L&I is undertaking a project to recommend alternate therapies in support of patients on chronic opioid therapy (COT). We are beginning this evidence-based, patient-centered effort with a pilot, focusing on a small number of providers who have injured workers on COT.
L&I is committed to keeping Washington safe and working. By providing resources and evidence-based treatment for chronic pain, we can get workers back to work, and reduce the risks of long-term opioid use.
Our goals for the pilot are to:
- Help busy providers manage patients on chronic opioids.
- Review claims of workers on chronic opioid therapy to identify harms, barriers and gaps in care or suboptimal treatment, and offer available resources to address identified issue.
- Provide resources for patients that are easier to access and understand.
- Provide and develop educational resources for providers.
Starting February 2022, L&I will contact selected providers treating injured workers on extended opioid therapy to participate in the pilot. After initial contact, our regional nurses will visit participating clinics to provide additional resources and support providers managing patients on chronic opioids.
Visit our Resources tab for information on non-opioid therapies and patient-centered material for injured workers. In addition, you can download the flyer that explains more about the pilot.
Contact
If you have any questions about this pilot, please send us an email at pharmacymanager@Lni.wa.gov
Background
- From 1999 to 2017, nearly 218,000 people died in the United States from overdoses involving prescription opioids.
- In Washington state, on average, 2 people died per day of an opioid overdose.
- According to the CDC, 46 people die every day from prescription opioid overdose.
- Surgeon General Vivek Murthy: “Substance use disorders represent one of the most pressing public health crises of our time.”
- In October 2017, the opioid epidemic was declared a public health emergency.
- As of 2019, about 4,600 workers are on COT.
- Combined, Jefferson, Clallam, Kitsap and Pierce counties account for 20 percent of the injured workers on COT. These counties have the highest number of injured workers on COT, nearly 900.
- Whatcom, Skagit and Snohomish counties combined account for more than 18.5 percent or 850 injured workers on COT.
Workers are identified for inclusion in the pilot if they receive chronic opioid therapy while they have an open claim. Additional criteria are described below.
Note that, even if the opioids were prescribed for conditions unrelated to an industrial injury, as long as the worker had an open claim at the time the opioid was prescribed, they would be included as eligible pilot participants.
Chronic Opioid Therapy (COT)
Based on Prescription Monitoring Program (PMP) records, COT is defined as receiving opioids for at least 60 days during the quarter in question.
COT is associated with a significant increase in risk of mortality and serious adverse outcomes. Appropriate prescribing of COT requires a thorough evaluation with regular monitoring and documentation, such as screening for risk from comorbid conditions, checking the PMP database, assessing for clinically meaningful improvement in function (CMIF), administering random urine drug tests, and using results from screening to guide therapy. Continuing to prescribe opioids in the absence of CMIF or after the development of a severe adverse event is not considered proper and necessary care.
Claims
The pilot focuses on those workers with state fund claims who are non-represented and whose claims are a year or less in age from the date of injury.
Providers
The pilot will engage with prescribers who belong to our medical provider network and have the ability to treat L&I workers.
The pilot will include vocational providers assigned to the claim, who may be asked to participate in a discussion with claim managers (CMs) and others.
The assigned VRC for a worker identified as a candidate for the mCOT Pilot will be contacted well in advance of the scheduled a multi-disciplinary staffing with the Opioid Review Team (ORT). The staffing will include the department pharmacist, associate medical director, the CM, and a regional occupational nurse consultant. After the staffing, the worker’s attending physician will be contacted to discuss the worker-centered recovery plan, if appropriate.
In anticipation of VRC involvement in the ORT discussions, L&I has developed resources and tools specific to the mCOT Pilot. The preparation guide will assist the VRC in preparing for the staffings by identifying barriers to the worker’s vocational recovery.
The assigned VRC’s participation in the collaborative staffing is voluntary, but highly encouraged. Your expertise and experience with the worker can inform the recovery as we examine complicated claims where opioids are promoting disability. Time spent in collaborative staffing meetings is billable.
If you have questions, contact Jaymie Mai at 360-902-6792 or pharmacymanager@Lni.wa.gov.
Modified Chronic Opioid Therapy Pilot
Pilot Flyer - You can download the flyer that explains more about the project.
L&I Regional Occupational Nurse Consultants
Provider Resources and Education
UW Medicine Pain and Opioid Consult Hotline for Clinicians – Providers can get coaching and advice for managing patients with complex chronic pain problems with opioids.
UW TelePain – Providers can get advice or consult with interprofessional pain specialists on difficult chronic pain cases.
Velocity and Validation of Opioid Tapers Matter - YouTube
L&I Guideline, Education and Resources
L&I Structured Intensive Multidisciplinary Pain Programs
Department of Health Opioid Prescribing Toolkits
AMDG Guideline, Education and Resources
CDC Guideline, Trainings and Resources for Providers
Patient Education and Resources
Advice for People Taking Opioid Medicine
Safe Medication Return Program
Stanford Pain Science Lecture Series