The Opioid Risk Tool (Ort) And Work Injury Treatment

In the field of medicine, tools are used to assess treatment’s nature and course.  These tools are used to make assessments to medical treatment. The tools are frequently questionnaires filled out by patients on their own.   These tools are considered a cost-effective and reliable means of obtaining information.

Opioid medications can be prescribed to treat work injuries. They can be used in circumstances of acute injuries and in circumstances of chronic pain. Medical Providers are very concerned over prescribed opioid medications as they are controlled substances and are subject to governmental scrutiny.

This article will discuss the Opioid Risk Tool (ORT), the topics addressed, in the ORT, how the ORT is scored, and why it is the ORT is important.

Are Opioids a Problem Within Workers’ Compensation?

It is reported that the “NCCI data shows that injured workers who were prescribed at least one prescription in 2016 received three times as many opioid prescriptions as the US opioid prescribing rate. These figures illustrate that workers compensation is directly affected by the far-reaching societal impacts of the opioid epidemic in the United States.” ncci

What Is the Opioid Risk Tool (ORT)?

 The ORT was developed by Webster, et al. as a “self-performed screening tool designed for use by adult patients in primary care settings before beginning opioid treatment for pain management.” ncbi

Note: within workers’ compensation medical treatment, there is concern and analysis over what is medically appropriate treatment that is intended to cure or relieve the effects of an injury pursuant to Labor Code Section 4600.   The ORT can be used as a basis for approving or denying the provision of narcotic medications. The ORT information may be employed by Utilization Review and Independent Medical Review for approval or denial of opioid prescriptions.

What are the Topics in the ORT?

The ORT includes the following topics:

  • Patient’s Gender
  • Patient’s Family History of Substance Abuse
    1. Alcohol
    2. Illegal Drugs
    3. Prescription Drugs
  • Patient’s Personal History of Substance Abuse
    1. Alcohol
    2. Illegal Drugs
    3. Prescription Drugs
  • Patient’s Age Range of Patient, Specially between 16 to 45 years
  • Patient’s History of Preadolescent Sexual Abuse
  • Patient’s Psychological Disease
    1. Attention Deficit Hyperactivity Disorder
    2. Obsessive-Compulsive Disorder
    3. Bipolar Disorder
    4. Schizophrenia
    5. Depression

How Is the Questionnaire Scored?

The scoring on the questions are as follow:

“Family history of substance abuse including alcohol (Female=1; Male=3), illegal drugs (2;3), and/or prescription drugs (4;4) Personal history of substance abuse including alcohol (Female=3; Male=3), illegal drugs (4;4), and/or prescription drugs (5;5) Whether the patient age range is between 16 to 45 years (1;1) A history of preadolescent sexual abuse (3;0) Psychological disease including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), bipolar disorder, schizophrenia (2;2); and/or depression (1;1).ncbi 

Note: There are gender differences when scoring the test.   Some drug and alcohol abuse answers score higher for males, and only females receive a score on the issue of preadolescent sexual abuse.

What Does the Score Mean?

“Scores are summed, and a score of 3 or below suggests a low risk for future opioid abuse, while a score of 4 to 7 indicates moderate risk. A score of 8 or greater suggests a high risk of future abusive drug-related behavior.” ncbi

Note:  Score suggesting a high risk of future abusive drug-related behavior may be used to call into question prescriptions for those patients.

How Does This Impact Injured Workers?

Medical providers will analyze these scores as part of their decision to prescribe opioid medications.  If the scores are too high, it is likely that a provider will consider alternative forms of medication and treatment for the individual to avoid the possibility of substance abuse.

Further, if opioids are prescribed to at risk patients, there may be additional monitoring taking place. “ Higher risk patients require more frequent monitoring than lower-risk patients. Follow-ups may include re-screening of risk, urine drug screening, and observation for other clues of drug abuse. These clues may consist of requests for dose escalation, doctor shopping, forging prescriptions, requesting early prescriptions, unscheduled clinic visits, or emergency room visits with complaints of pain.” ncbi 

https://www.ncbi.nlm.nih.gov/books/NBK553147/

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

 

 

What You Need To Know About The Cage-aid Questionnaire And Workers’ Compensation

Workers’ Compensation Medical Treatment can employ various questionnaires to assess an Injured Workers’ need for treatment.  One of these questionnaires is called CAGE-AID.

This article will discuss the purpose of the CAGE-AID questionnaire, how it is used in an industrial treatment setting, and how it may impact an injured worker’s treatment.

What is the CAGE-AID Questionnaire? 

The CAGE-Aid questionnaire is a substance abuse screening tool.  Substance abuse applies to alcohol, legal drugs and street drugs.

Why is Substance Abuse a Problem with Workers’ Compensation Treatment?

Substance abuse is a multi-factorial problem in workers’ compensation.  There are workers who, prior to their injury, have histories of either substance or alcohol abuse.  Further, there are workers, as a result of their injuries, begin to abuse drugs or alcohol.   This abuse can either be with prescription drugs, alcohol, or street drugs.  Finally, there are injured workers who, not as a result of their work injuries, engage in substance abuse.

Why is The Questionnaire  Called CAGE?

The abbreviation refers to some of the terms within the questions. The terms are cut, annoyed, guilty and eye opener.

What are the Questions Asked?

There are four questions.  They are:

Have you ever felt that you ought to cut down on your drinking or drug use?

Have people annoyed your by criticizing your drinking or drug use?

Have you ever felt bad or guilty about your drinking or drug use?

Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

How is it Scored?  

It is scored one for yes and zero for no.

How is The Score Interpreted? 

If one or more responses is yes, then it is regarded as a positive screening test.  Thus, possible substance abuse is something that the medical provider should explore with the partient.

How Should Injured Workers Answer the Questions?

These questions may impact medical treatment decisions.  Medical providers need accurate information in order to provide appropriate treatment.  Substance abuse, when combined with prescription drugs, can lead to harmful and deadly drug interactions.   Therefore, it is important to be honest when answering the questions.

Additionally, if an injured worker has a substance abuse problem that is preventing their recovery from a work injury, it is possible that the workers’ compensation medical system may provide some assistance with respect to substance abuse treatment.  This, however,  would be subject to the limitations within Labor Code Section 4600.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

 

THE CONTROLLED SUBSTANCE UTILIZATION REVIEW AND EVALUATION SYSTEM (CURES) AND WORKERS’ COMPENSATION: INJURED WORKERS, PRESCRIPTION DRUGS AND WORK INJURY TREATMENT: WHAT YOU NEED TO KNOW

Frequently, Injured Workers’ Medical Reports have the word “CURES” contained within it. This article will discuss what “CURES” means and the significance it has with respect to an Injured Workers’ claim and their access to treatment.

What is CURES?

The Controlled Substance Utilization Review and Evaluation System (CURES) “is a database of Schedule II, III and IV controlled substance prescriptions dispensed in California serving the public health, regulatory oversight agencies, and law enforcement. CURES 2.0 is committed to the reduction of prescription drug abuse and diversion without affecting legitimate medical practice or patient care.” Office of Attorney General, State of California.

In sum, Patients who are prescribed “controlled substances” will be tracked in a database.

What are Controlled Substances?

Per the United States Drug Enforcement Agency (DEA), “Drugs, substances, and certain chemicals used to make drugs are classified into five (5) distinct categories or schedules depending upon the drug’s acceptable medical use and the drug’s abuse or dependency potential.” For an alphabetical list of controlled substances, here is the link: https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf

What Are Schedule II Drugs? 

Per the DEA, “Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin.”[emphasis added]

What Are Schedule III Drugs? 

Per the DEA, “Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone.” [emphasis added]

What Are Schedule IV Drugs? 

Per the DEA, “Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol.” [emphasis added]

Who Has Access To CURES? 

According to the State of California, “CURES 2.0 is limited to licensed prescribers and licensed pharmacists strictly for patients in their direct care; and regulatory board staff and law enforcement personnel for official oversight or investigatory purposes.” Office of Attorney General, State of California.

What Does This Mean to Injured Workers? 

During your treatment for your industrial injury, your doctors may prescribe controlled substances that are subject to the CURES laws. This means that your prescriptions will be monitored with respect to drug abuse and diversion. Drug abuse applies to misuse by the individual patient. Diversion applies if the drugs prescribed are being distributed by the patient to other individuals. In sum, if your doctor is complying with CURES, your prescriptions, that are controlled substances with the reporting requirements, are being monitored.

Further, your medical provider may search CURES to see what medications you are taking. This allows them to make appropriate prescriptions in compliance with the mandate concerning drug substance abuse and drug diversion. They may document that they have done a CURES search within their medical reporting. Also, this search may alert your medical provider with respect to the need to address possible issues of addiction or substance abuse with respect to your course of treatment.

Is There Any Privacy Concerning CURES? 

Yes. Per the State of California “[t]he Health Insurance Portability and Accountability Act of 1996 (HIPAA) and confidentiality and disclosure provisions of California law cover the information contained in CURES 2.0.” Office of Attorney General, State of California.

What Information Is Contained In CURES?

Per the State of California, “California Health & Safety Code Section 11165(d) requires dispensing pharmacies, clinics, or other dispensers of Schedule II through IV controlled substances to provide specified dispensing information to the Department of Justice on a weekly basis.” Office of Attorney General, State of California.

For Injured Workers who are receiving “scheduled medication,” if it is a particular “scheduled drug,” it will be submitted to the CURES database.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information. Click Here.

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