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Proposed program would wean injured workers off opioids

New Hampshire Union Leader

October 28. 2017 11:47PM
Oxycodone pills are shown in this file image. ((Dreamstime))

New Hampshire's labor commissioner is "very interested" in creating a pilot program to get workers hurt on the job to use fewer opioid pain killers - improving their quality of life and saving insurers money.

Such a program recently began in Massachusetts.

"I think there is a lot of good that could be done if we're able to put something together and find people who are willing participants on both sides," Ken Merrifield said in an interview last week.

Merrifield has a reason for concern.

He called it "alarming" that the top 10 percent of New Hampshire workers' compensation claimants who use opioids are averaging about 2.5 times the dose recommended by the Centers for Disease Control and Prevention. (Figures on how many people that involved weren't available, he said.)

Massachusetts has started a two-year pilot program to help injured workers who have settled workers' compensation claims get treatment for pain management.

The pilot program, which requires both the worker and insurer to agree to participate, means injured workers are assigned a case coordinator within 30 days. That coordinator works to find treatment alternatives to manage a worker's pain that don't require addictive narcotics.

Merrifield has hosted two Concord visits from Senior Judge Omar Hernandez, who works at the Massachusetts Department of Industrial Accidents and who helped establish the program.

Hernandez hopes the program, which has eight cases so far, spreads to other states.

"There's no trademark or copyright on it," Hernandez said by phone. "I'm in my own little world trying to save a life. If I can save one, it's worth it."

Michael Pringle has worked for years to help wean injured workers away from opioids.

Pringle, director of specialty services for the Windham Group, a firm in the Manchester Millyard that helps manage employee injury cases, has helped injured workers cut their opioid use.

"The problem with chronic pain is that there isn't a cure for it," Pringle said.

Windham Group, which has 100 or so employees, including about 20 in Manchester, has received the first case in the Massachusetts pilot program.

People need to be taught to avoid "catastrophizing about the pain," said Pringle, a registered nurse. Injured workers often focus on the next dose of pain pills, count their pills and can name the date for the next prescription to get filled.

"What we try to do is re-educate them and get them not to focus on the pain but focus on what do you want to do," said Pringle. "What are your goals for pain management, because you're not going to be cured. This is never going to go away."

Acupuncture, massage therapy and aquatic physical therapy are other potential treatment options.

Seriously injured people often live alone, he said, after "their families have had enough" after becoming exhausted living with somebody who's in chronic pain.

Dealing with chronic pain produces a "blast radius," with the injured person at "ground zero" dealing with the most stress and discomfort.

"The blast radius includes their family, whatever relationships they had with their friends, their job, their employer, their place in society," Pringle said.

Massachusetts attorney Deborah Kohl has worked with Pringle and is a member of the pilot program committee. Pringle, who works for insurers, helped three of Kohl's clients, all injured workers.

"They all ended up with less opioids and basically kicked their addiction," Kohl said. "They were beta-like testing to see if it worked."

After spending thousands of dollars on prescription drugs, insurers often attempt to discontinue the opioid treatment, according to a Massachusetts presentation on the program. That can take a year in the Massachusetts court system. But the pilot program streamlines the process and gets cases to a medical coordinator in 30 days.

"It's really the person working with a case coordinator and doctor to come up with an alternative treatment plan that is supervised by a mediating judge," Kohl said.

"It was our belief that a judge making a decision on whether you get four pills a day or two pills a day is not an efficient manner of assisting people with an opioid addiction," Kohl said.

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