Pennsylvania Gov. Tom Wolf releases guidelines on prescribing opioids to injured workers
Steve Esack
Gov. Tom Wolf unveiled new guidelines Monday for how opioids are prescribed in workers’ compensation cases.
But his critics in the Legislature and business community claim the prescription guidelines would be weak and unenforceable compared to a bill Wolf vetoed three months ago.
Wolf’s administration sent out a news release touting the guidelines as ways to promote “safe, quality health care; ensure patient pain relief”; and reduce addiction.
“In 2017, there were more than 17,000 workers’ compensation claims made in Pennsylvania, and our state ranks third highest in the nation in the percentage of injured workers who become long-term opioid users,” Wolf said in the news release. “These prescribing guidelines will help to ensure that health care providers who treat patients with work-related injuries have the guidance they need.”
The Health Department posted the workers’ comp rules at about 8 p.m. Monday on its website, where it detailed instructions for how opioids are prescribed to children, dental patients and others.
The guidelines recommend prescribing up to 3,000 mg of an over-the-counter pain reliever, such as Tylenol, in possible combination with nonsteroidal anti-inflammatory drugs. More painful injuries can be treated with short-term, nonopioid muscle relaxant drugs like cyclobenzaprine.
Then there’s ice, physical therapy, chiropractic care and other treatment recommendations. Emergency room physicians should not prescribe more than 72 hours of opioids and only if absolutely necessary. Before opioids are administered for chronic pain, doctors should examine patients for mental health issues and order urine and other drug tests.
None of those ideas, however, are legally binding on physicians or medical facilities.
In the spring, Senate Bill 936 would have created a state-sanctioned list of all prescribed drugs injured workers could receive from employers under the Workers’ Compensation Act of 1915. That list would dictate dosage, duration and number of drugs doctors could prescribe. Under the bill, the employer could have blocked access to drugs until satisfied the patient and doctor have provided proof of need.
GOP lawmakers and business leaders hailed it as a way to fight the opioid crisis. Democratic lawmakers, unions and defense lawyers decried the bill as a government overreach that would be detrimental to injured workers.
Health Secretary Rachel Levine said Monday the vetoed bill covered too many drugs. The guidelines, she said, are strictly about trying to curb opioid dependency among injured workers.
The guidelines appear to be nothing more than recommendations that carry no legal weight, said G. Carlton Logue, executive director of the Senate Banking and Insurance Committee.
“It’s not clear what teeth they would even have,” he said.
Employers appreciate Wolf’s focus on the opioid epidemic, but he should have signed the Senate bill so Pennsylvania’s workers’ comp prescription rules are on par with other states, said Gene Barr, president of the Pennsylvania Chamber of Business and Industry in Harrisburg.
“States as ideologically diverse as California and Texas have implemented legislation similar to Senate Bill 936 and data from around the country has empirically shown this approach reducing opioid prescribing and addiction among injured workers,” Barr said.
The guidelines came shortly before the July 22 start of “Construction Opioid Awareness Week" in Pennsylvania. The public service promotion, prompted by House Resolution 981, is meant to get companies to warn workers about opioid abuse and to properly discard unused drugs.
During the news conference, Levine also said 1,083 infants in the state have been born addicted to opioids since Jan. 10. Emergency medical technicians and police have administered at least 7,624 shots of naloxone, an overdose-reversing drug.
Pennsylvania ranked fourth in the nation for opioid overdose deaths in 2017. There were 109 drug-related deaths in Northampton County and 197 in Lehigh County in 2017, according to county coroner reports, up from a combined 227 deaths in 2016.