Lawmakers come up with a plan to tackle opioid crisis
The Republican-controlled Pennsylvania House lawmakers have devised a plan they say will attack the state’s worsening opioid epidemic on a new front: the state’s workers’ compensation system.
Opponents of the measure call it a poorly disguised handout to the insurance industry that limits a doctor’s ability to treat injured workers.
Either way, the measure is moving quickly through the House with support from Republicans and business groups as well as disapproval from Democrats, labor groups, doctors and workers’ compensation lawyers.
The bill, introduced in February by Rep. Ryan MacKenzie, R Lehigh, would create an approved list of opioids and other drugs that can be prescribed to employees receiving medical care and financial assistance from the state after being injured on the job. The list, a so-called “formulary,” would also set dosage levels for medications.
To prescribe drugs not on the formulary — or to prescribe approved drugs at unapproved dosages — a doctor or patient would have to file an appeal with the Pennsylvania Department of Labor and Industry, which would over see the program.
The bill passed the House Labor and Industry Committee last week by a 14-12 vote and is scheduled to come up for a final vote in the House on Wednesday.
In an interview, Mr. MacKenzie said the idea came out of opioid hearings last year at Temple University in Philadelphia, where policymakers discussed ways to address the growing epidemic of painkiller abuse.
He said other states — including Texas, Ohio, New York and California — have approached the issue of doctors over-prescribing painkillers by creating drug formularies in workers’ compensation programs.
“This is something that is very common in private insurance and other practice areas,” he said.
Last year, a six-month investigation by the Pittsburgh Post-Gazette showed that Pennsylvania has lagged behind other states in measures to reduce opioid prescribing and has been less likely to discipline doctors for painkiller practices.
Mr. MacKenzie cited statistics from Ohio, which implemented a
formulary in 2011, that injured workers were prescribed 37 percent fewer opiate doses in 2014 than in 2010, according to numbers compiled by the Ohio Bureau of Workers’ Compensation. The number of workers’ compensation patients considered dependent on painkillers was cut in half — from 9,343 to 4,723.
The drugs would be approved by panels of doctors and medical professionals who give recommendations basedon peer-reviewed studies, he said.
Some doctors and workers’ compensation advocates have pushed back. They point out that injured workers gave up their right to sue employers for on-the-job injuries under the Workers’ Compensation Act of 1915, with the expectation that they can receive comprehensive medical care.
“Do you want your doctor to have some sort of bureaucrat present a guideline for how he’s supposed to treat you?” said Samuel Pond, a workers' compensation attorney at Philadelphia-based Pond Lehocky Stern Giordano.
Mr. Pond, and ads from a newly formed group called PA Works Now, dispute the notion that injured workers are at risk of becoming addicted to painkillers. He said Pennsylvania’s workers’ comp program already has sufficient protections.
“There’s a burden for me as a physician, now,” said William T. Ingram, owner and managing partner of the Injury Care Center, which sees more than 100 injured people a week in its physical medicine practice in Philadelphia. “This is an overarching cookbook for how medications should be prescribed, without any understanding of the particular problem the patient has.”
Recent restrictions on doctors, Dr. Ingram said, include a mandated check of the Prescription Drug Monitoring Program database to see their patients' controlled substance prescription history; for any patient receiving painkillers; as well as routine urine drug tests of opioid levels. “If you really want to talk about what’s gonna make a difference (in the opioid crisis), it’s already happening,” he said.
If anything, Mr. Pond argued, workers’ compensation should be expanded. On its website, PA Works Now is pushing other reforms, like the recovery of lost benefits and health-care packages and retirement payments, in addition to lost wages.
Mr. MacKenzie pointed out that Mr. Pond’s firm also owns Workers First Pharmacy, which provides prescription medication for its clients and could have the amount of prescribed drugs limited under the bill. Mr. Pond defended the pharmacy as an extension of the services he can provide injured workers and called Mr. MacKenzie an opportunist in using the opioid epidemic for political advantage.