Fix to Federal Work Comp Plan Starts with Opioid Restrictions, Panel Says

Liz Carey

Washington, DC ( – Attacking the opioid epidemic at the federal level starts with limiting the amount of opioids prescribed to federal workers injured on the job.

During a May 8 hearing of the House of Representatives Subcommittee on Workforce Protections, a subcommittee of the House Committee on Workforce and Education, panelists recommended the federal Office of Workers’ Compensation Program limit initial prescriptions of opioids to 7 days, and refill prescriptions to 30 days, with pre-authorization, among other things.

Current guidelines for opioid prescriptions within the federal government’s workers’ compensation program allows for an initial prescription of 60 days, with pre-authorization of refills.

That is a major problem, said Joe Paduda, president of CompPharma. The program guidelines allow for prescribers to prescribe up to two different opioids “at unlimited levels” for up to 60 days, Paduda said.

This is far beyond what is happening at the state level, he told the committee. Citing work in Ohio, Washington State and California, Paduda said many states were limiting initial prescriptions to 7 days and putting in place much stricter guidelines for refills.

The Federal Employees Compensation Act (FECA) must get in line with those guidelines, he said.

“Unfortunately, when it comes to dealing with the opioid crisis, the FECA and its administrators are 5 to 6 years behind the rest of the Workers’ Compensation industry,” he said during his testimony to the subcommittee. “Time is running out for federal patients taking opioids. FECA’s initial efforts on opioid control are far too permissive and wildly inconsistent with opioid guidelines.”

Paduda recommended that the guidelines for prescribing opioids be changed, as well as:

  • Requiring random drug screening for all patients prescribed opioids (outside of pre-employment drug screening and random workplace drug screening);
  • Requiring drug prescribers to utilize written screening tools;
  • Requiring opioid agreements signed by both the patient and the physician; and
  • Requiring documentation to changes in functionality and pain.

Rep. Mark DeSaulnier (D-CA) asked Paduda why the federal government lagged behind the states.

Paduda said it was the federal government’s failure to recognize the depth and significance of what is happening with the opioid epidemic.

Workers Compensation Research Institute’s (WCRI’s) Executive Vice President and Counsel Ramona Tanabe told the panel another issue was that a third of patients injured at work did not realize they were taking opioids. There is no requirement in the states WCRI studied, she said, that requires physicians to educate their patients about what they are taking.

Paduda said in the commercial workers’ compensation world, there were safeguards in place that provided that education. Patients were assigned liaisons who would notify patients that they had been prescribed an opioid, which would then notify them by mail. Additionally, drug monitoring programs could track whether or not the patient was taking an opioid in combination with other opioids or other dangerous drugs.

Paduda said these steps were ones the Office of Workers’ Compensation Program could take very quickly to help ensure patients don’t become unknowingly addicted to opioids.

Rep. Drew Ferguson (R-GA), a former dentist, cautioned that any reforms to FECA should not hinder good doctors from treating their patients.

“Don’t make the regulation s so cumbersome that the good providers are restricted in their ability to treat their patients,” he said.

The committee also heard from Inspector General Scott Dahl who said that more data analytics would help oversight organizations to see trends and spot trouble before it became a major issue. He noted that one compounded pain cream had been billed to the OWCP for nearly $30,000 for one bottle. Limits to reimbursements, or a ceiling price for some drugs, would also help save the organization, and the tax payers, millions in drug costs, he said.