by Jennifer M. Smith, Esq.

Opioid addiction and abuse continue to be a concern and an ever increasing cost in workers’ compensation claims. As discussed in the recent RxInformer article, “Red Flags in Opioid Therapy”, employers and insurers should be on the lookout for signs indicating fraud, abuse and misuse of opioid medications. Taken individually, any one of these signs could be overlooked. Analyzed comprehensively, however, any combination could indicate a serious problem needing further investigation. Once fraud, misuse or abuse of opioids is suspected, actions can be taken such as review by a nurse case manager, medical director or independent physician to examine the drug regimen of the claimant.

Medication Combinations

If an injured employee receives a combination of prescriptions for opioids, carisoprodol (Soma) and benzodiazepine (Xanax), this could signal misuse or abuse. The three together are nicknamed the “Holy Trinity” as they produce a feeling of euphoria. Opioids and carisoprodol combined are known as the “Las Vegas cocktail” and the effects mimic heroin.

Re-Filling Prescriptions Early, but within Authorized Time Frames

If an injured employee tries continuously to refill the opioid prescription early, but very narrowly within the authorized time frame, this could indicate stockpiling. After six months of this, the employee could stockpile enough of the drug to equal an additional one month supply of the medication.

Opioid Prescriptions from Multiple Physicians

Receiving opioid prescriptions from several different physicians in different practices could indicate unauthorized use or doctor shopping.

Frequently Changing Pharmacies

Alternating or frequently changing pharmacies could signal an injured worker is trying to evade detection of misuse or abuse of medications.