Commission to Tackle Opioid Abuse

Chairman Charlton Allen of the North Carolina Industrial Commission announced in early February he will appoint a task force to address opioid abuse and addiction, which have claimed the lives of at least nine North Carolina workers in recent years and are causing problems nationwide.

"Opioid misuse and addiction are a major public health crisis in this state. Many injured workers are prescribed opioid medications as part of treatment for their injuries, creating a nexus between the problems affecting the general population and the workers' compensation system," he said.

According to a 2014 report from the Centers for Disease Control and Prevention, which looked at prescriptions written for painkillers in every state, North Carolina had between 96-143 prescriptions per 100 people. Although that puts North Carolina among the states with the highest prescriptions for painkillers, it reflects a common pattern. CDC reported earlier that in 2012 physicians nationwide wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. The Industrial Commission looked at opioid misuse originating from or exacerbated by workplace injuries as part of its study last year on developing a drug formulary. The agency says its Workers' Compensation Opioid Task Force will be composed of representatives from various stakeholders in the state's workers' comp system.

The CDC notes actions at the state level can have an impact on prescribing patterns, and highlights the success of Florida in reversing overdose trends. Alarmed over a nearly 30% increase in overdose deaths between 2006-2010, Florida adopted legislative and enforcement actions which have resulted in the death rate dropping nearly 25% in recent years. Florida has also seen declines in prescribing rates for oxycodone, methadone, and hydrocodone.

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Indeed, although opioid abuse and addiction remain formidable problems, many comp systems across the country are reporting decreases in utilization and prescriptions. This favorable trend will likely get a boost from just-released guidelines of the American College of Physicians which say opioids should be considered for chronic back pain only when other alternatives don't work.

The CDC had said as much in earlier recommendations, and in 2014 the National Safety Council put out a white paper which concluded the combination of 200 mg of ibuprofen and 500 mg of acetaminophen is one of the strongest pain reliever combinations available. "It is clearly more efficacious than any of the opioids used alone or in combination with acetaminophen," the group said.

Observers have also pointed out that not only are too many physicians prescribing opioids for injured workers when alternatives are available, they are often not monitoring their patients as called for in various guidelines. In its study of longer-term opioid use, The Workers Compensation Research Institute found only 4% - 9% of injured workers received psychological evaluations and only 3% - 8% received psychological treatments.

"Even in states with the highest use of these services, only one in three injured workers with longer-term opioid use had a psychological evaluation and one in seven received psychological treatment," WCRI reported.