Step aside, opioids. Non-steroidal anti-inflammatories are now the most common therapeutic drug group prescribed to injured workers in the state, according a new report by the California Workers’ Compensation Institute.
CWCI said efforts to curb inappropriate use of opioids, such as utilization review, treatment guidelines and restrictions by payers, are having a measurable impact on usage rates. Opioids made up 30.5% of all prescriptions filled in the California workers’ compensation system 10 years ago, but that fell, to 18%, in the first half of 2018. Opioids made up 20.2% of workers’ comp prescriptions in 2017.
By comparison, NSAIDs grew, to 31.7%, of drugs dispensed to injured workers in 2018, compared to 21.4% in 2009.
Similarly, CWCI chronicled a dramatic increase in the usage of anticonvulsants, which also are also an alternative to opioids for the treatment of pain. Anticonvulsants made up 4.1% to 5.6% of workers’ comp prescriptions from 2009 to 2014, but increased steadily, to 9.7% in 2018, as opioid use declined.
Opioids were the most costly, as well as the most prevalent drug group used in workers’ comp a decade ago. CWCI said opioids made up 23.5% of the drug spend in 2009 but made up only 13.8% of the drug spend last year.
Dermatological agents and anticonvulsants have stepped in front of of opioids in terms of the share of spending. Dermatological agents represented 17.6% of the drug spend in 2018, up from 10.1% in 2009. Anticonvulsants represented 15.2% of the drug spend in 2009, up from 4.8% in 2009, CWCI said.
Those dermatological medications include high-cost topical creams and patches for pain management. While the number of dermatological prescriptions increased only moderately, from 5% of all prescriptions in 2009 to 5.6% in 2018, the share of total drug spend increased, from 10.1% to 17.6% during that period.
CWCI said that indicates an increase in the average amount paid for dermatological prescriptions, “which in 2017 surpassed opioids as the most costly drug group in California workers' compensation.”
The shift away from opioids to alternative drugs brings its own set of problems.
“Highly addictive benzodiazepines, such as Valium, Xanax, Ativan, Librium and Klonopin, are a prime example of this,” CWC said. “Originally prescribed as tranquilizers, benzodiazepines are found in multiple therapeutic drug groups, including anticonvulsants, antianxiety drugs and hypnotics/sedatives.”
The report notes that the Journal of the American Medical Association released a report last month that showed benzodiazepines are increasingly prescribed by physicians for a wide range of conditions, including back and chronic pain, anxiety and insomnia. Often they are combined with other drugs and are implicated in a growing number of overdose deaths.
The trend away from opioids to anticonvulsants is proving expensive for workers’ compensation insurers. The average cost of anticonvulsant prescriptions increased, from $102 in 2016 to $125 in 2018, a 22.5% price hike. The vast majority of the prescriptions are for brand-name drugs, CWCI said.
The average price of opioids, by contrast, decreased, from $70 in 2016 to $61 last year.