When I was around 13, my street savvy father sat me down to explain how drug pushers work.
Discussions about narcotics and workers’ comp made me think about what he told me. A tough blue-collar teamster, he also tried to educate me on not how the world is supposed to work, but how it really does.
And yet, the way the world really works still shocks me sometimes.
How is it possible — with all the laws and regs on the books — that doctors can sell narcotics to injured workers and neglect to monitor them adequately? We would assume a line of separation between selling these kinds of drugs and caring for patients. We would assume that there would already be enough accountability for doctors who sell narcotics.
According to my reading of Workers Compensation Research Institute (WCRI) studies, however, I conclude the following:
1) Drugs (including narcotics) sold by docs are more expensive than from the local pharm of choice. (http://www.wcrinet.org/studies/public/abstracts/phys_disp_wc-ab.html)
2) Docs are not monitoring opioid drug use as legally required — or taking precautions to prevent potential client addiction and even death. http://www.wcrinet.org/studies/public/abstracts/longer-term_use_of_opioids-ab.html
How is it possible — with all the laws and regs on the books — that doctors can sell narcotics to injured workers and neglect to monitor them adequately?
Consider Vicodin, the most commonly used narcotic for pain relief. It not only costs about 100 to 300 percent more per pill from the doc’s office compared to the local pharm, according to WCRI’s study, but the drug got more expensive at the doc’s office while it got cheaper at the drug store.
How much? Well, comparing its 2007-8 study period to 2010-11, Vicodin went up 37 percent per pill from the doc compared to an 8 percent decline at the local pharm. Other drugs magically got prescribed more when equivalent medications at the drug store were cheaper.
Why this is happening? To make ends meet due to revenue losses from insurer cost containment initiatives, doctors are trying to raise revenue by selling medications and taking initiatives.
Since Medicare does not cover drugs sold by docs like workers’ comp does, it only makes sense for docs to sell them to injured workers. Doctors are also having yo increase their patient load, which adds to the monitoring burden.
Now that I have established what is really going on, my next blog will cover what can be done, according to speakers at WCRI’s recent conference.
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