Tag Archives: Federal Law

Opioids And Doctor Choice

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

Chicago Mayor Rahm Emmanuel said in 2008 that “You never let a serious crisis go to waste.” In the context of opioids and workers compensation this could mean reforms to workers compensation systems beyond drug formularies If solving the opioid crisis means limiting the number of doctors who can prescribe opioids, then there will be fewer doctors who will treat workers compensation cases.

Additional licensure and certifications aren’t unheard of in the world of occupational health. In 2016, the Federal Motor Carrier Safety Administration implemented a new rule that only doctors on their registry can perform DOT Physical Examinations for truckers and other professional drivers. This reduced the number of doctors who can perform those examinations. 

When I testified on LB 408, a bill that would have implemented drug formularies for opioids under the Nebraska Workers’ Compensation Act, some doctors were testifying that there was little training in regards to prescribing opioids. Though an opioid prescription registry like the DOT examination registry wasn’t proposed, you could certainly see it proposed as a solution to the opioid problem.

By limiting the numbers of doctor who handle workers’ compensation claims through additional licensing requirements, injured employees will have fewer choices for medical treatment and are more likely to have their employer control their care.

Evidence shows that the workers compensation system has made some contribution to the opioid crisis. According to a 2015 report by the Bureau of Labor Statistics over 3.5 million employees were injured at work. Half of those injuries required the employee to miss sometime from work. A study of employees in 25 states done by the Workers Compensation Research Institute revealed that 55 to 85 percent of employees who missed at least one week of work were prescribed at least one opioid prescription.

When I testified on LB 408 the consensus among the doctors testifying on the legislation was that injured workers were more vulnerable to narcotic addiction than other patients who are prescribed narcotic pain medication. Scientific studies give some credence to these conclusions. Workers compensation claims can cause economic insecurity. According to an article in Scientific America, Addiction rates for opioids are 3.4 times higher for those with incomes under $20,000 per year than they are for employees making more than 50,000 per year.

But that article also shared studies that state that pain pill prescriptions are not driving the opioid epidemic. Patients with pre-existing addiction issues are more likely to become addicted to opioids and 75 percent of those who develop opioids start taking opioids in a non-prescribed manner. Furthermore, only 12 to 13 percent of ER patients who are treated for opioid overdoses are chronic pain patients.

Workers’ Compensation is traditionally an area of the law that is controlled by the states. Regulation of drugs is generally an area reserved for the federal government. Any laws imposing additional hurdles or requirements upon doctors who prescribe opioid drugs may have to come from the federal government.

Lobbying In D.C. On Behalf Of Injured Workers

Senator Tom Harkin and I met in D.C. to discuss the legal rights of injured workers.

On April 17, my colleagues from WILG (Workers Injury Law & Advocacy Group) and I gathered in Washington D.C. to lobby Congressional representatives on behalf of injured workers. We discussed several bills that will affect the interests of workers in Iowa and across the United States.

I had the pleasure of meeting with Senator Tom Harkin, Senator Chuck Grassley, Congressman Bruce Braley and Congressman Dave Loebsack in their offices where we discussed the following bills:

  • The MSP and Workers’ Compensation Settlement Agreement Act of 2012
  • The Akaka Amendment to S. 1789, The Post Service Reform Bill (an amendment to strip from S. 1789 those provisions that deform the Federal Employee Compensation Act).

As I explained at these meetings, the MSP and Worker’s Compensation Settlement Act of 2012 is necessary for three reasons:(1) to bring some reasonable and understandable system to CMS’ current uncertain and regulation-less system of establishing Medicare Set-aside Plans for workers’ compensation settlements; (2) to allow for an appeal of CMS’s MSA determination; and (3) to bring some reasonable time limits to CMS’ process of setting the MSA required for workers’ compensation settlements.

The Akaka Amendment to strip the FECA deform provisions out of S.1789 is necessary because the FECA deform provisions wrongfully reduces monetary benefits and treats the injured worker like a fraud (mandating period independent medical examinations, vocational rehabilitation and field nurses to hound the injured worker).

Workers’ compensation reform is a constant threat to the rights of workers across the country. It is important that all of us who participate in the work’ comp’ system do our part to protect and preserve these legal rights.