This document summarizes key findings from two studies conducted by the Workers Compensation Research Institute (WCRI) on narcotics use and prescribing patterns in workers' compensation claims. The studies found significant regional variations in narcotics prescribing, with above-average use in some Northeast and Mid-Atlantic states. Specifically, longer-term narcotics use was more common in Louisiana, New York, Pennsylvania, Texas, California, Massachusetts and North Carolina. However, few longer-term narcotics users received recommended monitoring and management services. WCRI is a leading independent research organization focused on workers' compensation policy issues.

1. Compliance with
Narcotics Guidelines
April 10-12, 2012
Walt Disney World Swan Resort

2. Accepted Learning Objectives:
1. Describe how managed care programs, employers, health
care providers and insurers are susceptible to increased
workers compensation costs due to prescription drug abuse.
2. Identify strategies employers and medical professionals can
use to help drug-dependent and addicted employees regain
control of their lives and return to work using results of
CompPharma’s survey, “Prescription Drug Management in
Workers’ Compensation – The Eighth Annual Survey.”
3. Describe how Washington State has addressed the over use
of opioids in workers’ compensation.

3. Disclosure Statement
• Joseph Paduda has disclosed that he
has a relationship with Reckitt
Benckiser’s Suboxone Sublingual Film.
• Dr. Richard A. Victor has disclosed no
relevant, real or apparent personal or
professional financial relationships.

4. Narcotics Use And
Compliance With
Guidelines
Richard Victor, J.D., Ph.D.
Executive Director
Workers Compensation
Research Institute

5. Today s Outline
• About heath care in workers
compensation
• Relevant findings from 2 WCRI studies
• About WCRI

6. About Workers Compensation
• Century-old social program
• Injured workers receive medical care, income
benefits, rehabilitation
• Patients entitled by law to all necessary care
• Patients have no deductibles or copayments,
no formularies or step therapy
• Physician dispensing is common in a growing
number of states
• Prices near AWP

7. Workers Compensation Facts
• Employers pay $79 billion in 2008
• Medical care represents more than
half of the cost
• 4.6 million work-injuries
• 2.3 million involve lost time from work
• 20% of total—lost more than 1 week
from work
• Median lost time is 16 weeks

8. Common Medical Conditions In
Workers Compensation
Medical Condition % Of Cases
Spine conditions
Sprain, strain and nonspecific spine pain 21%
Neurologic spine pain 7%
Other musculoskeletal conditions
Non-spine sprain and strain 15%
Shoulder inflammation 7%
Knee derangement 4%
Carpal tunnel syndrome 2%
Trauma
Fractures 10%
Laceration or contusion 12%
Other conditions 21%
Cases With > 7 Days Of Lost Time

9. Today s Outline
• About heath care in workers
compensation
 Relevant findings from 2 WCRI studies
• About WCRI

10. Two WCRI Studies Of Area
Variations In Prescribing Patterns

11. Major Findings From
WCRI Narcotics Studies

12. Data
• Nonsurgical cases
• Patients lost more than 1 week from work
• Results presented for episodes of
disability
• Snapshot at an average of 24 months
after injury

13. Data
• 17 states that represent more than 60%
of WC benefits in the U.S.
• 360,000 Rx for 75,000 nonsurgical
episodes of disability
• 16% to 50% of all episodes in each
state

14. Most Patients Get Rx Pain Medication
Nonsurgical Claims With > 7 Days Of Lost Time,
Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008

15. Most Patients Get Narcotics
Nonsurgical Claims With > 7 Days Of Lost Time,
Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008

16. Unusually High Use Of Narcotics
In NY, LA, PA, And MA
Nonsurgical Claims With > 7 Days Of Lost Time,
Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008

17. Also Higher Use Of Narcotics
In CA, MD, NC, And TX
Nonsurgical Claims With > 7 Days Of Lost Time,
Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008

18. Average Worker In Four States Had More
Narcotic Pills Per Episode Of Disability
Nonsurgical Claims With > 7 Days Of Lost Time,
Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008

19. Practice Patterns Favor Schedule II Narcotics
In Northeast & Mid-Atlantic States
Nonsurgical Claims With > 7 Days Of Lost Time,
Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008

20. Major Findings From
WCRI Narcotics Studies

21. Longer-Term Use Of Narcotics
• Study definition
– First narcotic Rx filled within first 3 months
after injury
– Narcotics continued after 6 months
post-injury
– 3+ Rx fills during months 7–12
• Nonsurgical cases

22. Longer-Term Use Common
In Louisiana And New York
Nonsurgical Claims With > 7 Days Of Lost Time,
Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008

23. Longer-Term Use Also More Likely
In PA, TX, CA, MA, And NC
Nonsurgical Claims With > 7 Days Of Lost Time,
Injuries From October 2005 To September 2006,
Prescriptions Filled Through March 2008

24. VeryModest Interstate Variation In At
Substantial Interstate Variation
Substantial Interstate Variation
Median MEUs 90thEpisode of Disability
The Per Percentile
50th Percentile 75th Percentile 90th Percentile
Morphine Equivalent Units Per Claim
Nonsurgical Claims With > 7 Days Of Lost Time That Were
Identified As Longer-Term Users Of Narcotics, Injuries From
October 2005 To September 2006, Prescriptions Filled
Through March 2008

25. Common Guideline Recommendations
For Monitoring & Management

26. Few Longer-Term Users Received
Services For Monitoring/Management
Nonsurgical Claims With > 7 Days Of Lost Time That Were
Identified As Longer-Term Users Of Narcotics, Injuries From
October 2005 To September 2006, Prescriptions Filled
Through March 2008

27. Few Longer-Term Users Received
Services For Monitoring/Management
Nonsurgical Claims With > 7 Days Of Lost Time That Were
Identified As Longer-Term Users Of Narcotics, Injuries From
October 2005 To September 2006, Prescriptions Filled
Through March 2008

28. Today s Outline
• About heath care in workers
compensation
• Relevant findings from 2 WCRI studies
 About WCRI

29. About WCRI
• Nation s largest independent think
tank on workers compensation public
policy issues
• Published hundreds of peer-reviewed
studies since founding in 1983
• Membership organization—diverse
• Not make recommendations nor take
positions on issues

30. About WCRI: Focus Of Current
Health Policy Research Agenda

31. About WCRI: Focus Of Current
Health Policy Research Agenda

32. Today s Outline