White House Targets Pill Mills

Medicare Set-Aside Blog on April 19, 2011
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One of the primary obstacles in MSAs is the pharmacy component, but is not just the overall expense that is the problem. Over the past decade I’ve seen a sampling of medical records from every state in the nation and from time to time I find myself truly disturbed by some physicians’ behaviors. They answer pain complaints with pills, virtually no questions asked and frequently upon request. Non-psychiatric trained doctors have no problem diagnosing and medicating depression without any attempt to resolve it or training to cope with it. We’ve witnessed the development of pain mills where a claimant doesn’t have to leave the building to receive all related treatment, from diagnosis, imaging and therapy to filling the prescription. We’ve seen situations where claimants are taking two or three of virtually the same type of medication simultaneously because the previous prescription was not discontinued when the next started. Claimants will take narcotics to the point of constipation and sleeplessness, which conditions they can then medicate too. And then there are the doctors who apparently can just not see how they are causing more harm than good. I remember once reading a medical record noting that the patient was extremely agitated because a tree beside his home was struck by lightning causing it to fall on his new boat, so the physician increased his oxycontin by 10mg to calm him down and that is where the dosage remained until it was increased again for another similarly inane event about 6 months later, ending up at 80mg three times per day within 12 months of the date of accident. I try not to think about how he was supposed to drive a boat with such debilitating back pain and depression, so perhaps it was for the best that he was not tempted by such an activity in the long run.

But the questionable over prescribing of narcotics is obviously not limited to workers’ compensation. Today the White House Director of National Drug Control Policy announced that the Obama Administration plans to address the national prescription drug abuse epidemic. The plan includes action in four major areas to reduce prescription drug abuse: education, monitoring, proper disposal, and enforcement. The report highlights how few physicians outside of specialty pain management programs actually receive even limited training on treating pain and no substance abuse detection training. Some will prescribe narcotics to treat minor conditions such as pain following dental surgery that go unused and not disposed of correctly and end up in the wrong hands. Among the many points, a prominent message was that doctors should be required to endure some level of mandatory drug training to identify “doctor shoppers” and to detect therapeutic duplication and drug-drug interactions to cut down on excessive fills that we are so familiar with in WC. Success of just this initiative will have a great impact in WC, especially with regard to MSP initiatives.