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Paduda: It's Not Just Opioids

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Yes, opioids are the biggest problem in workers’ compensation. Not just work comp medical, but in the entire work comp industry.

Joe Paduda

Joe Paduda

Opioids kill patients, prolong and intensify disability, ruin families, run up huge costs and lead to myriad other problems. But opioids are far from the only problematic drug class in our tiny little world.

No, we have gabapentin, Soma and anxiolytics. But today we’re going to focus on anti-psychotics — yet another misused medication that is causing harm to work comp patients.  

Reportedly some prescribers are writing scripts for these drugs as an alternative to opioids or other pain medications. They aren’t required to check prescription drug monitoring databases or otherwise deal with opioid-related issues when prescribing antipsychotics.

This lower “hassle factor” may drive increased use of these medications as opioid-related prescribing legislation becomes more common in more states.

As with opioids, a big issue is the side effects — in this case, tardive dyskinesia.

From Wikipedia:

TD is a disorder that results in involuntary, repetitive body movements. This may include grimacing, sticking out the tongue or smacking of the lips. Additionally there may be rapid jerking movements or slow writhing movements. In about 20% of people decreased functioning results.

Tardive dyskinesia occurs in some people as a result of long-term use of neuroleptic medications (antipsychotics, metoclopramide). These medications are usually used for mental illness … older neuroleptics [drugs] … are associated with high risk for tardive dyskinesia.

Suffice it to say that TD is pretty horrible. One of TD’s causes is long-term usage of antipsychotics, which, believe it or not, are becoming more prevalent in workers' compensation.

A close friend who runs the pharmacy program for a top 10 insurer told me prescriptions for these drugs are becoming increasingly common, and he’s now seeing scripts for drugs to treat their chief side effect, TD.

The good news is there’s now treatment for TD.  The bad news is the cost — between $125 and $150 a day for Ingrezza.

That’s $60,000 annually. Forever.

What does this mean for you?

Unintended consequences can be horrific.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.

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Do not post libelous remarks. You are solely responsible for the postings you input. By posting here you agree to hold harmless and indemnify WorkCompCentral for any damages and actions your post may cause.
Dr Jul 17, 2017 a 12:07 pm PDT

As long as Utilization Review continues to deny alternative treatments to pain medication, and as long as Independent Medical Review supports these denials of care the more treating physicians are squeezed into pharmaceutical alternatives one of which is opioids -- see my editorial, "Opioid Denials and Obstruction of Alternative Treatments," The Weinmann Report, 26 June 2017 (this piece has been submitted to workcompcentral for column consideration). We know that these denials of care are "constitutional" under the law: they're just bad medicine.

As for tardive dyskinesia, we thank the writer for his Wikipedia reference. May I refer interested parties to "Disorders of Movement, a mercifully short primer," Diseases of the Nervous System, 1975.

In a nutshell, it is difficult to honor Utilization Reviewers' decisions when so many such decisions fall outside parameters of scientific medicine and then enjoy "constitutional" protection.

Robert L. Weinmann, MD, Editor

Dr. Robert Weinmann Weinm Jul 17, 2017 a 12:07 pm PDT

"Disorders of Movement: a mercifully short primer," Diseases of the Nervous System," 1975, Feb: 36(2): 84-6, by Robert L. Weinmann, MD PMID 163723

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