To help combat this crisis, organizations such as the Official Disability Institute (ODG) and The American College of Occupational and Environmental Medicine (ACOEM) have released guidelines for prescribers in the appropriate use of opioids for treating pain specific to workplace injuries.

In a published in a recent edition of the Journal of Occupational and Environmental Medicine, researchers at the ReedGroup and Kaiser Permanente retroactively applied ACOEM’s April 2017 guidelines to 7,840 patients who underwent carpal tunnel release (CTR) surgery from 2007 to 2014. Of the 70 percent of cases prescribed an opioid, 29 percent were contrary to the guidelines, which recommend no more than a five-day supply of short-acting opioids for acute postoperative pain for new users. Patients given greater dosages averaged disability durations 1.9 days longer and medical costs $422 higher than their ACOEM-compliant counterparts.

While these cases were not exclusively workers’ compensation related, given the volume of injured workers who require CTR surgery annually, it’s easy to see how following the guidelines could substantially benefit payers and patients. The study estimates if 29 percent of the 577,000 CTR procedures performed annually��were prescribed an opioid according to ACOEM’s guidelines, the potential medical cost savings is $71 million per year with a reduction in disability durations by 124,000 days. Incredible.

Clinicians at the Center for Surgery and Public Health at Brigham and Women’s Hospital took guideline research a step further by analyzing more than 200,000 postoperative opioid prescribing patterns to define the ideal prescription length by procedure type. Their , published by JAMA Surgery, determined the optimal length of opiate prescription was four to nine days for general surgery procedures, four to 13 days for women’s health procedures, and six to 15 days for musculoskeletal procedures.

While it’s too soon to know the time and monetary impact these guidelines could yield if implemented, it’s heartening to see that the risk of prescription opioid misuse is being considered when looking to alleviate temporary acute pain. We must all be mindful of what is in the patient’s long-term best interests and limiting opioid prescription duration is a critical step in that process.

The post The Road to Optimal Opioid Prescription Length appeared first on 911�Թ�.

This sounded like a smoking gun on how��opioids can often lead to addiction.

When I dug deeper, the data was a little surprising.

Of the total illegal drug users the study cited:

• 12.2% tested positive for marijuana;
• 2.0% tested positive for cocaine;
• 1.3% tested positive for heroin; and
• 125 samples tested positive for PCP and MDMA.

As it turns out, the��majority of the people impacted were using marijuana.

In most cases, marijuana will clear a urine test within a month.��I wanted to check on the overall adult US population usage of marijuana. Of the US population over 12,�� used marijuana within the last month. ��That is only a 0.8% difference. ��If we remove the (under 16) population, who are likely not in the workers’ comp data, the margin is even narrower.�� There may be a slight correlation between��opioid usage and an increase in marijuana usage, but it is very small.

Regular heroin use in the US is between ��–�� based on the studies I have seen. ��The 1.3% usage of the people in the study would be��a 700 – 1300% increase over the general population. ��This��is still a small percentage of opioid users in general that use heroin, but an obvious statistical increase. ��It stands to reason that a higher percentage of opioid users would seek out other types of opioids, such as heroin, so there is no real surprise in the data.

However, these numbers don’t even cover��the main��risk. ��We can see a��correlation in heroin usage between opioid users and non-opioid users. ��What this study does not address is the greater threat posed for people who are cut off from their opioid prescription and their future illegal drug usage. These are the people that are far more likely��to use heroin to continue to��feed their addiction.

As always, the best solution is to manage and monitor treatment from early on so these people never become addicted. ��Industry programs such as our own have a very strong correlation between decreased��opioid usage, and a shorter duration of disability. ��We all must continue to focus on finding better ways��to get��people healthy.

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We are also starting to see some substantive legislative action in response to the opioid crisis that extends beyond formulary adjustments or drug reclassifications.

Massachusetts is the most recent state to limit opioid use,��enacting legislation that limits prescriptions to a 7-day supply.�� Massachusetts is among the nation’s worst states for heroin and opioid usage, with more than 100 drug fatalities each month.�� Although the bill’s language grants providers the flexibility to prescribe outside the 7-day limit, it will force providers to document their reasons, and severely impede any provider from acting as a “pill mill” without legal repercussions.

Specifically, Massachusetts’ , Section 19D states:

(a) When issuing a prescription for an opiate to an adult patient for outpatient use for the first time, a practitioner shall not issue a prescription for more than a 7-day supply. A practitioner shall not issue an opiate prescription to a minor for more than a 7-day supply at any time and shall discuss with the parent or guardian of the minor the risks associated with opiate and the reasons why the prescription is necessary.

(b) Notwithstanding subsection (a), if, in the professional medical judgment of a practitioner, more than a 7-day supply of an opiate is required to treat the adult or minor patient’s acute medical condition or is necessary for the treatment of chronic pain management, pain associated with a cancer diagnoses or for palliative care, then the practitioner may issue a prescription for the quantity needed to treat such acute medical condition, chronic pain, pain associated with a cancer diagnosis or pain experienced while the patient is in palliative care. The condition triggering the prescription of an opiate for more than a 7-day supply shall be documented in the patient’s medical record and the practitioner shall indicate that a non-opiate alternative was not appropriate to address the medical condition.

I think we will see more states follow suit with similar legislation, as new drug formularies and tighter opioid rules have already been proposed across the country. All of this movement will hopefully culminate in a new—and hopefully successful—phase in the nation’s battle against the ongoing opioid healthcare crisis.

The post Regulation of Opioids Increasing appeared first on 911�Թ�.

“Professor Peter Cohen argues that human beings have a deep need to bond and form connections. It’s how we get our satisfaction. If we can’t connect with each other, we will connect with anything we can find — the whirr of a roulette wheel or the prick of a syringe. He says we should stop talking about ‘addiction’ altogether, and instead call it ‘bonding.’ A heroin addict has bonded with heroin because she couldn’t bond as fully with anything else.

So the opposite of addiction is not sobriety. It is human connection.?”

They reference the famous drug experiment where a rat living in isolation will consistently choose water laced with cocaine or heroin over clean water until it kills them. But when this same experiment is conducted in a virtual “rat heaven” (e.g. great food, tunnels, and multiple rats living together), the rats will mostly choose the pure water. None of these rats died.

Addiction is something our industry combats daily and it’s something that, like many of you, I have experienced with people close to me. These were people I loved and respected, but they shared a common pattern of drug use that arose during personal crises. Divorce, financial issues, or disconnection from family were always present at these troublesome times.

An illness or injury can be an isolating event, and can certainly trigger stress in a person’s life. They may have worries about health, finances, productivity—the list can be long and varied. It is vital to provide a patient not just with treatment, but also with the support system, empathy, and connection to help them manage pain and recovery responsibly.

For these reasons, 911�Թ� takes a holistic view of a patient’s health so that our interactions account for the physical/chemical, psychological, and social aspects of treatment and healing. For instance, with our early intervention program, we identify a patient’s psychological/social risk factors and we also employ a “medical concierge” approach that provides support and advocacy, assures appropriate treatment, and monitors risk throughout the continuum of care. What this article reinforces to me is that the social warning signs will often be more powerful than the physical. If a patient is unhappy at work or at home, it is a potent indicator that any addictive substance might pose a risk, particularly if used as a substitute for human bonding.

Humans are social animals. Relationships are critical—in work, in life, and yes—in recovery from injury/illness. We need to look beyond the physical and psycho-social red flags of addiction, and think of preventing addiction in terms of caring, compassion, and connectedness in our claims and medical management efforts.

The post Main Cause of Addiction: Loneliness appeared first on 911�Թ�.

That is why I was so surprised by one of the commercials that aired during the game.

It was an “educational PSA-type” ad, not for opioids, but for Opioid Induced Constipation (OIC). was paid for by AstraZeneca and Dalichi Sankyo, two biopharmaceutical companies that also happen to market the OIC relief drug Movantik.

For the ostensibly educational “OIC Is Different” campaign, these two for-profit pharma companies joined forces with organizations like the U.S. Pain Foundation, The American Chronic Pain Association, The International Pain Foundation, amongst others.

What was most disturbing about this ad, though, wasn’t the awkward content or the blatant conflict of interest. What is truly disturbing is that the opioid issue in this country is now so severe, so mainstream, and so pervasive, that it’s created an “audience” large enough that marketers can justify using the most expensive advertising platform available to promote opioid side effects medication.

Now that is pretty scary.

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We’ve heard that:

• Shark attacks are up in the US (53 in 2013, vs. 42 in 2012).
• Terrorism and mass shootings (or “multi-party shooting incidents”) are responsible for in the US in 2015.

These are, of course, terrible.

Yet, I recently wrote about how the US has over 440,000 deaths per year from hospital errors. These fatalities are 1,000 times worse than those from the mass shooting crisis our nation is facing, and yet I’ve not heard one mention about this in any presidential debate thus far.

Now, we have 47,000 people in a single year according to the CDC’s latest 2014 figures. This problem has an impact 100 times greater than the mass shootings. When you consider that the majority of mass shootings are drug-related (dealer infighting), the issue of drug usage becomes glaringly apparent. When you also consider that these shooting figures do not account for single-incident and police shootings – including the civil unrest caused by the “war on drugs” that is tearing apart the social fabric of areas of our nation – drugs become an even more critical issue.

The comparison to the gangsters and rampant violence in the US during Prohibition (a.k.a, “the war on alcohol”) is an obvious one to me.

If you think that regulations and stricter controls are the answer, consider this: over 50% of all drug overdose deaths result from highly regulated prescription drugs (16,235). That is nearly double those from street heroin (8,257). When you realize that most new heroin users began as prescription opioid abusers, the idea that regulations will assist in solving this problem seems a bit absurd.

I have thought long and hard on this issue.

I hate what addiction does to families and individuals. Just like alcohol, some people can take medications with no adverse impact on their lives, while others have a propensity to addiction. I have experienced addiction problems in my own family, and I would not wish them on anyone.

Still, I am a data guy. If something is not working, and something else would work better, the correct answer seems obvious. I believe our country’s drug problem is a health issue — not a criminal issue. Countries such as Belgium that have shifted focus from prosecution to treatment have seen a significant reduction in both crime and addiction. Likewise, when addressed their drug crisis by shifting their strategy from punishment to treatment, the country saw drug usage, addiction, health issues, and incarceration rates all decline.

Alex Stevens, a professor of criminal justice at the University of Kent states: “The main lesson to learn – decriminalizing drugs doesn’t necessarily lead to disaster, and it does free up resources for more effective responses to drug-related problems.”

We have seen positive results from the legalization of marijuana in some states in the US, similar to those in the countries mentioned above. This change has certainly not led to any “crisis.”

My conclusion? The best approaches to address and reduce these issues are exactly what 911�Թ� is doing today. For example, patients in 911�Թ�’s Ultimate early intervention program, whose treatment is overseen by nurse case managers, have experienced very significant decreases in drug and opioid usage.

Our pharmacy review program focuses on long-term usage/addiction and does not cut patients off. Instead, patients are guided through a weaning program to prevent them from moving to harder and even more dangerous drugs.

Our Pharmacy Benefit Manager (PBM) partners also have formularies to prevent unnecessary prescriptions and addiction. Such programs positively impact people’s lives without the need to criminalize behaviors that might lead to jail or violence.

We are having a substantial and lasting impact on society, and these are treatment efforts that we can – and should – be proud of.

The post CDC Reports a Record-Breaking Year for U.S. Overdose Deaths appeared first on 911�Թ�.

Many drugs are coming off of patent, meaning generics of those drugs can now be manufactured. Historically, this has always driven down costs and “generics” was synonymous with “cheaper.”

A may give us a clue as to why this is happening.�� It turns out the pharmaceutical companies are buying smaller companies or their rivals, and jacking up their prices. Since 2008, branded drug prices have increased 127%, versus an 11% increase in the Consumer Price Index (CPI).

This is very similar to what is occurring in the hospital world. Hospitals are buying competing hospitals, medical groups and ambulatory surgery centers, and once they have established a virtual regional monopoly, they raise all the prices.

If you can’t beat them, buy them.

The post If You Can’t Beat Them, Buy Them: Why Some Drug Costs Are Going Up appeared first on 911�Թ�.

Issues with this practice include:

• The costs are way higher than a pharmacy or PBM (pharmacy benefit manager). They can only sell these drugs to workers’ compensation, auto or liability patients in states that allow it. Group health will not pay enough so this method is not worth it to them.
• There is a massive incentive for physicians to prescribe drugs, even when they are not needed. This is ESPECIALLY true for addictive drugs that could require lots of follow-up visits and prescriptions.
• It circumvents the formulary and controls of a PBM.
• The��physician can only prescribe what they have in-house, which may not be the best choice for the patient, may not be a generic, etc. ��The machines have limited selections.

No matter how you slice it, there is no benefit to society (except that the patient does not have to go to a Walgreens).����This small inconvenience does not seem to be a reasonable offset for the cost.

Read this amusing article addressing this topic, ��

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