The National Council on Compensation Insurance's Raji Chadarevian discussed opioid utilization, price and cost at NCCI’s recent Annual Issues Symposium 2018.

Joe Paduda

Six percent of opioid medications used in workers’ comp is for treating opioid use disorder; methadone and suboxone are the drugs of choice.

The older the claim is, the more opioids are prescribed. For 15-year-old claims, about 2.5 oxycodone pills were prescribed per day. As a result, claims that are more than 10 years old accounted for more than 50% of all oxycodone pills. And the top 10% of users consumed 79% of pills.

Those heavy users also get a lot of other medications to help them deal with side effects of opioids (and other conditions). These users get about seven non-opioid scripts for every 10 opioid scripts. These drugs include gabapentin, benzos and muscle relaxants.

Fortunately, Raji reported that there’s been a change over time as prescribers have shifted to non-benzo anticonvulsants and have made other changes to reduce health risks.

Raji handed the mic off to Dr. David Deitz (a good friend and colleague). Deitz gave a trenchant and informative description of marijuana, noting that way more is not known about marijuana’s (and its included compounds’) effects on humans than we do know. Some of the effects are reduced anxiety, reduced inflammation, euphoria, appetite stimulation and others you may have experienced yourself.

Deitz then reviewed the state of the science on cannabis. There is substantial evidence of benefit for the treatment of chronic pain and the treatment of nausea due to chemotherapy. Moderate benefit for anxiety, sleep loss and appetite/weight loss due to HIV/AIDS has been found.

Evidently there are a lot of restrictions on research into marijuana by the Food and Drug Administration. Some seem nonsensical. These restrictions are screwing up research and perhaps leading to wrong conclusions.

For work comp, cannabis may be useful as an adjunct, or secondary treatment for chronic pain, anxiety and spasticity related to spinal cord injuries.

A couple of other key points

Opioid mortality and the use of opioids for Medicare and Medicaid patients both declined in states with legalized use of marijuana.

Fifty-eight percent of voters support legalization of marijuana, and 70% oppose enforcement of federal laws in states that have.

The net: We don’t know much about cannabis, but we do know it absolutely helps in certain conditions, and most folks want it legalized.

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.