Injured workers in North Carolina would be limited in the amounts of opioids that they could be prescribed under proposed rules being developed by the N.C. Industrial Commission, which oversees the workers’ compensation system.

Charlton L. Allen, chairman of the industrial commission, said in a recent press release that opioid misuse and addiction are a major public health crisis in North Carolina. Allen said the proposed new rules are intended as a proactive step to limit opioid misuse and addiction among injured workers while ensuring that workers receive the care intended by the North Carolina Workers’ Compensation Act. The rules are designed to contain employer’s worker-related medical costs by making it more difficult for injured workers to get long-term prescriptions for opioids.

North Carolina is not the only state acting to address opioid costs and misuse. A number of states are taking steps to curb the overprescribing of opioids such as OxyContin, Vicodin, Percodan, and Percocet to injured workers and reduce rising costs related to these powerful narcotics. Prescription drugs account for about a fourth of workers’ compensation medical costs, according to the National Safety Council (NSC).

Research on medical outcomes of workers’ compensation cases in which opioids are prescribed has shown that opioid use beyond the acute phase of treatment can be an obstacle to recovery and increase an individual’s experience of pain, according to the NSC. In North Carolina, the proposed rules define the acute phase as the 12-week period after an accident. In some cases, an injury can involve more than one acute phase.

The proposed rules seek to target situations that pose a greater risk of opioid addiction and overdose including:

  • an opioid prescribed at a dosage of more than 50 mg morphine equivalent dose per day;
  • an opioid prescribed for more than 30 days; and
  • an opioid prescribed with a current benzodiazepine prescription—a dangerous combination that can lead to respiratory depression and death.

For example, the proposed rules state that a doctor should document in the medical records that non-opioid therapies are insufficient before prescribing an opioid. The doctor should prescribe the lowest number of days’ supply of a painkiller needed to treat an employee’s pain.

Raleigh attorney David Vtipil, who represents injured workers, questioned the need for some of the documentation requirements in the proposed rules.

“While opioid abuse is a problem, I fear that the requirement that medical providers provide extensive documentation in order to prescribe the opioids will discourage medical providers,” Vtipil says. “Take, for instance, an acute situation in an emergency room setting. How is the medical provider expected to know if it’s a workplace injury and then become familiar with multiple pages of rules about how the doctor can administer opioids for an injured worker? Even in long-term chronic situations, the complexity of the requirements may bring about the result that pain management doctors will decide not to treat injured workers.”

The earliest effective date of the rules, if adopted by the Industrial Commission, is May 1, 2018.

From our vantage point as North Carolina board-certified workers’ compensation attorneys who represent injured workers, the new rules are likely to mean more disputes between injured employees and the prescription benefit managers about the medication the workers may receive to control pain. Workers’ compensation administrators may try to limit future prescriptions of opioids for injured workers who are currently taking painkillers as part of pain management therapy.

Workers are well advised to seek the guidance of a knowledgeable Raleigh workers’ compensation attorney to understand their legal rights and whether an appeal is in order if their benefits have been denied.

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David E. Vtipil is a North Carolina board-certified specialist in workers’ compensation. His practice also includes representation of claimants in Social Security disability and personal injury. He has been in practice since 1993.