https://www.cwci.org/document.php?file=4039.pdf

The California Workers’ Compensation Institute (CWCI) released a report that shows that even though the efforts to reduce opioid use in the state have worked somewhat, they are still common in claims with multiple prescriptions and are the most prevalent drug type in “polypharmacy” claims, which involve five or more concurrent scripts.

Polypharmacy is the use of multiple drugs at the same time to treat one or more medical conditions in a patient. Oftentimes, other drugs are used to alleviate risks and side effects caused by other drugs prescribed to a patient. These drugs have their own risks however and can interact poorly, increasing the risk of overdosing. When opioids are in the mix the risks are even higher, and polypharmacy is concerning to those in the healthcare industry and particularly those in the workers’ comp industry. CWCI put together a report to understand how prevalent these claims are in California workers’ comp, and to recognize characteristics for these claims.

The study used prescription data from 2016-2017 and found that 43 percent of claims in the state had no overlapping prescriptions, 33 percent had two or more, 20 percent had three to four, and 4 percent had at least five concurrent prescriptions. Those 4 percent are considered polypharmacy claims.

They also found that over half of claims (51.6 percent) with one or two prescriptions drugs involved indemnity payments but for polypharmacy claims that figure rose to 91.3 percent. Polypharmacy claims also tended to be older – 21.5 percent were at least 10 years old compared to just 6 percent of claims with fewer prescriptions. These claims are also more common among older workers, over half (52.3 percent) of polypharmacy claims involved injured workers who were at least 50 years old at the time the drugs were dispensed, compared to 38.3 percent of non-polypharmacy claims where prescriptions were dispensed to older workers.

The top diagnostic category for polypharmacy claims (21.3 percent of claims) was back conditions without spinal cord involvement, including back sprains and strains.

Opioids and anti-inflammatory drugs were the most common kinds of drugs found in claims with three or more concurrent prescriptions. Opioids, anti-inflammatory drugs and muscle relaxants were the top three drug combination, and those three categories of drugs along with gastrointestinal agents were the top four drug combination. Among claims with three or more prescriptions opioids were present in 13 of the top 20 drug combinations, among claims with four or more prescriptions opioids were present in 16 of the top 20 drug combinations. Opioids were present in one out of every six polypharmacy claims, anti-inflammatories were present in one out of every seven of these claims.

Read the press release from CWCI and the full report here.