While Montana has made progress tackling opioid abuse, a recent report shows the state is behind on protecting injured workers from the drugs’ risks.
In Montana in service year 2016, 61 percent of claims with at least one prescription included a prescription for opioids, compared to 46 percent regionally and 44 percent nationally. That’s according to a report released by the National Council on Compensation Insurance in September.
Not included in the data are claims for the self-insured or claims by companies writing less than 1 percent of the market share in Montana. Ten states were excluded from the report because those states have a different agency collecting data on workers compensation claims. Montana’s region also includes Colorado, Utah and Idaho. (Wyoming was not included in the report.)
Key findings from the report were included in a presentation that research analysts with the Montana Department of Labor and Industry made to the Labor-Management Advisory Council, which monitors workers' compensation in Montana.
Experts say long-term use of opioids significantly increases the risk for addiction. Issuing a patient a second prescription for opioids, issuing a refill or prescribing the initial dosage for greater than one week doubles the chance the patient will be on the medication a year later, according to the Centers for Disease Control and Prevention.
The CDC urges doctors to limit opioid prescriptions to less than a week, or ideally less than three days, in order to reduce the chances of long-term use.
But in Montana last year, 40 percent of injured workers who obtained an opioid prescription did so for an injury that had occurred six years earlier, or more. Nationally that number was 15 percent and regionally it was 10 percent.
Injured workers in Montana are also slightly more likely to be prescribed dangerous combinations of drugs, the report found.
Six percent of the opioid claims made last year in Montana for injured workers were given to individuals who also had a prescription for benzodiazepines, which depress the central nervous system and are used to treat anxiety, insomnia and seizures. That number was 3 percent for both the region and the nation.
The combination of opioids and benzodiazepines can lead to breathing complications and death, the U.S. Food and Drug Administration found. The FDA advises medical professionals to prescribe both only when alternatives have been proven inadequate, and to carefully explain the risks to patients.
'Our work's not done'
The report's findings came a surprise to some, including Cindy Stergar, CEO of the Montana Primary Care Association. Stergar, who had not yet seen the report, was skeptical about the data and wondered whether 2016 was an anomalous year.
She called one of the findings "stunning," specifically that 21 percent of opioid claims for injured Montana workers last year were made to treat injuries that happened at least 16 years ago.
"In primary care, we are surprised because we’ve been very focused on how to treat chronic pain," Stergar said. "We would have expected (Montana) to be in line with other states, or possibly below."
Others pointed to efforts to crack down on prescription opioid abuse, saying the state has made progress in recent years.
For instance, over-prescribing of opioids by Montana doctors has gone down, according to the Drug Enforcement Administration.
"That has declined," said Stacy Zinn-Brittain, a group supervisor with the Billings DEA.
Jean Branscum, CEO of the Montana Medical Association, also said the stats were unexpected.
"It shows our work's not done," she said.
Branscum said Montana's elevated reliance on opioids for injured workers, as shown in the report, could be explained in part by more restrictive laws in other states limiting how long someone can continue to collect workers compensation benefits. Those out-of-state workers using opioids who had been time-limited out of workers compensation would not be captured in the NCCI report.
Montana passed its version of the limit in 2011, a law terminating medical benefits for injured workers five years after the injury, with some exceptions, including for permanent disability. Those workers are only beginning to be time-limited out of the system, and could skew the picture.
Branscum said best practice is to prescribe opioids only for acute pain and use alternatives, such as physical therapy or acupuncture, for chronic pain.
Branscum stressed that overall, the state is showing improvement on opioids. Montana saw a 14 percent reduction in yearly opioid prescriptions between 2013 and 2016, which is on par with the national rate of decline. The data comes from IQVIA, a health care analytics company.
Doctors are also making better use of a prescription drug registry to avoid over-prescribing or prescribing dangerous drug combinations, Branscum said.
And rural prescribers, who are more likely to be family medicine doctors and less likely to have specialty practices in chronic pain, are relying more on a dosage tool called knowyourdosemt.org, Branscum said. The online tool includes an “opioid calculator” for prescribing medical professionals.
"We should take a look at those stats to say, 'What more can we do?'" Branscum said. "We’re doing things now, and we need to do more."