The Ohio Bureau of Workers’ Compensation (BWC) is taking steps to try to undo the massive opioid dependency problem brought on by prescription medications.
BWC Acting Administrator/CEO Sarah Morrison announced a proposed new opioid prescribing rule to support the health and safety of Ohio’s injured workers. The proposed rule, presented at the monthly meeting of the BWC Board of Directors Medical Services and Safety Committee, defines best medical practices for the use of opioids to treat workplace injuries and illnesses. The rule would be the first of its kind in Ohio law.
“While opioid prescriptions are often an appropriate part of treatment for workplace injuries and illnesses, we know that long-term use can actually hinder recovery and a timely return to work,” Morrison said. “Ohio’s injured workers deserve the best possible treatment that addresses their medical needs without facing the life-changing consequences of opioid dependence or addiction.”
Under the rule, reimbursement for opioid prescriptions would be limited to claims in which current best medical practices are followed. The rule builds upon best practices developed by Governor Kasich’s Cabinet Opioid Action Team by addressing the needs of injured workers. Best practices include the development of an individualized treatment plan, risk assessment and close monitoring of the progress and improvement in function of the worker. The goal is to ensure best practices are followed at the onset of an injury, and throughout the course of treatment so injured workers receive care that ultimately improves their condition.
The rule also allows BWC to provide treatment for opioid dependence that arises from the use of opioid medications covered by BWC. Treatment for dependence could include psychological counseling and medication assisted treatment for recovery. Finally, a new peer-review process would address a prescriber’s failure to comply with best practices.
BWC began making improvements to its pharmacy program in 2010 to ensure injured workers receive medications necessary for their recovery without endangering their health. Since the creation of BWC’s first-ever formulary, there has been an ongoing reduction in prescriptions for opiates, as well as commonly overused drugs. Total opioid doses have decreased by 23.8 million, or 41 percent, since 2010.
“We’re in the midst of an opioid crisis in this state and across the country,” said Dr. Stephen Woods, BWC Chief Medical Officer. “This rule has important implications not just for injured workers, but to their families, friends and their surrounding communities.”
As part of the U.S. government’s urgent response to the epidemic of overdose deaths, the CDC recently issued new recommendations for prescribing opioid medications for chronic pain, excluding cancer, palliative, and end-of-life care. The CDC Guideline for Prescribing Opioids for Chronic Pain, United States, 2016 will help primary care providers ensure the safest and most effective treatment for their patients.
“I think guidelines are a good starting place,” Scioto County Health Commissioner Dr. Aaron Adams said. “I think we need to get the providers to start backpedling from all of the overprescribing we have dealt with over the years.”
The United States is currently experiencing an epidemic of prescription opioid overdose. Increased prescribing and sales of opioids—a quadrupling since 1999— helped create and fuel the epidemic. More than 40 Americans die each day from prescription opioid overdoses.
“We’ve seen so many deaths, so many overdoses, still from prescription drugs, not just the heroin,” Adams said. “We’ve got to develop a culture of prescribers that don’t prescribe opiates, particularly the hydrocodone, the oxycodone for chronic pain. We’ve got to get away from that. We use those for acute pain and try in certain situations that it’s required like post-operative care, some type of serious injury, or consider some type of lesser pain medications like the non-steroidal anti-infalatory derivatives, physical therapy, Tylenol (Acetaminophen), massage, other modalities to avoid the possibilities of addiction.”
The BWC Board of Directors is expected to vote on the proposal during its May 26 meeting. If approved, the rule would become effective Oct. 1, 2016.