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Prescribing Narcotics Over Physical Therapy Adds Cost to Job Injuries, May Delay Recovery

L&I makes significant payments for workplace injuries each year, with the biggest amount going to employees injured in major accidents involving machinery or construction injuries.  But one of today’s fastest-growing costs is payouts for strong painkillers, including many to workers who have to leave work for months or even years. Some never return, but remain on medication.


Nationally, workplace insurers spend nearly $1.4 billion on narcotic painkillers each year. But they also claim that when medications are started too early in treatment, or used too frequently or for too long, disability payouts can skyrocket as a result of a delay in the employee’s return to work. A 2008 study of claims by the California Workers Compensation Institute states that those who took high doses of opioid painkillers for injuries like back strain remained out of work three times longer than those with similar injuries who took lower doses. When medical care and disability payments are combined, the price tag for a workplace injury is nine times higher when strong narcotics (like OxyContin) are used than when workers do not take narcotics, according to a 2010 analysis by Accident Fund Holdings (AFH is an insurer that operates in 18 states).


Alex Swedlow, the head of research at the California Workers Compensation Institute, made the following statement: “What we see is an association between the greater use of opioids and delayed recovery from workplace injuries.”  Of course the use of narcotics to treat workplace injuries is part of a wider national problem involving abuse of powerful drugs like OxyContin, Percocet and Duragesic. But workplace injuries have drawn particular attention because the drugs are widely prescribed to treat common issues like back pain. Along with causing drowsiness and lethargy, opioids can lead to addiction or have other serious side effects like fatal overdoses.


Estimates project that the cost of a typical workplace injury — the sum of an employee’s medical expenses and lost wage payments — is about $13,000. However, when workers are prescribed short-acting painkillers like Percocet, that cost triples to $39,000 and triples again to $117,000 when a stronger, longer-acting opioid like OxyContin is prescribed, said Jeffrey Austin White, an executive with the CWC Institute.


Yet to a large extent, insurers are reaping the consequences of their own practices and policies. For the past ten years, they routinely reimbursed doctors for prescribing painkillers while cutting or eliminating payments for treatments like therapy that do not rely on drugs. This often happens after an injured worker is required to undergo an Independent Medical Examination performed by a physician hired by the insurance company (rather than their regular attending physician). Those policies may “have created a monster,” said Dr. Bernyce M. Peplowski, the medical director of the State Compensation Insurance Fund of California, a quasi-public agency.


For patients, those policies had negative consequences as well. One former waitress who suffered a back injury from a slip and fall accident five years ago recently won a lawsuit to force her insurer to cover physical therapy. The insurer cut off those payments after a few initial sessions, and the woman, now suffering from a permanent disability, had no option but to take strong painkillers. “It certainly did not help that she was cut off,” said Dr. Martinez.


Nationally, research shows that a tiny percentage of doctors prescribe the lion’s share of narcotic drugs for workplace injuries; in California, for instance, that figure is a mere 3%. Also, the vast majority of such prescriptions are taken by a small percentage of injured workers.


Between 2001 and 2008, narcotics prescriptions as a share of all drugs prescribed for workplace injuries increased 63%, and costs have followed suit. States are currently looking for ways to reverse the trend, and some – including Washington, New York, Colorado and Texas – have developed new pain treatment guidelines. Doctors in just four states — Louisiana, Massachusetts, New York and Pennsylvania — are the biggest prescribers of the drugs for workers’ injuries, according to a review of data from 17 states by the Workers Compensation Research Institute, a group in Cambridge, Mass.


There is no question that strong pain medications help many patients return to work and remain productive. But other injured workers taking high doses can develop chronic pain and face years of difficult treatments. It is not clear how, or if, the drugs are involved in the process, but when pain becomes chronic, the cost of a commonplace injury can equal a crippling one.


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Emery Reddy