Experts weigh in on Opioids, Opioids, Opioids and CWCI! Week of 3.12.2018

Mark Pew. Twitter @RxProfessor Are opioids worth the risks? A recent article I posted here on Linked In received the highest views of the week (3,650) and received over 30 comments, eliciting polarized responses. The article, “For all their risks, opioids had no pain-relieving advantage in a yearlong clinical trial” was published in the Los Angeles Times on March 6. If there is no statistical difference in the severity of pain between #opioids (morphine, Vicodin and oxycodone) and non-opioids (Tylenol, ibuprofen and lidocaine) for chronic musculoskeletal pain … why take on the added risks? This isn’t a speculative question. This is the result of a RCT (random controlled trial – the gold standard for clinical studies). 240 patients at the Veterans Administration, average age of 58, all with “pain bad enough to interfere with their daily activities and enjoyment of life”, and studied for a full year. Result? “The researchers saw no evidence that opioids were better than the alternatives.” It seems that any study about the efficacy of opioids now elicits strong opinions both for and against, and those opinions are not likely to change regardless of the evidence (sound familiar to other “conversations” we have in the U.S.?).

Out Front Ideas. Twitter @OutFrontIdeas with Kimberly George of Sedgwick and Mark Walls of Safety National. Alternatives to Opioids in Pain Management. Kimberly and Mark recently published an article on one of the key issues they identified to watch for 2018: Pain Management. In this article, they discuss alternatives to opioids when treating chronic pain.

There are a variety of programs to help people deal with pain, many of 
which are based on cognitive behavioral therapy (CBT). This short-term 
treatment is goal-oriented and takes a practical approach to problem 
solving by changing patterns of thinking and behavior. Doing so helps 
change the way patients feel.

In order to take a deep dive into this issue, they spoke with two of the nation’s most highly respected pain management experts, Beth Darnall on Twitter @BethDarnall, a clinical associate professor in the division of pain management at Stanford and Dr. Steve Stanos on Twitter @AmerAcadPainMed and medical director of pain management services for the Swedish Medical System in Seattle, who each gave them great insights into the experience of pain, how it can be best treated and non-pharmaceutical ways to treat pain.

Rita Wilson. Tower MSA Partners CEO Rita Wilson recalls her own parenting lessons while examining the disconnect between CMS’s proactive stance on opioid limitations and its opioid-friendly review process for WCMSAs. At the same time, she recognizes that the inappropriate use of opioids throughout the life of a workers’ comp claim places CMS in a difficult situation. Wilson suggests establishing and enforcing CMS-like boundaries at Rx fill time and avoid sending WCMSAs with inappropriate opioids to CMS in the first place.

Joe Paduda. Twitter @paduda Quick takeaways from CWCI’s annual meeting in Oakland, CA. One of the best conferences of the year is CWCI’s annual get together in Oakland California. Read Joe’s full recap on CWCI here. Here are my key takeaways:

-Average drug spend dropped 34% from 2012 to 2015 – Rx and DME 
combined amount to 8 percent of total spend of med payments at 
24 months after inception

-Opioid spend dropped dramatically, while NSAIDs went up

-Compared to all claims reported, Cumulative Trauma injuries 
have increased – a lot – since 2009. CWCI thoroughly debunked the 
contention by others that CT cases have decreased

-IMR decisions continue to uphold UR determinations more than nine 
times out of ten, a rate that’s held steady since 2014

-UR decisions on compounds are upheld in 99.2 percent of all cases

-Work comp administrative expenses are higher in California than 
any other state -- by a lot. Part of the answer is the outright 
abuse of the IMR process by a handful of scummy providers in SoCal
...and a couple up north too. 

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