by Sheena Harrison of Business Insurance
California lawmakers and workers compensation regulators want to curb prescription opioid abuse, and they are turning to Washington state for inspiration in the fight against narcotic addiction and deaths.
Last fall, prescription drug abuse provisions were left out of a California workers compensation reform bill to help the legislation win passage, experts say.
Now that those reforms are being implemented, California is attacking opioid painkillers on several fronts, including new workers comp medical regulations and a push to boost funding for the state’s prescription drug monitoring program.
“There’s a lot of interest in the opioid abuse issue, which was not addressed in” the recently passed law, said Marjorie Berte, Western region vice president at the American Insurance Association.
California’s Division of Workers’ Compensation is devising new medical treatment guidelines similar to those used by Washington, sources say.
Dr. Gary Franklin, a neurologist and medical director for the Washington State Department of Labor & Industries, is advising the California workers comp division, but he declined to discuss details.
Dr. Franklin’s research and recommendations helped spur development of the Washington state medical treatment guidelines adopted in 2007.
After adoption, Washington saw a 23% drop in prescription painkiller-related deaths between 2008 and 2011, the latest data available. That compared with an eightfold increase in such deaths during the previous 10 years, according to a statement the Washington State Department of Health released in January.
Among other recommendations, Dr. Franklin says opioid prescriptions should be provided for a maximum of six weeks after an acute injury or surgery, and that nonopioid pain relievers should be used as a first line of pain management for nonacute cases.
“Give people the comfort they need, but make sure that they’re improving from what you’re doing,” Dr. Franklin said. “And maybe think about using opioids intermittently instead of increasing doses every day.”
Also, Dr. Franklin said states should require doctors to keep opioid doses at less than a morphine equivalent of 120 milligrams per day, a threshold dosage that could lead to opioid overdose if exceeded.
“There’s no way to stop this public health emergency unless you do something” about dosage, he said.
Dr. Franklin shared his thoughts last month during a joint hearing of the California Senate Labor Committee and the Assembly Insurance Committee.
During the three-hour hearing that focused on opioids in workers comp, California Insurance Commissioner Dave Jones said California has no guidelines for the use or prescription of opioids. He said Washington state could serve as a model for guidelines being developed by California.
California could consider adopting a prescription drug formulary that limits the use of certain medications, if the pending guidelines aren’t effective, he said.
“This may be an acceptable approach in the case of some of the most powerful and risky types of opioids,” Mr. Jones said in a video of the hearing.
William Zachry, vice president of risk management at supermarket operator Safeway Inc. in Pleasanton, Calif., said he’s hopeful the Washington medical treatment guidelines will become the standard for opioid regulation in California and other states.
“I strongly believe that if California and the other states adopt the treatment guidelines that have already been established in the state of Washington, it will be easier for implementation throughout the United States to have just one set of guidelines instead of having (varying) sets of guidelines trying to control opioids,” Mr. Zachry said.
In addition to workers compensation regulatory efforts, a bill introduced in the California Senate in February aims to bolster the state’s prescription drug monitoring program and help identify problematic opioid prescriptions.
Another Senate bill on the table could go further to help curb opioid abuse in workers comp and California’s overall health care system.
Introduced in January, this legislation would require coroners to file a report when they think a death is caused by prescription drug use.
The measure the Senate unveiled in February would establish a state fund to pay for the Controlled Substance Utilization Review and Evaluation System, known as CURES.
The database, operated by the California Department of Justice, allows physicians, pharmacists and other providers to see whether a patient already has prescriptions for controlled substances, before they issue a new prescription for such medications. The state’s pharmacists and clinics are required to submit prescription information into the database but doctors that dispense prescriptions from their offices do not.
However, the controlled substance review system may be taken down in July because it does not have an operational budget, according to a January report from the Oakland-based California Workers’ Compensation Institute.
That report estimated that California’s workers comp system could save $57.2 million in prescription drug costs by keeping the controlled substance review database running and allowing third-party payers to access it.
Institute President Alex Swedlow said the database could be a critical component of the state’s efforts to curb prescription drug abuse.
“Payers in workers comp have a very limited view about the total medications that are being delivered to the injured workers under their review,” Mr. Swedlow said.
Mark Sektnan, president of the Sacramento-based Association of California Insurance Cos., said the industry group hopes that the state will renew funding for the database and make the program mandatory for medical providers.
“Right now, it’s a voluntary program, so it tends not to be very robust,” Mr. Sektnan said. “So the information’s not very good. We need everybody to participate, and everybody needs to use the system.”
During last month’s legislative hearing, Mr. Jones said insurers have offered to help pay for the prescription drug database, if physicians are required to report when they dispense prescriptions through their offices, rather than through a pharmacy.
“I think that’s fair,” Mr. Jones said. “If employers are going to pay through their insurance premiums for CURES, we need to make sure that CURES is complete and robust and provides full information.”