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  • ACOEM/IAIABC Comment to State WC Officials on Prescription Opioid Abuse in the U.S.

    September 23, 2011
    Scottie Spates
    Alabama Department of Industrial Relations
    649 Monroe Street
    Montgomery, AL 36131

    Dear Mr. Spates:

    We are writing today on behalf of the American College of Occupational and Environmental Medicine (ACOEM) and the International Association of Industrial Accident Boards and Commissions (IAIABC) to express our deep concern over the growing issue of prescription opioid abuse in the United States – which has the potential to seriously impact the health and well being of our national workforce.

    The abuse of prescription opioids has become a grave personal risk to injured workers, a disruptive force in the lives of those close to claimants harmed by abuse, and a cost concern to other stakeholders in the United States workers’ compensation system.

    While we are not opposed to the safe and controlled use of prescription drugs for pain relief, we are concerned about clear upward trends in the incidence of prescription opioid abuse. Like many other aspects of medicine, care must be taken to administer treatment properly in order to promote healing and minimize undesirable side effects.

    Signs of an epidemic of prescription opioid abuse abound both within and outside the workers’ compensation system. In the United States, deaths from unintentional drug overdoses almost equal deaths from motor vehicle accidents and the majority of these deaths are due to prescribed opioids. A resource page found at www.iaiabc.org contains even more chilling data on the extent of this problem. 

    Recent research by the Workers Compensation Research Institute (WCRI), and other prominent organizations like the National Council on Compensation Insurance (NCCI), clearly shows very inconsistent patterns of use of prescription medication across states.  This indicates a knowledge gap.

    Several states have taken innovative and positive steps to protect against drug abuse and misuse. Your agency may already be in the vanguard of states grappling with this problem. If so, we applaud your efforts.  

    For those who haven’t already addressed this issue, we wish we could tell you that there is a simple solution, like passing a law against some easy target of abuse.  But as Dr. Gary Franklin, Medical Director for the Washington system, has noted, “It takes a multifaceted, holistic approach to stop this epidemic of abuse.”

    Many different strategies have been employed by workers’ compensation agencies to address this issue. One tool is to effectively deploy a treatment guideline with pain management recommendations.  Another important element of chronic opioid management is a Prescription Drug Monitoring Program (PDMP).  Pre-screening for abuse potential and drug screening are also key elements of chronic opioid management.

    In addition, a state’s requirement for the use of guidelines needs to be communicated well to clinicians and claims handlers. An agency can also ensure appropriate compensation for pain management in fee schedules, including incentives for providers to utilize the state’s PDMP.  Finally, judges, attorneys, patients and family members need to be aware of what constitutes proper management of prescription medications. 

    There is an educational role for state agencies as well: they can help by informing patients, adjusters, and workers compensation agency staff about the dimensions of this problem and appropriate responses.  In particular, injured workers should be aware of the risks of prescription opioid use and the desirability for their physician to engage in a monitoring program.  

    ACOEM and the IAIABC urge you to learn about the extent of this issue in your state. Lives and livelihoods are at stake. You may be interested in the following opportunities to learn more:  

    • A resource page for workers’ compensation officials.  Documents on this page contain proof of needless death, disability, and disrupted lives. Also, it highlights controls and successful programs. Review these resources at www.iaiabc.org 
    • A complimentary webinar for state regulators and medical professionals on November 2, 2011. Nationally recognized leaders in the struggle against drug abuse will present a highly practical set of actions you can take to protect workers and their families. Sign-up at www.iaiabc.org 

    We would be pleased to answer any questions you may have about this statement or how your state might more effectively control inappropriate use of prescription opioids.

    Sincerely,
    Barry Eisenberg     
    Executive Director, ACOEM    

    Gregory C. Krohm
    Executive Director, IAIABC