In recent years, the number of cases involving the use of opioid medication as a regular course of treatment for chronic pain, failed back syndrome, poor surgical results, and other non-life threatening conditions have increased. Workers’ Compensation Commissions, employees, employers and insurers recognize this fact. All are seeking ways to address an ever increasing problem of addiction.In March 2016, the Center for Disease Control and Prevention (CDC) issued guidelines to address this issue. Director Tom Frieden was quoted in an interview as follows: “Starting a patient on opiates is a momentous decision, and it should only be done if the patient and the doctor have a full understanding of the substantial risk involved.” (Washington Post, March 16, 2016).
Opiates have a significant role for surgical patients to provide a reduction of pain and enhance post-surgical recovery. However, too often opiates are prescribed for chronic pain without a clear understanding of the risks. In many cases, the pain is not reduced, and the request for more medication becomes a reality. The physician sometimes prescribes the medication to avoid an unfavorable review by a patient or the possibility of defending a malpractice claim.
From an employer and insurer standpoint, the cost of such medication can be as much as $2,500.00 per month or more, with little or no evidence of improvement of the injured worker’s symptoms. This ever increasing cycle should be stopped.
Recognizing and Identifying Such Cases Early Benefit the Employee and the Employer/Insurer
The early recognition and identification by the claimant and employers/insurers of potential opioid abuse cases and the cooperative steps of all parties and worker’s compensation administrators to address the problem benefits all. Elements of such recognition and identification include:
- Evaluation of the nature of the underlying medical condition and need for opioid medication. Is the medication being used to control pain for subjective symptoms as opposed to objectively determinable symptoms?
- Is the patient better off utilizing other forms of medical treatment such as physical therapy, exercise, and use of anti-inflammatory non-steroidal medication?
- Once opioids are prescribed, are they managed by qualified pain management physicians?
- Is there a contract between physician and patient whereby the patient agrees to take only the medication prescribed in the amounts prescribed exclusively by that physician?
- Is the patient consulting multiple healthcare providers to obtain medication?
- Are there unannounced urine checks to ensure patient compliance?
Role of Workers’ Compensation Commissions and Administrators
The opportunity of employees, claimant’s attorneys, employers and insurer attorneys, and Commissions to address this ever growing problem is upon us. The employee claimant needs appropriate treatment, including in-patient multi-disciplinary modalities. Such treatment would include a team approach with consultations by physicians, psychologists, physical therapists, occupational therapists, nurse case managers, social workers, etc. Counseling for the claimant’s family should also be available. Employers and insurers as a matter of wise case management need to recognize that paying for appropriate treatment sooner is cost effective in the long run. Commissions and Workers’ Compensation Administrators would oversee the treatment and when necessary, relieve employers and insurers of long-term liability in the event of non-compliance by the employee. The employee must demonstrate continuous efforts to cooperate fully with the treatment plan of care.
In-Patient Treatment Facilities
Maryland is fortunate to have in-patient management programs. They include Johns Hopkins, Father Martin’s Ashely, and Sinai Hospital. There are other in-patient centers out of state that are reputable and provide accommodations for family members who may provide additional support to the patient.
Recommendations
The early recognition and identification of potential opioid cases, the willingness of all parties to cooperate in such cases, and the role of Commissions and Administrators are deemed to be significant steps to eradicate a growing national problem. Unfortunately, the alternative fact of drug overdoses and possible death remains a troubling social problem.
Don Maiberger is a member of Anderson & Quinn, LLC, in Rockville, Maryland, specializing in workers’ compensation. He has tried hundreds of workers’ compensation matters in Maryland and the District of Columbia, and has negotiated favorable settlements and resolutions through mediation. He has also been invited to lecture on a variety of issues involving workers’ compensation.
