regularly by physicians
- KASPER has to be in all medical records
- Criticisms – complicated the treatment system, etc.
- HB 217 to eliminate problems by HB 1
- HB 296 requires Workers Comp Commissioner to establish a specific PDMP
- Heroin overdoses up in Kentucky, no studies related overdoses to reduction of opioid use as unintended consequences
Massachusetts Opioid Crisis
- Opioid Alternative Treatment Pathway
- Judges are in a dilemma – will usually send the case along to litigation, let the opioid alternative alone
- One year to hearing
- Post lump sum hearings – no compensation at risk
- Medicals are lifetime in Massachusetts even if case settled
Proposed Opioid Alternative Treatment Process
- Voluntary program
- Pilot program for two years
- Monthly status updates to Workers Comp Advisory Council
ALTERNATIVES TO OPIOIDS IN TREATING PAIN
As injured workers are steered away from treating their pain with opioids, some in the workers’ compensation community have asked, “What is the alternative for treating pain?” Join us as we learn about two emerging alternatives: marijuana and evidence-based non-pharmacological treatments, including mindfulness-based and cognitive behavioral approaches. The session will feature the latest research on these alternatives as well as first-hand accounts from state government officials on how one alternative, medical marijuana, is being incorporated into the treatment of injured workers in their state workers’ compensation systems as well as what it is like to be managing a program that is very new and federally illegal.
Mr. Paul Sighinolfi, Executive Director of the Maine Workers’ Compensation Board
Mr. Paul Tauriello, Director of the Division of Workers’ Compensation, Colorado Department of Labor
Dr. Dawn Ehde, University of Washington
Dr. Dean Hashimoto, Chair of the Health Care Services Board, Commonwealth of Massachusetts
National Academy of Science Report on Medical Marijuana
- Improvement in chronic pan
- Substantial evidence
- Very little known about efficacy
- Increased risk of vehicle crashes
- Development of schizophrenia and psychosis
- Marijuana cannot be associated with an increase in job injuries
- 25% decrease in opioid mortality rate in states that had medical marijuana
- 20% decrease in opioid addiction rate in states with medical marijuana
- Federal laws are main obstacle
- Lack of prescription standards, routes of administration, dosage
- Difficult to conform to federal banking and other laws.
Some states have allowed coverage in WC
- California – Cockerell vs Farmers Insurance
- Maine – Series of Cases
- Massachusetts – unpublished
- Colorado – ?
- New Mexico
Colorado
- Obama administration – Ogden Memo loosened the Federal enforcement
- First to allow recreationally
- Smoothest harmonization
- Marijuana – $1.3 billion sales – 30% increase over last year
Maine
- Certification as FDA has not approved, so no prescriptions can be written
- Typical patient 58 year old with back pain
- Condition specific recommendation or certification
- November 2009 – 2.5 ounces
- Added in intractable pain as a condition
- Burgoin case – ALJ ruled that marijuana was reasonable necessary, appealed to Supreme Court, cost of medications vs. just marijuana indicated a 75% in medication costs.
Questions
Centered on concerns about
- Operating a vehicle or
- Being under the influence on-the-job
- Better way to treat pain that just prescribing marijuana – should be a total approach
- Marijuana is another tool in the toolbox of pain treatment
Non-pharmaceutical Pain Management
- Biopsychosocial Model of Pain
- Who manages the pain – the individual themselves
- Physical activity-Exercise
- Cognitive Behavioral Therapy – CBT –
- changing the negative thinking
- better than no treatment
- magnitude of pain relief is similar to analgesics
- Mindfulness Meditation
- Should be integrated into overall pain treatment
- Collaborative Care – integrated healthcare – Care Manager is the hub of treatment
Questions
How does one have the Workers Comp community accept the psychological treatment part of an injury as the attempt is to avoid this type of treatment – screening at 6- 10 weeks of care for high risk to send to collaborative care
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