Prescription opioid misuse is a major problem in the United States, costing $78.5 billion each year for health care costs, lost productivity, addiction treatment and criminal justice involvement. Around 21 to 29 percent of patients prescribed opioids end up misusing them and, of these, 4 to 6 percent transition to heroin abuse.
In workers’ compensation, opioids make up a third of all prescribed pain relief drugs and account for 20 percent of the total claim spend. One of our industry's most available resources to influence opioid use is the nurse case manager. Case management intervention plays a significant role in limiting opioid abuse including:
- Ensuring medication safety across the care continuum
- Enforcing greater compliance with medication usage
- Improving education and communication with all parties
- Reducing or decreasing inappropriate drug utilization
- Delivering peer review documentation of medical necessity
- Improving patient outcomes
In fact, it’s becoming more evident that case management is the missing link in successful opioid management and weaning programs. Case management intervention is especially effective after a comprehensive pharmacy review (CPR) has taken place. This is when a pharmacist or peer physician has conducted an evidence-based peer review of prescriptions and the prescriber’s treatment plan. The CPR includes recommendations to modify the drug therapy — and will typically include weaning or tapering. However, if the pharmacist or peer physician is unable to reach an agreement with the provider — or the provider agrees, but does not implement the changes, the case is referred for case management review.
In these cases, the case manager arranges an onsite visit with the prescriber. The case manager will take the peer review report, sit down with the prescriber to review the recommendations, and come to an agreement on the treatment plan. The modified plan might include anything from developing strategies to facilitate weaning, tapering or discontinuation of one or more narcotics to recommendation of supportive therapies, such as physical therapy, aquatic therapy, cognitive behavior training, home exercise, home stretching program, biofeedback therapy, and work hardening.
In 57.3 percent of the case management drug intervention cases, the prescriber agrees to all or part of the modifications. In many cases, the physical presence of a nurse in the prescribing doctor's office makes a positive impact.
Genex works with customers to address long-term problem cases, but one of our main goals is to also engage customers on a more proactive basis, where case managers are helping identify narcotic risk factors from day one. This includes a detailed medication assessment, where case managers look for risk factors that could signal the injured worker is at risk for opioid addiction. If these issues are addressed early, it can go a long way in preventing dependency and addiction from occurring in the first place.