FDA Issues Naloxone Recommendations for Opioids and OUD Drugs

The FDA issued a new series of recommendations for healthcare professionals addressing the importance of prescribing naloxone – the opioid overdose reversal drug – with and without opioids and opioid use disorder (OUD) medications.

Opioids are often prescribed in workers’ comp, and to a lesser extent, OUD medications also appear in workers’ comp claims. As these drugs are impacted by these recommendations, it is very possible that workers’ comp claims may see an increase in naloxone prescriptions due to the following FDA recommendations.

To reduce the risk of death from opioid overdose, the FDA recommends that providers discuss and/or co-prescribe naloxone with:

  • All patients who are prescribed opioid pain relievers
  • All patients who are prescribed medicines to treat OUD
  • All other patients at increased risk of opioid overdose, even if the patient is not receiving a prescription for an opioid or OUD drug

Co-prescribing for naloxone is recommended for all patients who are prescribed opioid pain relievers, and are at increased risk of opioid overdose, such as patients who are also using benzodiazepines or other medicines that depress the central nervous system, who have a history of opioid use disorder (OUD), or who have experienced a previous opioid overdose.

For all patients who are prescribed medicines to treat OUD, providers should strongly consider naloxone co-prescriptions for methadone and buprenorphine-containing products, as well as for patients who have household members, including children, or other close contacts at risk for accidental ingestion or opioid overdose.

For other patients at increased risk of opioid overdose, even if the patient is not receiving a prescription for an opioid or OUD drug, providers should consider naloxone. This can include patients with a current or past diagnosis of OUD.

Furthermore, the FDA is requiring drug manufacturers of all opioid and OUD medications to add new recommendations to their drugs’ prescribing information regarding naloxone. This is to help drive the aforementioned recommendations into practice.

Tags: FDA, naloxone, opioid, prescription, prescribe, co-prescribe, OUD, opioid use disorder

Overcoming Obstacles to Patient Recovery Amid a Global Pandemic

Healthesystems’ VP of Clinical Services, Silvia Sacalis, BS, PharmD, was featured in the International Association of Industrial Accident Boards and Commissions’ (IAIABC) Perspectives publication.

Dr. Sacalis penned an article on the fast-moving impacts that COVID-19 has had on the healthcare system and workplace environment, exploring challenges presented to workers’ comp.

Societal and infrastructural ripples have disrupted the overall delivery and management of patient care, and as healthcare policy initiatives and funding are prioritized to address the more immediate concerns related to management of COVID-19, Dr. Sacalis emphasizes the need to not lose sight of ongoing challenges within the workers’ compensation population that may be exacerbated by the pandemic.

This includes challenges such as:

  • Opioid use and misuse
  • Mental health concerns
  • Chronic health conditions

The article is available in full online. IAIABC members can view the article as part of the latest issue of Perspectives, and non-members may click here for a PDF of the article.

Tags: Silvia Sacalis, IAIABC, COVID-19, mental health, comorbidities, chronic health conditions, opioid, misuse, pandemic

American Medical Association Publishes Opioid Task Force Report

The American Medical Association (AMA), shortly after asking the Centers for Disease Control and Prevention (CDC) to reevaluate their opioid guidelines, has published a report from their opioid task force, detailing physician’s progress toward ending the opioid epidemic.

The report notes that the AMA taskforce’s recommendations have led to:

  • A 37.1% decrease in opioid prescriptions from 244.5 million in 2014 to 153.7 million in 2019
  • A 64.4% increase in the use of state prescription drug monitoring programs, which hit 739 million queries in 2019
  • Hundreds of thousands of physicians accessing continuing education on substance use disorders, pain management, and more
  • 85,000+ physicians and healthcare professionals certified to prescribe buprenorphine in office, an increase of nearly 50,000 since 2017

While the report celebrates these developments, it states that over 2 million Americans have untreated substance use disorders, specifically encouraging policymakers to remove barriers to evidence-based care for patients with pain and those with a substance use disorder, stating the epidemic will continue or worsen without such change.

The AMA points to research data, noting that 92% of pain medicine specialists have been required to submit prior authorization requests for non-opioid pain care, which requires physicians and staff to spend hours per day on such requests. In essence, trying to use an alternative to opioids has been met with difficulty.

Furthermore, the AMA believes that opioid policy has been driven by a reaction crisis framework; the AMA wants healthcare workers, policy makers, and other stakeholders, to develop a new, holistic model for preventing overdose, one that acknowledges patient individuality in order to provide better care. The AMA believes that various opioid guidelines that have enforced hard opioid limits may be considered one-size-fits-all strategies.

Overall, the AMA has six recommendations for embracing this new policy model:

  • Remove prior authorization, step therapy and other inappropriate administrative burdens or barriers that delay or deny care for FDA-approved medications used as part of medication-assisted treatment for opioid use disorder
  • Support assessment, referral and treatment for co-occurring mental health disorders as well as enforce meaningful oversight and enforcement of state and federal mental health and substance use disorder parity laws, including requiring health insurance companies to demonstrate parity compliance at the time of their rate and form filing
  • Remove administrative and other barriers to comprehensive, multi-modal, multidisciplinary pain care and rehabilitation programs
  • Support maternal and child health by increasing access to evidence-based treatment, preserving families, and ensuring that policies are nonpunitive
  • Support increased efforts to expand sterile needle and syringe services programs as well as reforms in the civil and criminal justice system that help ensure access to high quality, evidence-based care for opioid use disorder, including medication-assisted treatment
  • Implement systems to accurately track overdose and mortality trends to provide equitable public health interventions that include comprehensive, disaggregated, racial and ethnic data collection related to testing, hospitalization and mortality associated with opioids and other substances

Tags: AMA, American Medical Association, opioid, overdose, taskforce, recommendations

Connecticut Enacts Major COVID-19 Presumption

In late July, Connecticut Governor Ned Lamont signed Executive Order 7JJJ, which grants workers’ comp coverage to various employees who presumably contracted COVID-19 on the job.

The order applies to workers who missed a day or more of work between March 10, 2020 and May 20, 2020 due to a COVID-19 diagnosis, assuming the employee did not receive an offer to work from home, and that they have been deemed essential by the Department of Economic and Community Development (DECD), pursuant to Executive Order 7H.

Executive Order 7H, passed back on March 20th, applied to, but was not limited to, sixteen critical infrastructure sectors recognized as essential as defined by the Department of Homeland Security. Each of these sectors covers a wide range of industries and occupations.

The 16 sectors include:

  • Chemical sector
  • Commercial facilities sector – which includes entertainment and media, gaming (casinos), lodging, outdoor events, public assembly, real estate, retail and sports leagues
  • Communications sector
  • Critical manufacturing sector
  • Dams sector
  • Defense industrial base sector
  • Emergency services sector – which includes first responders
  • Energy sector
  • Financial services sector
  • Food and agriculture sector
  • Government facilities sector
  • Healthcare and public health sector
  • Information technology sector
  • Nuclear reactors, materials, and waste sector
  • Transportation systems sector
  • Water and wastewater systems sector

However, Executive Order 7H also specifically mentions occupations not listed in the Department of Homeland Security’s essential sectors, including grocery stores and big-box stores or wholesale clubs, provided they also sell groceries, as well as gas stations and convenience stores, food and beverage retailers (including liquor/package stores and manufacturer permittees) and restaurants.

Furthermore, the DECD may deem any other business essential should it determine that it is in the best interest of the state to have the workforce continue at full capacity to properly respond to the pandemic.

Tags: Connecticut, COVID-19, presumption, coverage, compensable, essential workers, industries, sectors, Department of Homeland Security

Returning to Work in the COVID-19 Era

As of July 22, 2020, the World Health Organization (WHO) documented over 14 million cases of COVID-19 globally and over 600,000 deaths,1 while within the U.S. the Centers for Disease Control and Prevention (CDC) estimated 3.9 million cases and 142,000 deaths.2

As these numbers continue to rise, COVID-19 continues to affect all facets of society and will for the foreseeable future. Narrowing the focus to workers’ comp, in Florida, COVID-19 claims made up 15% of all indemnity claims,3 while the Workers’ Compensation Insurance Rating Bureau (WCIRB) estimates that in California, COVID-19 claim costs will range anywhere from $600 million to $2 billion.4

With states reopening and individuals reentering the workforce after socially isolating, the idea of what constitutes a safe workplace has changed, and the term "return to work" now takes on a whole new meaning.

In addition to the complexities of reintroducing injured workers to the workforce, employers now must incorporate risk management strategies that protect their entire employee population from viral exposure. Meanwhile, the industry is tackling other new challenges that have emerged due to the enormous and ubiquitous impact of COVID-19.

Components of Successful Return to Work Amid the COVID-19 Pandemic

  • Reduce barriers to care to facilitate injured worker recovery
  • Consider unique risks of special populations, including specific job roles and employees with comorbidities
  • Implement measures to foster a safe workplace to protect all employees, including those returning from injury or illness
  • Account for the impacts of employees returning to work following viral infection

To read the article in full, download the white paper.

Tags: COVID-19, return to work, workplace safety, infection, prevention, barrier, disruption, population management, recovery

Driving a More Personalized Claim Experience in a Digital World

WorkCompWire, an online news service focused on workers’ comp, featured a Partner Post from Healthesystems, which examines how the growth of complex claims requires workers’ comp programs to detect early warning signs of claim escalation, while also embracing clinical decision tools to better guide claims.

These challenges point to the need to automate data analysis to inform clinical decisions and their targeted interventions, in addition to increasing data collection to provide more informed insights.

This article discusses how smart technologies such as artificial intelligence (AI), natural language processing (NLP), and more, can augment human decision making to strengthen workers’ comp programs.

Read the article in full online at WorkCompWire.

Tags: WorkCompWire, Healthesystems, AI, artificial intelligence, NLP, natural language processing, complex claim, escalation