Opioid/narcotic medications and the injured worker

Issue: BCMJ, vol. 50, No. 10, December 2008, Page 572 WorkSafeBC

WorkSafeBC has developed a practice and process for the prescription of opioid/narcotic medications for injured workers—here’s what you need to know.

In 2007 in British Columbia, more than 1550 injured workers were taking prescribed opioid/narcotic medications—not including Tylenol 3—for longer than 12 weeks post­injury or postsurgery. WorkSafeBC policy limits reimbursement for opioid use to the first 8 weeks postinjury or postsurgery in the majority of cases. Clinical evidence suggests that long-term use of high-dose opioids may be associated with certain risks, including developing tolerance, dependence, and potential addiction, as well as accidental death and heightened pain sensitivity. In addition, long-term use of opioids may not improve physical function or pain management.

Following pain management principles and medical best practices adopted and approved by the College of Physicians and Surgeons of Ontario and adopted by the College of Physicians and Surgeons of BC (Evidence-Based Recommendations for Medical Management of Chronic Non-Malignant Pain: Reference Guide for Clinicians), WorkSafeBC has developed a practice and process for the prescription of opioid/narcotic medications for injured workers. One of the goals of the practice initiative is to ensure that WorkSafeBC applies its policy on opioids consistently across the entire province.

The process

In accordance with policy, WorkSafe­BC covers the costs of opioid/narcotic medications for injured workers for up to 8 weeks postinjury or postsurgery. However, in special or extenuating cir­cumstances, WorkSafeBC may cover the costs beyond this acute period.

For injured workers who require opioids beyond the 8-week acute period, the process for WorkSafeBC to continue paying for prescribed medications involves both the injured worker and his or her physician.

If your injured worker patient is on opioids 7 weeks postinjury or postsurgery, you will receive two documents:

• D.I.R.E. score reference form—for your use only. This form does not need to be returned to WorkSafeBC, but the actual D.I.R.E. score is required on the form described below. This scoring instrument provides insight as to whether your patient is likely to receive benefit/harm from a trial of opioid treatment for chronic nonmalignant pain.
• Physician Request for Opioid/Narcotic Funding Extension Form (68D80)—for completion and return to WorkSafeBC within 4 weeks.

Payment for the completion and timely return of the Opioid/Narcotic Funding Extension Form (68D80) is under Code 19909, Standardized As­sessment Form, and is $75.

If you would like to discuss your patient’s condition and treatment, the possible use of therapeutic alternatives, or your concerns that your patient may not be a good candidate for continued use of opioids, please contact the medical advisor listed on the covering letter.

At the same time that you receive the scoring instrument and form, your injured worker patient will receive a letter from WorkSafeBC, enclosing a Worker Opioid/Narcotic Agreement to be signed and returned within 4 weeks if ongoing medication is required. This agreement is between your patient and WorkSafeBC and does not involve you.

If WorkSafeBC has not received the completed forms 4 weeks after they are sent to you and your patient—particularly Form 68D80, which must come from you—the medical advisor will contact you to verify your decision that further opioid medication is not required.

If the signed forms are returned, the medical advisor will contact you to develop an action plan to:

• Continue the medication with a follow-up review at a specified time.
• Wean the worker off the opioids.
• Help the worker make the transition to alternate medication or treatment.
• Discontinue the prescription.

If the agreement between you and the medical advisor is to continue the opioid medication for your injured worker patient, another review will be scheduled for 6 months after the initial prescription. At that time WorkSafeBC’s Opioid Team may become involved to develop a further action plan with you, the treating physician, and your injured worker/patient.

The intent of WorkSafeBC’s new practice and process for prescription of opioid/narcotic medications is to support physicians in following evidence-based medical best practices to achieve optimum outcomes for injured workers and to ensure that injured workers throughout British Columbia receive consistent service from WorkSafeBC.

If you have any questions or concerns regarding opioid/narcotic prescriptions for your injured worker patient, please call your local WorkSafeBC office and speak to a medical advisor.

—Peter Rothfels, BEd, MD, ASAM
WorkSafeBC Director of Clinical Services
Chief Medical Officer

Peter Rothfels, MD. Opioid/narcotic medications and the injured worker. BCMJ, Vol. 50, No. 10, December, 2008, Page(s) 572 - WorkSafeBC.

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