Avoiding Addiction: Strategies to Aid with the Pain Management Dilemma

A unique and costly challenge for many employers and insurers is managing workers who have become addicted to narcotic medication as a result of pain management treatment for a work related accident.

Growing awareness of the effects that pain management can sometimes present for injured workers has necessitated a more critical look at the issue.  From an employer’s perspective, there are ways in which this challenge can be successfully addressed, and the Maryland Workers Compensation Commission is demonstrating its support of that effort.

Consider the following tips to curtail issues related to pain management and to offer alternative suggestions to combat this emerging problem:

  • Evaluate whether the medication is helping or hindering the injured worker.   There are plenty of times when the long term use of some narcotic medication is justified.   Key things to look for are the type of injury involved and whether the medications improve function, including the injured worker’s ability to work. 
  • Ask the Commission to review a pain management referral from the outset.  The best way to avoid addiction is to avoid starting narcotics in the first place.  Request that limitations be placed on the referral.  If the injured worker seems particularly at risk for dependence, ask the Commissioner to specifically limit the authorization for pain management to non-narcotic therapies; or, alternatively, request the Commissioner to review the pain management plan. 
  • If the Commission orders pain management, ask that the program require an opiate/narcotic contract and random urine screens.   Pain management providers often advise patients that a urine screen will be performed at their next appointment, negating the purpose of the test. 
  • Engage the parties to agree on a reputable pain management provider from the outset.   Recommend three names and ask the Commissioner to commemorate the name of the provider in the Order and to specify that pain management is only authorized with that provider.
  • Notify the injured worker’s attorney in writing of the plan to have the injured worker weaned off of narcotic medication when an Independent Medical Examination (IME) indicates overuse of medication.  Share the IME report with the attorney and request that the injured worker discuss the recommendations with their treating physician.  Provide a specific time frame for the employer/insurer to continue authorization of narcotics (e.g., 60 or 90 days) in order to avoid symptoms of withdrawal.  Invite the attorney to request a hearing in the event the injured worker does not agree with the plan.  This will effectively bring the matter before the Commission for further discussion.     
  • Demonstrate a history of discrepancy, diversion or dependency by the injured worker.   When there is a resistance to an offer of inpatient detoxification, there are often other issues to uncover.   A check of the Maryland Judiciary Case Search website and/or surveillance may offer insight.  Perform a pharmacy canvass in the area where the injured worker resides and highlight instances of lost prescriptions, early refills and diversion to present before the Commission.   
  • Educate yourself before litigating the issue.  Research the medications being prescribed and become familiar with generic names, compound medications, dosages, etc.  The more information that can be provided to the Commissioner about why the level of narcotics being used is inappropriate, the more successful your argument will be to adjust the plan.
  • Minimizing narcotic usage may aid in resolving claims.  While inpatient detoxification is expensive, it is much less costly in the long run than the price associated with providing lifetime narcotics.  Many times an injured worker will truly desire to settle their case but the future medical allocation for the prescribed medication can make settlement cost prohibitive. 
  • Employers should consider filing Issues to assist in early intervention when appropriate.   The Commission is wary of unnecessary pain management referrals and there is a trend toward taking a hard line approach when an injured worker appears to be headed down the wrong path.   Commissioners would rather see a case before a problem escalates. 
  • Consider providing the Commission with an additional review of the narcotic(s) being prescribed, including proper dosages and drug interactions.  This can be accomplished through a Utilization Review by specialized vendors.   A “records review” can be an effective tool in highlighting ineffective treatment and a “pharmacy review” can identify overmedicating prescriptions.                   

In summary, referrals to pain management have dramatically increased over time in Worker’s Compensation cases.  It seems that often providers refer injured workers to pain management rather than confronting the patient whose complaints outweigh the diagnostic evidence.  These complaints can be fueled by various factors that are completely unrelated to the work accident claim.  The growing trend toward pain management is, at times, having a very negative effect on the recovery process as well as the injured worker’s ability to return to work.  Utilizing the tips provided above can assist in proactively avoiding the prolonged and harmful effects associated with improper pain management for both the injured worker and the employer.