The Opioid Problem
The opioid epidemic isn’t a new one. It is a predicament faced by many communities around the United States and in the Pacific Northwest, and significantly impacts injured workers in Washington State. Recently Everett, WA has been making headlines because it has been associated with a devastating black market OxyContin drug ring with ties to Purdue Pharma, the maker of OxyContin. This black market and related allegations have been covered in recent articles by both the LA Times (see Article I and Article II on this matter) and the Wall Street Journal.
This isn’t the start of Purdue Pharma’s problems related to its manufacture and sale of OxyContin. In 2007 the maker and three executives pled guilty in federal court to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused, and agreed to pay over $600M in fines. However, by 2010, it was too late. Across the country, doctors had already been prescribing the powerful and highly addictive painkiller (related to Heroin) and many patients were already hooked. OxyContin is just one, name brand variety of opioids prescribed primarily for pain. Other common opioids include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), and codeine to name a few. The fentanyl patch is another popular form of opioid medication that many patients aren’t even aware is an opioid.
Opioids in Washington State
As you can imagine, Washington State’s industrial insurance system, a system designed to provide treatment and other benefits to injured workers has been dramatically impacted by this epidemic. In 2006, when I first started practicing as a workers compensation attorney in Washington State, it was very common to see injured workers being prescribed protracted courses of opioids to treat pain. This isn’t surprising, since Purdue Pharma had launched an aggressive campaign to convince providers that OxyContin was specially formulated to pose a lower threat of abuse and addiction to patients than other opioid formulations.
To its credit, the Department of Labor and Industries detected a surge in death rates for injured workers being prescribed these opioids and it began taking action to research and address the problem. In fact the Department received a grant from the Centers for Disease Control and Prevention to assess the effects and impacts of the Agency Medical Directors’ Opioid Dosing Guidelines. Medical Director, Dr. Gary Franklin led this effort. The team has published a number of peer reviewed articles on point and has used its research to develop guidelines for the prescription of opioids under the Industrial Insurance Act. According to Dr. Franklin, the 2007 publication of their “Agency Medical Directors’ Opioid Dosing Guidelines” was the first of its kind published in the entire country and established a 120 milligram daily cap for the medication. Since then, the guidelines were updated in 2010 and 2013, but the 120 milligram cap remained.
Oversight and Prevention
In January 2013, the Department of Labor and Industries launched a statewide network for providers who treat injured workers, referred to as the Medical Provider Network (MPN). The MPN is part of legislation passed in 2011. In order for providers to treat injured workers and be compensated by the Department for that treatment, the provider must be a member of the MPN. Members of the MPN are required to follow “best practices” including opioid prescription guidelines. Providers found to be non-compliant may be denied MPN membership or have their MPN status revoked. Additionally the Washington State Medical Commission oversees medical care to ensure that the required standard of care is not violated. In July 2016, Dr. Frank Li, a well-known pain management doctor and director of Seattle Pain Centers, who treated many injured workers under the Industrial Insurance Act had his license revoked by the Washington State Medical Commission for failing to properly monitor prescription use of powerful opiates. This crack-down story was extensively covered by the Seattle Times. Furthermore, according to a follow-up coverage by the Seattle Times:
“As many as 20 health-care providers who worked for Seattle Pain Centers have been suspended from the state Labor & Industries department network, which authorizes treatment for workers’ compensation claims.”
As a workers compensation attorney representing clients that suffer from the opioid problem, this recent development has left a large number of injured workers without an active attending physician on their claim. Unfortunately, this puts the injured worker in a very difficult position. Many of these individuals are actively being prescribed opioid pain medications, making them unattractive patients to other providers because of the likelihood of opioid addiction. Fortunately, in addition to the dosage guidelines, the Department of Labor and Industries’ treatment guidelines provide guidance for Department approved opioid detoxification.
In simple terms, there are three options: (1) a gradual tapering under the direction of the attending physician, (2) a short (3-5 day) in-patient detoxification followed by complete weaning over the course of an out-patient pain management program, or (3) if the addiction rises to the level of a mental health diagnosis, up to six months of treatment in a licensed chemical dependency treatment center may be authorized.
Personal Experience and Reality
Unfortunately, detoxification for individuals with a chronic addiction is not as simple as these three options make it appear. These injured workers are truly and deeply addicted to these prescription medications. In just the last year I have encountered clients on as high as an 800 milligram morphine-equivalent daily dosage of opioid pain medication, clients who have had complete psychotic breakdowns during the course of the in-patient detoxification program, clients who have been cut-off opioid pain medications without warning or weaning who have turned to black market or street drugs to avoid the unpleasant withdrawal symptoms, clients who have relapsed after completing the in-patient detoxification program, at least one client who unexpectedly died in his sleep while taking high dosages of opioid medications, and countless clients who refuse to acknowledge the addicting effects of the medication they are taking. Make no mistake about it, these clients are often difficult to work with and, I suspect, equally difficult patients to treat.
There are no easy solutions here. Most injured workers are doing their best to follow medical advice and heal from their injuries and conditions, most medical providers are doing their best to treat patients while following best practices and medical guidelines, and the Department of Labor and Industries is doing its best to develop policies and regulations to limit the negative effects of opioid pain management. Still the epidemic rages on. From blue collar towns like Everett to big cities; our country continues to grapple with the mess opioid addiction leaves in its wake.
If you or someone you know is a Washington State injured worker addicted to opioid pain medications, obtaining authorization for treatment to help overcome the addiction is possible under the Industrial Insurance Act. Talk to the doctor, claims manger or consult with an experienced attorney and obtain the help needed. There are no easy solutions, but one person and one step at a time; we can overcome this opioid epidemic.
Additional resources: L&I Medical Provider Network website