New FDA Warning: Avoid Prescribing Opioids & Benzos Together

In a recent announcement by the FDA, boxed warning labels will now be required to advise against the utilization of prescription opioid pain medicines alongside benzodiazepines unless no other adequate alternative treatment method exists. Warnings about the risks of combining these two classes of drugs are nothing new. Already required on drug warning labels, additional black box warnings are an effort by the FDA to reach out to those who may have “missed the message.”

Classified as Central Nervous System (CNS) depressants, each drug alone can trigger side effects such as respiratory depression (slowed/labored breathing), coma, and death, the effects of which are enhanced in combination. For clinicians living in the dark, these risks will now be spelled out in the black boxes of 389 different pharmaceuticals. Additionally, opioid painkillers such as oxycodone and benzos like alprazolam (i.e. Xanax®) – even the combination of opioid cough medicines with benzos and other CNS depressants (like alcohol) should be avoided. If the drugs must be used together, clinicians have been advised to warn patients of these risks.

The FDA’s latest measure in battling the nationwide epidemic of prescription opioid abuse, essentially classifies this drug combination in the “last resort” genre. Rates of emergency room visits resulting from the nonmedical use of this combination of drugs has tripled from 2004-2011, with the rates of drug-related deaths following suit. According to the FDA, these rates coincide with a 41% increase in patients prescribed both an opioid and benzo between years 2002-2014. The measure is a win for public health officials from 17 states and territories and 13 cities who petitioned the agency in February to require the boxed warning in an effort to fight the routine but unproven treatment method.

Bridging the gap is possible, however, with the help of clinically proven injury and disability treatments from ANS Solutions. Our expert medical legal nurse consultation services and Pharmacotherapy Review Program get the result patients need – without side effects – protecting and enhancing the quality of life for injured workers, and guarding against the medical and financial risks of unproven treatment methods with scientifically-backed protocols. Are you ready to set out on a new path in worker’s comp injury management? Contact http://www.ans-solutions.com today!

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Prescription Drugs and the Workers’ Compensation Arena

The U.S. remains the biggest global consumer of prescription drugs, up from around 76 million in 1991 to nearly 207 million in 2013 however a recent court ruling has called into direct question the prescription practices of physicians nationwide (Volkow).

The occurrence of unnecessary or medically inappropriate prescribing of opioids in pain management is compromising the lives and well-being of injured workers.  There are a number of serious issues concerning the use of opioids in pain management:

• Not cost effective
  Evidence-based reviews are seldom consulted prior to the prescribing of opioids, and a lack of appropriate physician monitoring and/or patient compliance further contributes to longer recovery periods and increased cost.
• Increased drug-drug interactions
  Polypharmacy, the use of 4 or more medications simultaneously with opioids, can result in drug-drug interactions with severe consequences for patient health.
• Risk for Addiction and Abuse
  The highly addictive nature of opioids leads to the necessity of higher doses over time, resulting in cost increase and greater risk of overdose/addiction. .
• Lack of evidence for proven benefit
  Recovery and return to work rates are not improved by the use of opioids in pain treatment. The American Academy of Neurology and a number of states have released product guidelines advising physicians to proceed with caution when initiating opioid therapy for pain or long-term use.

• Dose dependent risks for serious harm
  Physicians and patients are not always properly educated on use and good faith prescription practices and guidelines, including risks of remaining on disability, addiction, drug-drug interactions, and dosages at which death and risk of overdose dramatically increase.

Where do we go from here?
It’s never been more obvious than now that effective pain treatment must focus on the legitimacy and efficacy of treatments, keeping in mind the quality of care and quality of life of injured workers.  At ANS Solutions our pharmacotherapy review program is focused on protecting the injured worker by:

• Better addressing the needs of pain patients with the assessment of treatment programs and help of evidence based reviews.
• Improving recovery times with the proper monitoring and modifications of treatment.

• Reducing the risks associated with common opioid treatment regimens by consolidating and coordinating drug therapies between multiple prescribers, identifying duplicate therapies and excessive dosages, and pointing out alternate medication regimens.

Positive change stems from a comprehensive and economically responsible approach in the treatment of pain in workers compensation claims settlements. To learn more about pharmacotherapy review contact ANS today.

References

Volkow, Nora D. Prescription Opioid and Heroin Abuse, House Committee on Energy and Commerce Subcommittee on Oversight and Investigations. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/prescription-opioid-heroin-abuse;  April 29, 2014.

Original content posted on: http://ans-solutions.com/prescription-drugs-and-the-workers-compensation-arena/

What’s Trending with California Workers’ Compensation

Though workers’ comp claims frequency is declining, a recently released California hospital report indicates claim severity is on the rise. Obtaining data from 35 hospitals and individual facilities, the Milliman and Keenan Healthcare report sourced more than 3,500 claims for review.

Trends identified in the report:

• A decline in indemnity and medical-only claims, with ALAE costs playing an increasing role in overall claims costs in recent years. More specifically:
  • Higher average costs per indemnity for workers over 30.
  • Lesser average severity of indemnity claims in workers 30 and younger, with payments more likely to be incurred as age increases.
• Over the 10-year period ending in 2014, overall losses per $100 of payroll have remained flat. This cumulative effect is believed due to reform laws enacted during this time, as identified in the report:
  • 2005-2014: Severity per indemnity claim (indemnity, medical, and allocated loss adjustment) rises almost 5.5%.
  • 2003-2004: Drop in claim severity (reform laws enacted during this time).
  • 2003-2008: Indemnity claim frequency declines dramatically.
• Costs per indemnity claim for 2014 accidents has decreased approximately 10% from the previous year.
• Litigated claims showed a significantly higher average claim severity. They contributed to 20% of total claims with indemnity payment, and account for approximately 54% of total incurred losses.
• Cost projections for 2015: $2.20 loss cost per $100 of payroll.

A Balanced Approach to Medical Cost Containment

In California’s complex and ever-changing workers’ comp environment, informed decision-making is essential to safeguarding results. At ANS, we pride ourselves at staying at the forefront of (legal and technological) industry changes to ensure the best possible outcomes for both our clients and injured workers.ANS’s three-staged Pharmacotherapy Review Program ensures economically balanced and appropriate treatment options for injured workers. Our legal nurse experts excel at presenting actionable treatment modification recommendations in clear, written proposals for treating physicians, including recommendations such as:

• Consolidation and coordination of drug therapies between multiple prescribers.
• Consideration of alternate therapies.
• Specification of weaning programs for over-prescribed narcotics.
• Use of generics where applicable.

The end result? A cost effective treatment regimen that simultaneously enhances the quality of care for injured workers. Discover more about this advanced and comprehensive treatment strategy. Contact http://www.ans-solutions.com today.

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