In January 2008, external experts sitting on the Ontario Workplace Safety and Insurance Board (WSIB)’s new Drug Advisory Committee began to meet monthly to provide recommendations on how best to manage the WSIB’s drug benefit program with respect to efficacy, safety and cost. At the same time, the WSIB also began identifying trends in the use of prescription narcotics (opioids) by injured workers. Two years later, it reported some troubling numbers.
According to the WSIB, between 2001 and 2009, narcotic prescription costs increased by close to 700 per cent—from $4.4 million to $35 million—while the number of lost-time claims was decreasing. By 2010, the WSIB reported that 40 per cent more injured workers were being prescribed opioids compared to 10 years ago, and the number of narcotic prescriptions increased by 100 per cent over the same period. The doses prescribed by physicians had also gone up since 2006.
Given that opioids (pain-relieving drugs such as morphine, codeine and oxycodone) are addictive and potentially lethal, these numbers worried the WSIB. Drawing on evidence provided by its Drug Advisory Committee, the WSIB implemented a new Narcotics Strategy that took effect in February 2010.
Under the strategy, the WSIB initially only allows prescriptions for short-acting narcotics for a maximum of 12 weeks following a new injury or recurrence. Long-acting drugs are not allowed during this period. After 12 weeks of ongoing narcotics use, WSIB clinical staff reviews the worker’s case regarding the ongoing use and commencement of a long-acting narcotic. (Workers with serious injuries or those with occupational diseases are excluded from the strategy’s approach.)
According to the WSIB, this approach to narcotics therapy is based on two key principles:
- authorization of opioids for workers should support treatment goals that include improvement in function, quality of life, and safe and sustained return to work; and
- a graduated approach to guide authorization of prescribed narcotics for the management of non-cancer pain is consistent with best practice.
IWH scientist helps shape strategy
Work by the Institute for Work & Health (IWH) helped to shape the new WSIB narcotics strategy. IWH Scientist Dr. Andrea Furlan had been serving on the WSIB’s Drug Advisory Committee since it was first established in 2008. And her work in the field of opioid use and chronic pain made her a much sought-after subject-matter expert.
In 2007, physician regulatory colleges across Canada came together to update guidelines on opioid use and chronic pain. Collectively, they formed the National Opioid Use Guideline Group (NOUGG). In May 2010, NOUGG released the new Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-cancer Pain. The research team behind the guideline was led by Furlan (see the related case study).
Based on recommendations from Furlan and her fellow committee members, the WSIB’s Narcotics Strategy has had a documented impact on the volume of long-acting narcotic prescriptions. In its report 2012-2016 Strategic Plan: Measuring Results: Q1 2013, which focused on return-to-work and recovery outcomes, the WSIB noted that use of long-acting narcotics for new claims within 12 weeks of injury declined by 87.4 per cent compared to 2009, and annual narcotics spending decreased by $6.1 million (17.3 per cent) since 2009. “This means that fewer injured workers are exposed to the potential harmful effects of these medications,” the WSIB adds.