A recent Liberty Mutual study detailed the problems associated with cases where opioids are prescribed within 15 days following lower back injury. Data showed patients receiving opioids shortly after an injury, when compared to patients who received no early opioids, were:

• Disabled an average of 69 days longer
• Three times more likely to need surgery
• Six times more likely to become dependent on opioids

PComp takes a proactive, evidence-based approach to claim management. We encourage the members to use the first fill program. This limits the amount of any prescription which can be filled to a two week supply. This prompts closer examination when a second opioid prescription is requested.

Using evidenced based practice means, for example, ensuring opioids are only utilized after conservative treatment, and after non-opioid medications have failed, instead of opioid use as an initial pain management option.

PComp partners with CorVel for their pharmacy program. PComp's claim representatives receive an email for every opioid that is prescribed. The PComp claims representative must approve or deny these prescriptions. We are also able to file a utilization review after prolonged opioid use to see if the continued use is reasonable and necessary.

PComp's claims representatives follow all claims closely for opioid use; including watching for multiple claims, co-morbidities, multiple prescribers, multiple pharmacies and by claimants seeking opioids for their own use or as a reason to be off work. We follow all claims, make suggestions for conservative treatment and other ways to manage pain. We utilize early intervention with nurse case management. We've seen that sometimes it takes a face to face with a nurse to open the provider's eyes regarding opioid abuses. We will question claimants and providers when something doesn't make sense. Our claims representatives have years of experience which helps them get a sense of whether something seems odd about the claim. It also helps that we have built strong relationships with providers used by PComp member counties.