There are a large number of injured workers who are on opioids, and we know that if they are not used or prescribed properly those kinds of drugs can lead down a bad road. We are also starting to understand that when opioids are combined with other drugs the results could be even worse. In the study discussed in this article, researchers were looking at psychotropic drugs, specifically Benzodiazepines. Psychotropic drugs like antidepressants, anti-anxiety, or antipsychotic medications can alter brain chemicals, and affect mood and behavior. Some workers’ comp patients who are feeling mental symptoms on top of their physical symptoms sometimes take these kinds of psychotropic drugs.
Benzodiazepines are anti-anxiety medications. They work pretty quickly, and people who take them over a long time build a tolerance to them or can become dependent on them. Stopping the medication cold turkey can lead to withdrawal symptoms.
The researchers looked at a little over 11,000 lost time claims filed in the Louisiana Workers’ Compensation Corporation system from 1999 to 2002, and followed up with the claimants for the seven years after they filed their report. They found that in a significant portion of the claims benzodiazepines were prescribed together with opioids, especially for claims that cost over $100,000.
Both drugs saw an increase in dosage the longer the claim lasted, though benzodiazepine use plateaued after a few years. They found that the combination of opioids and benzodiazepines can increase the risk of addiction and death. Patients may have a higher risk of mental health problems and abuse, which could delay their return to work and keep the claim open longer.
About 15.8% of claimants that were prescribed short acting opioids were also taking benzodiazepines, while 59% of claimants prescribed long acting opioids were taking benzodiazepines. Those patients on both opioids and benzodiazepines (apart from patients on one or the other or neither) had higher claims costs and longer claim durations. Authors estimate that the average difference between claimants who were prescribed neither medication and those prescribed benzodiazepines translated to almost $24,000 and a claim duration of just about 200 days longer. The difference between claimants taking only a short acting opioid and those taking short acting opioids and benzodiazepines averaged to almost $80,000 and a claim duration of 805 days longer for those on the combination of drugs. Claimants taking a long acting opioid versus claimants on long acting opioids and benzodiazepines resulted in an average difference of just over $70,000 and a claim that was 447 days longer than claimants on just the opioid.
Benzodiazepines alone do not seem to contribute to claim costs as much as opioids do when used alone, but the two of them together increase claim costs more than either one alone. While this is just one study and researchers think that more research will need to be done to establish real cause-and-effect relationships, they did suggest that physicians be careful when prescribing this combination of drugs and take a closer look at the mental health of the patient.