American College of Physicians Guideline Steers Doctors Away from Opioids for Low Back Pain
A new low back pain treatment guideline from the American College of Physicians (not to be confused with ACOEM) is the latest medical guideline to discourage the use of opioids for low back pain. Instead, it encourages such treatments as exercise, acupuncture or biofeedback. ACP President Dr. Nitin Damle said “Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients. Physicians should select therapies that have the fewest harms and costs.”
The ACP developed its treatment guideline based on a systematic review of published research on low back pain treatments. The guideline applies to cases of nonradicular low back pain, where pain is not radiating into the patient’s leg. Mark Pew, senior vice president at Prium, said the new ACP guideline will help get the message across about opioids. Pew said that he agreed with the ACP guideline strategy of first trying non-drug therapies for treating chronic low back pain, followed by non-opioid drugs, followed by opioids if all other options have failed. “In other words, opioids should almost never be considered because one of the foregoing options will likely work.”
NJ Gov. Chris Christie Signed SB 3 – Sets 5 Day Limit on Initial Opioid Prescriptions
New Jersey Gov. Chris Christie signed SB 3 into law, limiting initial opioid prescribing to acute pain and for a 5 day supply. The bill also requires prescribers to document a patient’s history of opioid use before writing the initial prescription, as well as documenting the patient’s response to non-opioid therapies, including alternate drugs and non-drug treatments. The bill also mandates opioid education for prescribers. The bill does not appear to be specific to workers’ comp, but Brian Allen, VP Government Affairs at Optum, said SB 3 should benefit the workers’ comp system where many injured workers have been taking opioids long term.
Neurontin and Lyrica Under Growing Scrutiny
Prescription Drug Monitoring Databases (PDMPs) are regarded as important tools in fighting opioid misuse. However, most PDMPs do not track drugs used to treat neuropathic pain, such as Neurontin and Lyrica. Neurontin is a non-opioid drug used to treat chronic pain. Lyrica, is a Schedule V drug and also affects chemicals in the brain that send pain signals across the nervous system. Both drugs evade detection by most PDMPs that track Schedule II – IV drugs.
Neurontin and Lyrica have both gained a reputation among illicit users as drugs that can enhance the high from other medications. And Neurontin is particularly dangerous because, according to Ohio PDMP director John Hannah, it may contribute to sedation and respiratory depression. And unlike opioids, there is no antidote like naloxone (Narcan) that can be administered in emergencies.
The good news is that states like Ohio are getting smarter. For example, while prescribers are not required to check the Ohio PDMP to dispense gabapentin, which is the generic for Neurontin, and also includes the brands Horizant and Gralise, they are required to at least report prescribing it. This way any prescriber, when pulling up a patient’s PDMP profile, can see if it’s been prescribed, and take appropriate action.
Pennsylvania Lawmaker is Pushing Hard for a Drug Formulary
Rep. Ryan Mackenzie has sponsored HB 18, which would direct the state Department of Labor & Industry to select a nationally recognized, evidence based drug formulary for Pennsylvania’s workers’ compensation system.
Rep. Mackenzie testified before the House Labor and Industry Committee that Pennsylvania averages the third highest in opioids prescribed per work injury. He said that while Pennsylvania has made several reforms to combat the opioid epidemic, including a robust PDMP in 2014, there was no silver bullet, and the state needed a multi-pronged approach.
A few notable issues regarding HB 18 are that it calls for a very quick turnaround time. The comment period would only be 90 days, and within 30 days of the comment period the department would be required to implement the formulary and make it available online. Joe Paddua said “This is way too brief.” Also, the bill requires that UR organizations would have to be certified under Section 2151 of the Insurance Company law of 1921. ,
Trump Nominates Former U.S. Attorney Alexander Acosta for Labor Secretary
With Andrew Puzder withdrawing from consideration as Labor Secretary, Trump nominated Alexander Acosta. You may recall that Andrew Puzder is the chief executive officer of CKE Restaurants Inc. the parent company of Carl’s and Hardee’s. Alexander Acosta, on the other hand, is a former U.S. attorney and member of the National Labor Relations Board (NLRB).
AFL-CIO President Richard Trumka said, “We’ve gone from a fast food CEO who routinely violates labor law to a public servant with experience enforcing it.” Trumka said Acosta’s nomination deserves serious consideration.
Mark Walls, vice president of communications and strategy at Safety National, said, “President Trump is not going to name a cabinet member who does not support his focus on less government.” He said that Acosta is a well respected business leader who has a strong background dealing with labor issues as a member of the NLRB, interacting heavily with business and labor. Acosta is a Miami native born to Cuban immigrants and is Trump’s first Hispanic nominee.
Kentucky Republicans Propose New Reforms Including a Drug Formulary
The Republicans now control both the Kentucky House and Senate. They are moving fast, via HB 296, to reform the workers’ comp system to make work comp for affordable for employers. The bill proposes the creation of medical treatment guidelines, including guidelines that address chronic pain management and opioid abuse, and establish a drug formulary by Dec. 31, 2018. The bill also caps partial disability benefits at 15 years.
Representative Adam Koenig said “We’ve got a drug epidemic, we’re working on a drug formulary and other things so we can make sure our prescription drugs are being used as they should rather than being abused.” Mr. Koenig has a point as Kentucky is tied for third with the most opioid related drug overdose deaths per capita in 2015, according to CDC data.
Claimants’ attorney Chad Jennings had a different take, stating “This bill is an assault on injured workers and their families in Kentucky, and it’s going to permit more savings for the insurance companies. Kentucky loss costs have dropped 11 straight years. There’s no evidence there’s a need to pass along additional savings to insurance companies.”