OPIOID/NARCOTIC MEDICATIONS AND THE INJURED WORKER

WorkSafeBC has developed a practice and process for the prescription
of opioid/narcotic medications for injured workers-here's what you
need to know.

In 2007 in British Columbia, more than 1550 injured workers were
taking prescribed opioid/narcotic medications-not including Tylenol
3-for longer than 12 weeks post-injury or postsurgery.

WorkSafeBC policy limits reimbursement for opioid use to the first 8
weeks postinjury or postsurgery in the majority of cases. Clinical
evidence suggests that long-term use of high-dose opioids may be
associated with certain risks, including developing tolerance,
dependence, and potential addiction, as well as accidental death and
heightened pain sensitivity. In addition, long-term use of opioids may
not improve physical function or pain management.

Following pain management principles and medical best practices adopted and
approved by the College of Physicians and Surgeons of Ontario and adopted by
the College of Physicians and Surgeons of BC (Evidence-Based Recommendations
for Medical Management of Chronic Non-Malignant Pain: Reference Guide for
Clinicians), WorkSafeBC has developed a practice and process for the
prescription of opioid/narcotic medications for injured workers. One of the
goals of the practice initiative is to ensure that WorkSafeBC applies its
policy on opioids consistently across the entire province.

The process

In accordance with policy, WorkSafe-BC covers the costs of
opioid/narcotic medications for injured workers for up to 8 weeks
postinjury or postsurgery. However, in special or extenuating
cir-cumstances, WorkSafeBC may cover the costs beyond this acute period.

For injured workers who require opioids beyond the 8-week acute
period, the process for WorkSafeBC to continue paying for prescribed
medications involves both the injured worker and his or her physician.

If your injured worker patient is on opioids 7 weeks postinjury or
postsurgery, you will receive two documents:

- - D.I.R.E. score reference form-for your use only. This form does not
need to be returned to WorkSafeBC, but the actual D.I.R.E. score is
required on the form described below. This scoring instrument provides
insight as to whether your patient is likely to receive benefit/harm
from a trial of opioid treatment for chronic nonmalignant pain.

- - Physician Request for Opioid/Narcotic Funding Extension Form
(68D80)-for completion and return to WorkSafeBC within 4 weeks.

Payment for the completion and timely return of the Opioid/Narcotic
Funding Extension Form (68D80) is under Code 19909, Standardized
As-sessment Form, and is $75.

If you would like to discuss your patient's condition and treatment,
the possible use of therapeutic alternatives, or your concerns that
your patient may not be a good candidate for continued use of opioids,
please contact the medical advisor listed on the covering letter.

At the same time that you receive the scoring instrument and form,
your injured worker patient will receive a letter from WorkSafeBC,
enclosing a Worker Opioid/Narcotic Agreement to be signed and returned
within 4 weeks if ongoing medication is required. This agreement is
between your patient and WorkSafeBC and does not involve you.

If WorkSafeBC has not received the completed forms 4 weeks after they
are sent to you and your patient-particularly Form 68D80, which must
come from you-the medical advisor will contact you to verify your
decision that further opioid medication is not required.

If the signed forms are returned, the medical advisor will contact you
to develop an action plan to:

- - Continue the medication with a follow-up review at a specified
time.

- - Wean the worker off the opioids.

- - Help the worker make the transition to alternate medication or
treatment.

- - Discontinue the prescription.

If the agreement between you and the medical advisor is to continue
the opioid medication for your injured worker patient, another review
will be scheduled for 6 months after the initial prescription. At that
time WorkSafeBC's Opioid Team may become involved to develop a further
action plan with you, the treating physician, and your injured
worker/patient.

The intent of WorkSafeBC's new practice and process for prescription
of opioid/narcotic medications is to support physicians in following
evidence-based medical best practices to achieve optimum outcomes for
injured workers and to ensure that injured workers throughout British
Columbia receive consistent service from WorkSafeBC.

If you have any questions or concerns regarding opioid/narcotic
prescriptions for your injured worker patient, please call your local
WorkSafeBC office and speak to a medical advisor.

Peter Rothfels, BEd, MD, ASAM WorkSafeBC Director of Clinical
Services Chief Medical Officer