Could North Carolina Workers' Compensation Doctors be Overprescribing “Schedule II” Drugs?

January 19, 2010, by Michael A. DeMayo

A recent report released by the California Workers’ Compensation Institute has many experts and consultants who specialize in North Carolina workers’ compensation quite concerned. The CWCI found that just 3% of doctors who treat workers’ comp patients in the Golden State prescribe over 55% of the “Schedule II” medications, which include potentially addictive drugs like methadone, codeine, and fentanyl. The report, Prescribing Patterns of Schedule II Opioids in California Workers’ Compensation, found a variety of disturbing findings, including:

• The top one percent of hurt workers ingested 25 times more medication than did the average workers’ compensation patient.
• 279 physician prescribers drove two-thirds of all drug-related payments
• Over 50% of Schedule II drug claims involved minor back pain – certainly a troubling issue, but not an issue that necessarily requires strong medications.
• Schedule II drugs prescribed in CA skyrocketed from just 1.4% in 2005 to 7.2% by 2009.
• Payment for Schedule II drugs also increased by over 500%.

Dr. Arnold Milstein, the leader of Stanford University’s Clinical Excellence Research Center, explained why regulatory agencies may not be putting the brakes on what’s clearly an over-prescription problem: “The State Medical Licensing Board is horribly underfunded in terms of stopping these obviously crazy prescribing patterns by a small percentage of doctors.”

Another expert, Joe Paduda of Health Strategy Associates, explained why physicians might take unfair advantage of the system: “The workers’ comp industry is a very soft target for healthcare providers and other people who want to take advantage of regulatory or other loopholes.”

The California system, apparently, is set up in such a way that patients get encouraged to go the prescription med route instead of trying alternative, non-medication related modalities, such as physical therapy and strength training.

In any case, what might this CWCI report mean for the North Carolina workers’ compensation system?

States differ tremendously in their workers’ comp programs. And no North Carolina institution has done a similarly thorough study on Schedule II workers’ comp prescriptions. But it shouldn’t come as that much of a surprise that a minority of doctors causes the most abuse. The so-called “Pareto principle” – also known as the 80-20 Rule – is a well-established economic principle. It suggests that, in any given population, a minority of participants will drive the majority of results. For instance, if you own a small business, 20% of your clients will yield 80% of your work. 20% of your clients will also yield 80% of your problems. And so forth. So the fact that a small minority of doctors caused the majority of the Schedule II drug abuse shouldn’t be too much of a surprise. Indeed, data should find a similar pattern here in North Carolina.

If you or someone you care about needs help with a benefits issue or help with a recalcitrant employer or insurer, connect immediately with a North Carolina workers’ compensation law firm.

More Web Resources:

Prescribing Patterns of Schedule II Opioids in California Workers’ Compensation

California Workers’ Compensation Institute


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