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Opioid Abuse Crisis:

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Title: Opioid Abuse Crisis:


1
Opioid Abuse Crisis The Plague of Workers
CompensationKathleen Fraser RN-BC, MSN, MHA,
CCM, CRRNPresident-Elect National CMSA
2
  • Life is ten percent what happens to you and
    ninety percent how you respond to it.
  • Lou Holtz

3
  • Deaths from prescription opioid painkillers have
    reached epidemic levels in the past decade.

4
  • Opioid analgesics are now responsible for more
    deaths than the number of deaths from suicide,
    motor vehicle crashes, cocaine and heroin
    overdoses combined!

5
  • Persons with pharmaceutical opioid-related
    substance use disorders are disproportionally
  • Caucasian
  • Female
  • Middle-age
  • Residents of rural communities
  • Yet more men than women die of overdoses from
    prescription painkillers.

6
  • A disturbing trend has been caused by a whole
    host of factors
  • A philosophical shift in physician attitudes
    toward the treatment of pain.
  • The Joint Commission on the Accreditation of
    Healthcare Organizations core principles state
    that patients have a right to pain assessment
    and management and a patients self-report is the
    most reliable indicator of pain.

7
  • While this attitudinal shift may be positive for
    chronic pain sufferers, regulatory systems must
    be designed to effectively monitor these powerful
    prescriptions.

8
  • Improving the way prescription painkillers are
    prescribed can reduce the number of people who
    misuse, abuse or overdose from these powerful
    drugs, while making sure patients have access to
    safe, effective treatment.

9
  • Opioid analgesics, such as oxycodone,
    hydrocodone, and methadone, were involved in
    approximately 75 of pharmaceutical overdose
    deaths.

10
  • . According to the Center for Disease Control,
    Appropriate screening, identification, and
    clinical management by health care providers are
    essential parts of both behavioral health and
    chronic pain management.

11
  • Some people obtain prescriptions from multiple
    prescribers by "doctor shopping." Pinning down
    just where the problem lies is a task which is
    arguably as tough as correcting the problem of
    opioid abuse itself.

12
  • There needs to be better mechanisms to hold
    prescribers accountable, enable
  • the use of drug monitoring and testing,
  • and monitor pain management clinics.

13
  • The most surprising thing is that the payer
    community has been consistently paying for these
    drugs but has shown little concern for curbing
    the abuse. While the responsibility doesnt lie
    with payers alone, it is now critical that
    workers compensation stakeholders come together
    to stop these inappropriate prescribing patterns.

14
  • Workers compensation stakeholders must confront
    the inappropriate use of narcotics in the system.
    Injured workers are suffering and employers are
    paying for the unintended consequences of these
    drugs.
  •  
  •  

15
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16
  • Nonmedical use of prescription painkillers costs
    health insurers up to 72.5 billion annually in
    direct health care costs.
  • Over half a million emergency department visits
    in 2012 were due to people misusing or abusing
    prescription painkillers. 

17
  • Research indicates
  • Temporary Disability payments are 3.5 times more
    with opioid prescriptions .
  • There is a 322 greater likelihood for
    litigation.
  • According to National Council on Compensation
    Insurance, Inc. (NCCI), approximately 38 of
    pharmacy costs in Workers Compensation are for
    opioids and opioid combinations, amounting to
    over 1.5 Billion.
  • Contributing to over 100 Billion in lost
    productivity, medical costs and disability
    payments.

18
  • Alone we can do so little together we can do
    so much.
  • Helen Keller

19
  • Improved utilization of statewide databases that
    track opioid prescriptions, ferreting out and
    punishing overprescribing doctors, dealing with
    the growing number of pain management clinics and
    stricter controls in management of provider
    networks are among the solutions a number of
    states have adopted or are considering to tackle
    this multifaceted problem

20
  • Opioids usually result in a change of motivation
    within the injured employee. The employees focus
    of recovery from the injury is replaced with a
    focus on obtaining more of the opioid. The long
    term use of opioids results in a sub-conscious
    (or sometimes even a conscious), desire not to
    recover from the injury but to stay off work to
    use the opioid.

21
No STATES ARE IMMUNE TO THIS EPIDEMIC!
  • Louisiana and New York had the highest
    utilization of opioids on a long term basis.
  • In California, 3 percent of the states doctors
    prescribe 55 percent of the opioids.

22
  • Many states report problems with "pill mills"
    where doctors prescribe large quantities of
    painkillers to people who dont need them
    medically. They usually go to pill mills so that
    they can obtain drugs and resell them on the
    street.

23
  • Georgia just passed a pill mill bill that
    would license and regulate pain management
    clinics and now require the owner of such an
    establishment to be a doctor.
  • States like Kentucky, Ohio, Tennessee, West
    Virginia, Texas, Louisiana, Mississippi and
    Florida have passed similar legislation.

24
  • . In Ohio, pharmacists must record Opioid
    prescriptions in the online Ohio Automated Rx
    Reporting System (OARRS). These new guidelines
    encourage prescribers to use the data in OARRS so
    that they will know how much pain medication a
    patient already is receiving, perhaps from
    multiple prescribers. The guidelines also
    strongly advise prescribers to talk with their
    patients about managing their chronic pain, the
    risks of an unintentional overdose from their
    prescription pain medication, the potential for
    pain medication abuse, and secure storage of
    their pain medications, to prevent misuse by
    others.

25
  • In Approximately 20 states the doctor can both
    prescribe and sell the drug to the injured
    employee, tripling the overall claim cost
  • In Illinois a single Vicodin pill will cost an
    average of 53 cents at a pharmacy, yet sold by
    the doctor prescribing , the Vicodin pill sold
    for 1.44. Roughly a third of the prescriptions
    written in Illinois were for drugs dispensed by
    the physicians.
  • The spread was even greater in Connecticut, where
    the single Vicodin pill sold by pharmacies
    averaged 37 cents, but 1.43 when sold by the
    doctor prescribing the pill. This is not a best
    practice as it bypasses the pharmacist oversight.

26
Prescription Drug Monitoring Program
  • Marylands PDMP will make prescription
    information available, upon authorized request,
    to law enforcement agencies, health professional
    licensing boards and four units of DHMH5 to
    support investigations into improper professional
    practice, prescription fraud and illegal CDS
    diversion.

27
Collaboration in Maryland
  • The Advisory Board on Prescription Drug
    Monitoring the Boards of Physicians, Nursing and
    Pharmacy the University of Maryland, School of
    Pharmacy the Governors Office of Crime Control
    Prevention (GOCCP) Chesapeake Regional
    Information System for Our Patients (CRISP) and
    other DHMH agencies and professional
    organizations, ADAA will provide PDMP training
    and education on issues related to prescription
    drug abuse and overdose to an array of
    stakeholders, including healthcare providers, law
    enforcement, public health professionals and the
    general public.

28
  • Maryland Medical Assistance (MA), in both the
    Fee-For-Service Program (FFS) and Managed Care
    Organizations (MCO), currently employs procedures
    to identify and remedy activities of both
    recipients and providers that could contribute to
    the misuse of pharmaceutical opioids. Although
    these programs have been developed primarily for
    the purpose of quality assurance, cost
    containment and fraud detection, they will be
    utilized as a component of strategies to reduce
    opioid overdose. These programs include a
    corrective care management program and
    prospective drug utilization review.

29
  • Although heroin-related overdoses declined in
    Maryland from 2007 to 2011, the state witnessed a
    significant rise in overdoses related to
    pharmaceutical opioid analgesics during this
    period. Early data from 2012 suggests resurgence
    in heroin-related overdoses concurrent with the
    first reduction in pharmaceutical opioid-related
    overdoses in years.

30
  • Doctors who have been convicted of behaving like
    street drug dealers, or who lost their licenses
    due to similar findings, will need to apply not
    just to the Board of Medical Examiners, but also
    to the Director of Consumer Affairs, if they want
    to practice again. They will need to demonstrate
    that they can be trusted with the responsibility
    they once abdicated.

31
The Role of case management?
  • The case management process is carried out within
    the ethical and legal realm of a case managers
    scope of practice, using critical thinking and
    evidence-based knowledge. If we want to preserve
    the ethical ethos of case management, case
    managers must know the ethical standards which
    they are held and comply with them.

32
  • The ethics of excellence are grounded in
    action-what you actually do, rather than what you
    say you believe. Talk, as the saying goes, is
    cheap.
  • Price Pritchett

33
Standards of Practice
  • Empowering the client to problem-solve by
    exploring options of care, when available, and
    alternative plans, when necessary, to achieve
    desired outcomes.
  • Encouraging the appropriate use of health care
    services and strives to improve quality of care
    and maintain cost effectiveness on a case-by-case
    basis.
  • Assisting the client in the safe transitioning of
    care to the next most appropriate level.
  • Striving to promote client self-advocacy and
    self-determination.
  • Advocating for both the client, employer and the
    payer to facilitate positive outcomes for the
    client, the health care team, and the payer.

34
  • Prescription monitoring and nurse case managers
    can combat the problem. If a nurse case manager
    is not already assigned to a lost time claim,
    the issuance of a prescription to the injured
    employee for any narcotic should be an automatic
    trigger to assign that claim to the nurse case
    manager.

35
  • If a nurse case manager is already assigned to
    the claim, the nurse should discuss with the
    treating physician the use of short-acting
    opioids rather than long-acting opioids. Careful
    monitoring of the opioid use by both the pharmacy
    benefit management company and the nurse case
    manager is essential to holding down the cost of
    the claim and preventing opioid addiction.

36
  • Be the thermostat, not just the
    thermometer
  • Dr. Martin Luther King

37
Website Resources
  •  
  • WorkCompWire, http//www.workcompwire.com
  • Centers for Disease Control and Prevention,
    http//www.cdc.gov
  • Managing Opioid Use in Workers Compensation,
    http//www.scripnet.com
  •  
  • Amaxx Risk Solutions, Inc, www.reduceyourworkersc
    omp.com.
  •  
  • Insurance Journal, http//www.insurancejournal.com
  •  
  • Workers Compensation Research Institute,
    http//www.wcri.com
  • adaa.dhmh.maryland.gov/

38
  • How do you keep your passion
  • for Case Management when our
  • patients, their families, bosses,
  • physicians, employers, adjusters,
  • etc, etc, etc.
  • can drain the passion
  • completely out of you?

39
  • The pessimist may be right in the long run, but
    the optimist has a better time during the trip.
  • Anonymous

40
  • Hang in there!
  • Keep your sense of humor!
  • Be kind!
  • Have fun!

41
  • We are all here for a spell get all the good
    laughs you can.
  • Will Rogers

42
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43
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