MWCC.MS.GOV  Services  Medical Fee Schedule MWCC’s Opiate Treatment Guidelines A Starting Point to Fight the Addiction Epidemic MWCC.MS.GOV  Services  Medical Fee Schedule Effective Date June 14, 2017

Opiate Facts Insufficient data to show long term use of opioids effectively treats chronic nonmalignant pain Chronic pain is defined as pain that lasts longer than 3 months In 2012, 259 million prescriptions for opioids were written in the U.S., which is enough for every adult to have a bottle of pills Scope of the guidelines are to address the use of opioids to manage non-cancer related pain

How Does a $575 Life-Saving Drug Jump to $4,500 How Does a $575 Life-Saving Drug Jump to $4,500? Blame a Perverse System In 2014, the Evzio auto-injector got FDA approval and hitthe market for a list price of $575, an exciting new tool to battle the country's overwhelming opioid epidemic. But three years after Evzio came out, its cost has exploded to $4,500 per prescription. Like the pharma company Mylan did with Epi-Pen—another simple, life-saving drug—Evzio's maker has raised its price as high as the market will bear.

Opioid Prescription Guidelines Failure to review the Prescription Drug Monitoring Program when prescribing opioids including documenting the review was completed or why the program was inaccessible at the time

If a contraindication for the prescription of an opioid is present, then the provider must clearly document the extenuating circumstances that lead to the continuation of the opioid. Contraindications are: If the patient did not meet the goals to improve pain and function If psychological evaluation deems the patient to be a high-risk candidate If the medication has not reduced the patient’s subjective pain complaints by more than 30% If patient cannot perform at least sedentary level of work because of sedentary pain complaints (may still be disabled for other reasons besides pain) If cannot function secondary to side effects from medication

When receives prescriptions from more than one practitioner If patients refuse non-interventional treatment options that might improve physical function and pain levels (physical therapy, cognitive behavioral therapy) If shows significant nonorganic behaviors (i.e. strongly positive Waddell’s) When receives prescriptions from more than one practitioner Has inconsistent drug screens, absent extenuating circumstances Prior to discontinuation for an inconsistent drug screen, a confirmation GCMS screen must be completed to ensure that a false-positive / negative did not occur Failure to perform Random drug testing no less than two times per year. Monthly screens are not indicated because they are not random. Drug screens in excess of two per year should be clinically documented as to why they are medically necessary

Psychological Evaluation – If long-term opioids are to be used greater than three months, a psychological evaluation is recommended / required

Mandated Drug Testing – Provide for drug testing at a minimum of twice a year as well as a confirmatory GCMS screen following an inconsistent initial screen

Treatment for Addiction – Provide treatment for addiction should opioid abuse disorder manifest itself and is directly related to the use of controlled substances prescribed for the workers’ compensation injury. Treatment will be covered for up to one year unless documented that more than one year is medically necessary.

Medications & Combinations To Avoid: Avoid using Mperidine and use special precautions with Methadone Avoid transbuccal administration versus oral administration Avoid combining opioids with: Agonists / antagonists (i.e. Pentazocine) Benzodiazepines Tapering: Tapering should be performed either via conservation reduction of 10% of the dosage per week, or up to 25% of the dosage every four days

What’s the reality of the guidelines? File a motion to suspend benefits (medical treatment of the opioid prescription) Must have an EME addressing medical necessity & reasonable If to be discontinued, address tapering