January 15, 2013 Posted by Hanagan & McGovern

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We need to get ready – it’s coming – and there isn’t anything that can be done to stop it. What I’m talking about is the vigorous regulation of prescription pain medications.

pillsA recent study by the CDC (Center for Disease Control) presented some pretty alarming statistics with respect to prescription pain medications. These medications, also frequently referred to as Opioids, are linked to a growing and deadly epidemic of prescription painkiller abuse.  Some of the reported facts from the CDC study show that prescription pain killers were involved in 14,800 overdose deaths in 2008.  Combined, these total more deaths than resulted from cocaine and heroin use combined.  And these are just the deaths from overdose.  The misuse of these Opioids were responsible for more than 475,000 emergency room visits and countless treatment programs for substance abuse.ER Scene

The CDC reported that for every death (14,800) there were:

  • 10    Treatment admissions for abuse;
  • 32   Emergency room visits for misuse or abuse;
  • 130 people who abuse or are dependent;
  • 825 people using painkillers for nonmedical reasons.

That is 12.2 million people in the US taking pain medication for nonmedical reasons in 2010.  To put that in perspective, that is roughly the population of the entire state of Illinois.

The State of Maine, relatively small by population standards, reported spending in excess of $100 million annually for treatment of painkiller addiction.   Some sources have estimated that nonmedical use of prescription painkillers costs health insurers up to $72.5 billion annually in direct health care costs.

The misusage numbers are alarming numbers in and of themselves.  But, when coupled with the cost to the various states for providing emergency care and treatment for addiction, there isn’t much question that tighter regulations are on the way.  We don’t have a crystal ball, but what we expect to see in the not too distant future are some combination of the following efforts to combat this problem:

  1. General practice physicians -  will be limited to prescribing Opioids to their patients for something along the order of one to two months.  Thereafter, it will be  necessary to see a medical specialist.
  2. Medical specialists – will be limited to prescribing Opioids only while the patient is undergoing active care.  Thereafter,  a patient will need to be referred to a Pain Management Specialist for longer term pain management, if it becomes necessary.
  3. Pain Management Specialists – have already have been working to curb the undesirable use of pain medications with efforts such as:
    • Using Pain Contracts, an agreement the patient signs that impresses upon them the importance of using the medication as intended.  The patient  promises to use the medication only as directed and won’t make the medication available for others to use.  Violation of the contract will result in the patient being booted from the pain management program.  From what we have seen in the past, there will likely be a zero tolerance policy for violators.  In combination with regulations requiring controlled access to medications, this will help prevent doctor shopping to find someone else to prescribe the medication.
    • Frequent and unannounced urine testing, to make sure the patient is not taking other unprescribed medication and is taking the prescribed medication.
    • A push toward alternative therapies. We’ve noted some medical specialists recently discussing the return of psychological behavior modification therapies for some pain patients.
  4. Pharmacies and controlled access – similar to what we see now if you want to purchase Pseudoephedrine. The states will operate a database and track an individual’s purchase of pain medications. Doing so should dramatically help to curtail anyone from using multiple physicians and pharmacies to obtain multiple prescriptions and acquiring Opioids to distribute to nonmedical users.

This is an issue that goes way beyond injured workers and the question of whether they took one too many pills or were able to skip a few. The broader problem is that an outrageous amount of pain medication is being used by people that don’t need it and aren’t supposed to be using it. Unfortunately, they are getting it from people that have had it prescribed to them but aren’t using it and doctors that shouldn’t be prescribing it at all. That is getting ready to stop.


Hanagan & McGovern is a Mt. Vernon, Illinois, workers’ compensation and personal injury law firm serving southern and central Illinois.   If you have questions concerning this article or have other workers compensation questions, please contact usGNZ4YKNXUZFH

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  1. terry bakowski says:

    I’m all for curtailing illicit drug use, that has myriad benefits, BUT.. when narcotics contracts appear to be used as bludgeons, PM docs are unresponsive to patients with severe (read: approaching cancer-pain level) chronic pain and insouciant about the side effects, there’s something rather wrong with that picture. What can the patient do to receive -viable- pain medication when the doc arbitrarily writes a scrip for a pain patch that summarily gets denied by her insurance, leaving her insufficiently medicated? No forethought there, as in, “gee.. will my patient have adequate pain coverage if this med’s not approved in a) a timely fashion or b) at-tall, at-all?”, no, nothing like -that- occurred. I want to know about the PMs liability, responsibility and obligation to ‘first, do no harm’. That means, in some cases, ‘if it ain’t broke, don’t try to fix it ’cause you -think- you know better what works than the patient who’s had chronic pain for over a decade’. What office in the Illinois government do I complain to, I’d love to know. It’s not a Happy New Year for all of us out here.

    • It is unclear from your post whether your doctor has prescribed the medication and your insurance carrier has denied it, or whether the doctor would not prescribe pain medication to begin with. If it is the former, then your doctor should be able to assist you in getting approval for the medication from your insurer. If the later, your complaint has to do with the appropriate standard of care and the only suggestion I have would be to contact the AMA and ask for guidance on who you can contact. This does not appear to be a situation where you feel the doctor is mistreating you, rather that the professional standards regarding use of pain medication for people in your situation are wrong, so a complaint to the state department of professional is probably not warranted.

  2. FYI – When I went to Germany on a social worker trip regarding health care, they had 2 different types of health care. One was the state run system and the other was private ins. We met with a pain management specialist. In the state run system, she got paid per patient, not per visit; whereas, with private ins. she was paid per visit. Therefore, for the state patients, they would end up on a higher dose of pain meds than they needed because she would want to have them controlled within 3 mos (not to mention it would oftentimes take them 6 years to get through enough physicians to get to her in the first place). However, the private patients would be on the amount of pain meds that they really needed because she had the payment to increase the amount incrementally.

    Cheryl Powell

    Comment Moved From unrelated post:

  3. Mark Pew says:

    Very interesting post. I follow the prescription drug issue for a living in Work Comp and speak/teach on this subject nationwide so your application of Evidence Based Medicine and state guidelines (and general common sense) is spot-on. However, other than your point 4 which I presume to be linked to PDMP’s (with KY, MA, NY and TN mandating their use), the FDA opioid blueprint and White House strategies published in 2011 and Florida not allowing physicians to dispense Schedule II’s, I have not seen any trends in the statutes or rules towards your other suggestions. With the caveat of not having the crystal ball, I would be interested to know who may be driving those trends and any potential ETA.

    • I am not suggesting that we already have a trend, I am suggesting that we will see some further restrictions. I honestly don’t see any alternative, as the traditional means of limiting access to people that need them isn’t working and the medications are getting into the hands of recreational users and abusers in very large numbers.

      Someone has to monitor who is getting what medications filled and when, and the Prescription Drug Monitoring Programs would seem to be an effective (actually, the most effective way of the possible alternatives I mentioned) to do this. I see the other alternatives as “baby steps” that regulators may take, perhaps as a means to avoid the costs associated with the PDMP’s.

      With respect to the pain management specialists using contracts, we are seeing them in our practice used by some physicians in southwest Indiana, with unannounced urine testing in both Indiana and southern Illinois. If and when these sorts of measures may become required is anyone’s guess, but with the numbers announced by the CDC I don’t think they are far behind.

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