Workers’ comp has urgent need for ‘pharmacovigilance’ – Drug of Choice?

PropertyCasualty360.com – November 11,2016
By:  Ron Skrocki

As agents and brokers prepare to counsel clients on ways to minimize the risk of opioid abuse and addiction in workers’ compensation programs, they should be aware of the principles of pharmacovigilance.

This is a practice that has long been used in the pharmaceutical industry to ensure safety around prescription drug use. It involves various stakeholders participating in the monitoring and reporting of adverse drug reactions that could be dangerous — as well as promoting their safe, prescribed usage.

As the term implies, comprehensive and ongoing surveillance of prescribing and usage patterns is the key to safety, and this spirit of vigilance is urgently needed in workers’ comp around opioid use.

Excessive use and addiction

Addiction to prescription painkillers is a growing problem in the United States. Physicians feel compelled to write a prescription at each patient visit, and patients equally desire a quick fix for health issues, particularly pain. As a result, opioid prescription sales have increased 300 percent since 1999. Another consequence is that drug overdoses, predominantly from opioid painkillers such as OxyContin and Percocet, now exceed car crashes as the leading cause of unintentional death.

By its nature, the workers’ comp industry experiences a disproportionately high incidence of opioid use due to the type of accidents and injuries that occur. For claimants with chronic pain issues, opioid abuse can occur in up to 41 percent of cases.

Claimants prescribed an opioid painkiller can develop a tolerance to the drug, require increased dosages and become highly reliant. These claimants may require extensive time away from work, lose the motivation to return and become negatively affected in a number of other ways.

Vigilance at the macro and micro level

At the macro level, regulators can strengthen pharmacovigilance. Norwalk, Connecticut-based Shatterproof, an organization that strives to end addiction, supports legislation that would require physicians and pharmacies to engage with state-run prescription drug monitoring programs to help identify and address prescription drug abuse.

Mandating a closed formulary backed by evidence-based medical guidelines is another macro-level change that would promote alternative pain therapies and use of opioids only when medically necessary.

At the micro level, nurse case managers serve as the central architects for “pharmacovigilance.” Their monitoring helps detect situations that require further review and proactive intervention. For example, they may find prescription costs are rising faster than overall medical costs on a particular claim, without a subsequent improvement in the injured worker’s functional status. They may detect other signs of abuse, such as opioid prescriptions from three or more providers or a significant increase in dosage — all of which can be addressed to avoid the spiral into addiction.