 More Illinoisans die from an opioid overdose than from the barrel of a gun. But
imagine the public outcry if a state-run program was passing out weaponry to
civilians.
Enter Illinois’ workers’ compensation system, which contains a little-known
loophole that puts injured workers at risk of drug addiction and overdose.
Doctors treating injured workers in Illinois through the workers’ comp system
can sell the drugs they prescribe directly out of their office. And that comes
with life-threatening consequences.
A study from Johns Hopkins researchers reveals that when physicians are allowed
to do this, they prescribe more than three times the quantity of opioid drugs
they would prescribe otherwise. And workers are off the job for 85 percent
longer.
Perhaps even more concerning, those researchers couldn’t find a single
legitimate medical reason why this is happening in Illinois. They concluded that
financial incentives were the likely culprit. We’ll get back to that in a
minute.
Fortunately, state government already has taken major steps to address the
rising body count of opioid addiction.
Take Illinois’ Prescription Monitoring Program, or PMP, which requires
pharmacies filling prescriptions to record the recipient’s name, address and the
drug supplied to a state database. These numbers are reported on a daily basis.
Pharmacies comply with this requirement. But many physicians selling drugs out
their office do not, according to Randy Malan, the PMP’s clinical director.
Malan said physician-dispensing sites are not registered in the database.
So what if there was a bad actor in that system?
“We wouldn’t know,” Malan said.
This blind spot means that if a doctor tried to treat an injured person
receiving physician-dispensed drugs from elsewhere, she might not be able to
make a holistic judgment of the patient. That lack of information easily could
lead to a vulnerable worker receiving a “holy trinity,” Malan said. He’s
referring to the dangerous drug cocktail of an opioid such as Vicodin, a muscle
relaxant such as Soma and a benzodiazepine such as Xanax. This combination can
be lethal.
Unfortunately, physician dispensing is not a niche industry in the Land of
Lincoln. In fact, it’s booming.
Physician-dispensed drugs account for more than 60 percent of the cost of
prescriptions covered by workers’ comp in Illinois, according to the Workers
Compensation Research Institute, or WCRI. And that cost share is increasing.
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 “This appears to have been driven by the significant increase in
the price per pill for physician-dispensed prescriptions,” WCRI
experts wrote in a July 2016 report.
That is a shocking result. It means efforts in 2012 to curb
costly markups at physician-dispensing sites had the exact opposite
effect.
Five years ago, Illinois began tying the price of
physician-dispensed drugs to their average wholesale price in order
to limit high markups. But soon after this policy change, physicians
started prescribing new, obscure and sometimes more powerful dosages
of familiar drugs. This effectively made the price controls moot.
For example, shortly after the new rules took effect, doctors began
selling a previously nonexistent strength of
hydrocodone-acetaminophen, commonly known as Vicodin. While it was
nowhere to be found in pharmacies, this new strength was the most
common form physicians dispensed in 2014.
Why? Physicians could sell it at more than $3 a pill – triple the
price of the typical dose at the pharmacy.
This practice doesn’t just present an immediate danger to workers.
It’s also a threat to their families and communities. Just because
an injured worker is overprescribed opioids doesn’t mean he will use
all of them. In fact, data from the federal Centers for Disease
Control and Prevention show most people who abuse prescription
medications get them for free from friends and relatives, not drug
dealers.
For these reasons and more, 21 states have taken steps to curtail
physician dispensing within workers’ compensation laws or more
broadly. Illinois has not.
Thankfully, House Bill 2892 offers a way forward. This bill, filed
by state Rep. Barbara Wheeler, R-Crystal Lake, would ban physician
dispensing within the workers’ comp system while allowing limited
exceptions for areas without access to a nearby pharmacy.
It’s a reform that addresses a major worker health issue, not to
mention saves on workers’ comp insurance costs for Illinois
businesses trying to keep afloat. How often does such a simple fix
pop up in Springfield?
Opioid addiction isn’t a partisan issue. Lawmakers should act to
address the state’s role in promoting it as soon as possible.
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