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What’s lurking in an injured worker’s medicine cabinet is gaining more attention as experts are discovering that prescription medications, over-the-counter drugs, vitamins and even herbal supplements can complicate or prolong a workers compensation claim.
In worst-case scenarios, dangerous drug interactions can kill a patient, as has been the case with benzodiazepines and opioids — a lethal combination that has garnered much media attention with a string of celebrity deaths and a new black box warning by the U.S. Food and Drug Administration.
“There is a big problem with combinations of medications,” said Dr. Theresa Bartlett, Troy, Michigan-based vice president of medical quality at Sedgwick Claims Management Services Inc. “It can be multiple prescribers or over-the-counter medications they don’t share with (a treating physician) that can cause adverse events.”
It can be common for patients to use several prescription and over-the-counter drugs, a situation known as polypharmacy.
Experts say problems arise when injured workers and other patients fail to share a complete list of their medications with their treating physician — whether unintentionally or to purposely avoid stigma, such as if they’re taking antidepressants or anxiety drugs.
Tom Ryan, New York-based market research leader for Marsh L.L.C.’s Workers’ Compensation Center of Excellence, said people may forget to tell their doctor about a medication when they’re dealing with a barrage of paperwork in the initial stages of treatments.
“They might be overwhelmed from the injury, so they may not be the best historian on the medications they might be taking,” he said, adding that it’s not uncommon to see workers take as many as six drugs prior to injury, as many as half of them are over the counter.
Most employers and insurers partner with pharmacy benefit managers and medical management companies that provide services to help fill in gaps with the coordination of care for comp claimants. But even then, experts say there are holes when a patient doesn’t think to mention a drug that they regularly take.
“At the end of the day, you are injured (so) it’s harder to think about these things,” said Dr. Melissa Burke, Hartford, Connecticutbased national pharmacy director for Travelers Cos. Inc.
This is true especially with medicines purchased over the counter, said Sylvia Sacalis, Tampa, Florida-based vice president of clinical services with Healthesystems L.L.C. Sometimes it’s a matter of an injured worker taking ibuprofen or acetaminophen every day for another condition or ailment, which could react adversely with prescription painkillers.
“Giving patients the benefit of the doubt, sometimes they just don’t know,” said Dr. Sacalis. “They don’t know a vitamin can interact (with a drug), They don’t know an herbal supplement can interact, creams and orals can interact … I think there’s just a lack of knowledge.”
One drug that can complicate a workers comp claim is the popular cholesterol drug Lipitor. Dr. Sacalis said research shows Lipitor use can cause soft-tissue pain. A study published in The Journal of the American Medical Association in April 2016 found that as many as 10% of patients taking statins — Lipitor is one of them — have experienced muscle pain, weakness or cramping.
If an injured worker is prescribed that drug prior to their injury and, months later, is still experiencing pain, Dr. Sacalis said the person’s workers comp physician often has to wonder: Is the pain caused by Lipitor or the worker’s injury?
“In severe cases, Lipitor can cause myalgia,” said Dr. Mary Reaston, Carlsbad, California-based chief science officer and founder of Emerge Diagnostics Inc., a company that tests soft-tissue injuries.
Dr. Reaston called the combinations of drug treatments — over-the-counter and prescription and oftentimes undisclosed — a “tremendous problem” in workers comp. Doctors “may be missing the boat; the worker might not have an injury but a side effect of their medication,” said Dr. Reaston, adding employers need to get more involved in workers comp medical treatment with improved pharmacy management practices and more coordination with group health.
Dr. Sacalis said she believes at the heart of the problem is the time a physician spends with an injured worker and that the worker is not looked at “as a whole person” with pre-existing conditions, comorbidities, and a penchant for taking vitamins. “In the (medical) climate today, (physicians) are just strapped for time,” she said. “They are swamped … But behind the scenes of a claim or medical record is a human. These aren’t injured workers. They are people.”