Powerful Schedule II opioid painkillers accounted for about 7%of all outpatient drugs dispensed to California injured workersover the past two years, consuming nearly 20% of Californiaworkers' compensation outpatient prescription dollars, according tonew California Workers' Compensation Institute (CWCI)data.

Using a large sample of prescriptions dispensed to Californiainjured workers from 2002 through 2012, CWCI researchers confirmedmajor trends noted in earlier research, including a spike in theuse of Schedule II opioid analgesics such as Oxycodone, Morphine,and Fentanyl about a decade ago, with the most dramatic increaseoccurring between 2005 and 2008 when these meds increased from 1.4%to 5.4% of injured worker prescriptions. That growth continued at amore moderate rate from 2008 through 2010, at which point ScheduleII opioids hit 6.9% of all workers' comp outpatient scripts, and19.7% of prescription payments. The new results indicate that sincethen, Schedule II opioids have showed little change, hoveringaround 7% of workers' compensation prescriptions and 20% of theprescription dollars for the past two years. Unlike CWCI's 2012analysis, which showed a potential drop off in the use of ScheduleII opioids in the second half of 2011, the latest data reveal nosuch decline, and as noted last year, rather than signaling areversal in the trend, the short-term decline in Schedule II opioidutilization suggested by the initial results from the last half of2011 may have reflected factors such as billing cycles for year-endservices, data submission delays due to processing utilizationreview decisions, and liens.

Whether use of these narcotics to treat injured workers willcontinue at this level remains to be seen, and a number of factorscould affect the trend. For example, a current bill (SB 809) nowbefore the Assembly would fund the state's CURES prescriptionmonitoring program and require those who dispense Schedule IIopioids to report to the Department of Justice whenever they fill aprescription for these meds. Though doctors would not be requiredto check with CURES before writing a Schedule II prescription, amore robust CURES database and more user friendly program couldhelp curb abuse and doctor shopping to the extent that morephysicians voluntarily check the state database before prescribingSchedule II drugs. In any event, CWCI will continue to monitor theprevalence and costs associated with opioid analgesics inCalifornia workers' compensation. In the meantime, the Institutehas issued a Bulletin to its members and subscribers summarizingthe latest opioid painkiller utilization and payment results inCalifornia workers' compensation and plans to release a moredetailed report on the 2002-2012 trends, including breakdowns bydrug type, in the next few weeks. That report will be available toCWCI members and subscribers in the Research section of theInstitute's website, www.cwci.org.