Much has been written about the problem of opioid abuse and addiction. Narcotics prescribed over the long term, multiple prescriptions, multiple prescribers, poor clinical outcomes, decreasing functionality and problem behavior are all red flags that a pain situation has gotten out of control.

While a biopsychosocial approach to treating the whole person is the only effective method to stop the cycle of pain complaints and additional drug use, what can be done to help those without a skilled care manager or responsible physician? Two recent developments in West Virginia and Maine represent new approaches to fighting this public health epidemic.

Lawsuits Against Pharmacies and Physicians

Virginia’s Supreme Court of Appeals recently ruled to allow lawsuits against physicians and facilities for negligently prescribing and dispensing drugs, even by patients who admittedly used illicit drugs in the past. The move draws new attention to the physicians and pharmacies that are incautiously administering opioids to their patients, and raises the consequences for those who behave inappropriately or simply do not pay attention to the warning signs.

To assist in the reduction of overprescribing, workers’ compensation payers are advised to check if physicians are accessing prescription drug monitoring programs and to review practice history for red flags. However, though this intervention is vital, it is important to remember that most patients who are harmed by excessive opioids are not seeing multiple prescribers and, therefore, would not be identified by a PDMP database review.

Make Harder-to-Abuse Opioids More Affordable

The second approach comes most recently from Maine, where lawmakers are looking to reduce the amount of opioid addiction by making abuse-deterrent opioids more affordable for patients seeking pain relief. Currently, insurance companies charge more for harder-to-abuse opioids than those typically prescribed. The legislation is designed to make insurance companies cover the drugs equally. Massachusetts passed a similar law last year, and other states are considering the same.

Several manufacturing techniques make medications harder-to-abuse, such as designing them to be more difficult to crush, cut or dissolve, or converting them into a gel so they are harder to inject. Some insurance companies and physicians are skeptical of the outcome from this bill, since the harder-to-abuse opioids are all name-brand drugs, which cost quite a bit more than a generic. Similar to the PDMP database, this intervention targets only that population apt to abuse prescription medication by unintended routes (e.g., intravenous, snorting, and smoking). Most patients harmed by excessive opioids are not in this population.

Opioid misuse and overprescribing are problems and Paradigm Outcomes is committed to ensuring that injured workers and our clients don’t fall victim. Though the drug-abusing population is an important group in need of identification and mitigation strategies, there is a larger population of overmedicated, injured workers who require nuanced intervention to decrease over-prescription and the supply of opioids. By providing injured workers with comprehensive care management, we can help facilitate effective pain management and reduce the risk of opioid addiction and abuse, providing a better outcome for everyone involved.

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