Naloxone (Narcan): What Workers Comp Payers Need to Know

Though it has been on the market since 1971, this year is expected to be a landmark year in Naloxone (Narcan) sales nationwide, and this trend is expected to continue due not only to the opioid epidemic sweeping the nation, but the fact that opioids still remain the most frequently prescribed category of medication used in workers’ comp pain management.

Preventing Death from Opioid Overdose

In its hallmark form, Naloxone was approved for injection by the FDA in 1971. An opioid agonist, it was used in hospital and emergency settings to temporarily reverse the dangerous effects of overdose, including sedation, low blood pressure, and potentially fatal respiratory depression. However new outpatient options have recently entered the market, putting this potentially life-saving drug in the hands of the general public.

• Evzio (2014)
  The first FDA-approved naloxone auto-injector available in the U.S., this small, portable device, similar in nature to an Epi-pen, can be used by patients or family members in the event of overdose. (Holds a significantly higher average wholesale price than Narcan and traditional injectables.)
• Narcan (2016)
  A single-dose, ready-to-use nasal spray that requires the patient to be lying on their back for proper administration.

Not a Magic Bullet
Reversing the effects of opioids at the receptor site and blocking further binding, naloxone takes effect in 3 minutes, wearing off in about 30-to-90 minutes depending on the opioid taken. Though it reverses the clinical and toxic effects of overdose, it only displaces opioids for a short time.

Access Expanding
Despite its short-term effects, legislative and regulatory reforms are making naloxone increasingly available nationwide as states struggle to combat the opioid epidemic. Anesthesiologists, PMR physicians, physician assistants, nurse practitioners and pain management specialists are writing the majority of prescriptions for patients undergoing opioid treatment therapies. Civil liability protection has been expanded for First Responders employing its use. Some states have even made naloxone available for sale as an over-the-counter medication.

Turn the Tide
Due to opioid over-prescription and abuse in our country, Naloxone is unfortunately a necessary medication. However, at ANS Solutions, we believe the best way to prevent opioid overdose is by circumnavigating its use with the patient-doctor education and equally effective, scientifically-proven alternative medical treatments that protect the outcome of injured workers, and reduce unnecessary opioid treatments and associated costs. With our medical cost containment strategies, safe, efficacious cost-effective care is possible. Discover more at http://www.ans-solutions.com today.

Sources: http://helioscomp.com/docs/default-source/continuing-education-2016/072816-optum-naloxone-use-in-wc-ce_final.pdf 

Original content posted on http://ans-solutions.com/naloxone-narcan-what-workers-comp-payers-need-to-know/

How Common is Illegal Drug Use Among Pain Patients?

At the American Pain Society’s 35th Annual Scientific Meeting in Austin, findings were released on the use of illicit substances among chronic pain patients. Of 450,081 patients included in a study by Baltimore-based pain medication monitoring firm Ameritox, 10.4% of urine samples tested positive for the use of at least one illicit substance.

How Many of Those Identified Were Workers Comp Patients?
Workers compensation was the primary payer for 22,525 of the 450,081 patients in the study, conducted between January 2013 and July 2015, which showed the use of illicit substances 8.4% of the time in workers comp patients. The group with the highest level of detection, at 16.4%, was Medicaid patients. The lowest: Medicare at 8.1%. Commercially insured individuals were detected at 8.4%, and patient paid tests at 12.5%, respectively. Of those receiving opioid pain treatment drugs, the use of illicit substances was detected at the following rate:

• For patients prescribed Hydrocodone – 10.9%
• For patients prescribed Codeine – 10.7%
• For patients prescribed Oxymorphone – 8.2%

Risk Mitigation and Pharmacotherapy Review
With the use of highly addictive opioids in the treatment of pain, a lack of utilization and/or awareness of risk mitigation strategies is a common driver for poor outcomes. Often times the potential for addiction or the existence of past drug abuse and even behavior consistent with drug abuse are over looked. When this happens the quality of treatment and life in large loss workers compensations claims are severely compromised while associated treatment costs continue to rise.

At ANS, our highly credentialed Legal nurse consultants develop actionable treatment recommendations to enhance the quality of life of injured workers while also ensuring optimal financial outcomes through:

• Comprehensive, holistic medical records reviews and treatment assessments.
• The identification of at-risk individuals and dangerous or deadly drug interactions.
• Uncovering of unnecessary opioid treatment regimens and baseless dosage increases.
• The recommended use of equally effective, less risky, alternative treatment methods where applicable.
• Compliance protocols for monitoring the usage of habit-forming medications, such as opioids.
• Opioid tapering/weaning programs to curb the risk of opioid addiction.

Improve outcomes and reduce costs with the most effective pharma cost containment strategies in the industry. Contact http://www.ans-solutions.com today.

Content was originally published at  http://ans-solutions.com/how-common-is-illegal-drug-use-among-pain-patients/.

Key Takeaways from a Recent National Safety Council Survey

Subsequent to the CDC’s new guidelines regarding the treatment of chronic pain, The National Safety Council (NSC) released its latest survey regarding doctor prescribing practices. Summarized below, the statistics:

CDC Guidelines: Use non-opioid therapies first.
NSC Stats: 74% of doctors erroneously believe opioids (morphine, oxycodone) are the most effective way to treat pain.

The Missing Link: Research shows OTC pain meds (ibuprofen, acetaminophen) offer the most effective relief for acute pain.

CDC Guidelines: Do not use opioids for the routine treatment of chronic pain.
NSC Stats: 67% of doctors base there prescribing practices – in part – on patient expectations.

The Missing Link: Patients are often unaware – and doctors wary to inform them – of the effectiveness of alternative treatments for pain. 50% of those patients would return to those prescribers offering alternative treatment.

CDC Guidelines: No longer than 3 days of opioid treatment, beginning with the lowest effective dose.
NSC Stats: 99% of doctors are prescribing these highly addictive drugs for longer than the CDCs recommended time frame – 23% for at least a month.
The Missing Link: Though doctors have the best interests of patients at heart, additional education and training on effective pain management are integral to curbing the rising opioid epidemic.

CDC Guidelines: Address harms of opioid use and assess risk for abuse prior to opioid therapy.
NSC Stats: 84% screen for abuse.
The Missing Link: Only 32% screen for a family history of addiction – a strong indicator.

CDC Guidelines: Re-evaluate risks of continued therapy regularly.
NSC Stats: 99% of doctors have seen a pill-seeking patient – only 32% refer pill-seekers to treatment.
The Missing Link(s): 88% of doctors find referrals overly difficult due to patient unwillingness to cooperate, lack of insurance coverage for such treatments, long wait lists, or lack of providers.

Actionable Treatment Recommendations

ANS's Pharmacotherapy Review Program employs a three staged approach to ensure economically balanced and appropriate treatment options for injured workers. Our legal nurse experts are able to present actionable treatment modification recommendations in a written proposal to treating physicians. Key items of interest covered through the recommendations include:

• 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 is a cost effective treatment regimen that simultaneously enhances the quality of care for injured workers. To find out more contact ANS today.

This content was originally posted at http://ans-solutions.com/key-takeaways-from-a-recent-national-safety-council-survey/

6 Ways Pain Management is Mismanaged

There is a significant body of evidence suggesting that many Americans suffer from chronic pain and much of that pain is inadequately or ineffectively treated. Particularly in the case of chronic pain treatment via opioid analgesics, proper chronic pain management is critical in determining whether opioids are used in a manner that is both medically appropriate and in compliance with regulations. Pain management is an important area of patient care that is integral to the practice of medicine, yet so often it is mismanaged. Here we review six most common ways pain is mismanaged:

• Inadequate attention to patient education and informed consent. Deciding to begin opioid therapy for chronic pain should only be made after a physician and patient discuss the risks. Pain patients should have a clear understanding that the clinical basis for the use of these medications for chronic pain is limited, risk of addiction is real, and that taking opioids with other substances or certain conditions (i.e. depression or a history of substance abuse) may further increase risk.
• Inadequate attention to initial assessment. A proper assessment will help to determine if an opioid based pain treatment regime is medically appropriate and necessary. It will also help in uncovering risks associated with use for a particular individual.
• Inadequate monitoring during the use of habit forming medications. Due to its highly addictive and dangerous nature, opioids are associated with drug addiction and abuse. Chronic pain treatment benefit from opioid dose reductions or tapering or weaning off the opioid.
• Excessive reliance on opioids for chronic pain management without adequate attention to alternative treatments. Prescribers should use opioid therapy only when safer and equally as effective alternative therapies prove to be ineffective.
• Baseless dosage increases without adequate attention to risks or alternative treatments. The risks associated with opioids increase with higher doses and even more in conjunction with other comorbidities (i.e. mental illnesses, respiratory disorders, pre-existing substance use disorder and sleep apnea) and with concurrent use with respiratory depressants such as benzodiazepines or alcohol.
• Lack of utilization of available tools or lack of knowledge of available tools for risk mitigation. Our Pharmacotherpay Review program uncovers major issues including duplicate therapies, dangerous or deadly drug interactions, or behaviors related to drug addiction. All of which can have a dramatic impact on a patient’s health.

ANS Pharmacotherapy Review

A well informed physician’s practice can improve safety and the outcome of chronic pain treatment for patients. This is an area where the expert medical cost containment solutions of ANS Solutions can help. Our Pharmacotherapy Review Program provides three highly effective stages that not only contribute to lower medical costs in workers’ compensation claims, but greatly enhance the quality of life and care for injured workers.

For more information, visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/6-ways-pain-management-is-miss-managed/