Oxycontin and Workers Compensation: Prescription for Trouble

There is an interesting convergence of issues concerning the pain killer, Oxycontin. Originally developed to combat cancer pain, Oxycontin has been aggressively marketed over the past three years by its manufacturer Purdue, to the point where the drug is now the pain-killer of preference for work related injuries. This drug is twice as powerful as morphine and, while not technically addicting, it can create withdrawal symptoms when a person stops taking it. According to a study by NCCI, Oxycontin is prescribed for pain in 69% of permanent partial disability cases. This same study also points out that 49% of these prescriptions go to people with back injuries. When you combine that with the next interesting piece of data – Oxycontin is almost always dispensed in 50 day supplies (100 tablets) -- you have a potentially volatile mix.

Most back pain resolves itself in a few weeks, especially where employers are able to keep injured workers productive through the use of temporary modified duty. But if employers cannot accommodate the injury, if the injured worker is inactive, sitting at home and thinking mostly about the pain, it is probably natural for the worker to seek more relief – and natural for the doctor to grant it in the form of a strong medication. This may be a case where the miracle drug is producing something less than a miracle in at least some of the lives of the people taking it.

There are a lot of problems associated with this particular drug. The Government Accounting Office recently issued an alert on Oxycontin. The GAO criticized the marketing program undertaken by Purdue. There has been much publicity about drug store robberies seeking this particular drug – many pharmacies now will not stock it. Street users have learned (via the manufacturer’s warnings!) to crush the drug, thereby getting an enhanced “high.”

So here is perhaps the full circle of trouble: the standard prescription puts 100 pills into the hands of the injured worker. That’s a lot of pills, especially if the pain resolves itself sooner rather than later. What happens to the extra pills? They could be a very valuable commodity on the street. Conversely, if the worker does not get better, if he or she sits inactive at home and runs through the 50 day supply, there is a strong chance of becoming dependent upon the drug and seeking a refill. That puts the injured worker on the slippery slope to permanent disability. The back pain can evolve from a temporary condition to a more or less permanent dependency on this powerful medication.

The possible over-and/or mis-prescribing of this particular drug are alarming. To be sure, there are no easy answers here. We will keep you posted.