“Opioids” are a type of drug that reduces pain by acting on the nervous system. Some opioids, like heroin, are illegal street drugs. Most, however, are doctor-prescribed medications, with some common examples including oxycodone (OxyContin), acetaminophen with hydrocodone (Vicodin), and fentanyl (Duragesic). While opioids can manage severe pain, they are also addictive and tolerance-building, leading to a nationwide “opioid crisis” of fatal overdoses. In North Carolina, the opioid crisis is creeping toward epidemic proportions, spurring the North Carolina Industrial Commission (NCIC) to implement new rules for prescribing opioids to injured workers. Our Charlotte workers’ compensation attorneys examine these rules in closer detail.
NC Workers’ Compensation System Creates New Rules for Opioid Medications
In February 2017, the Industrial Commission – the organization which operates North Carolina’s workers’ compensation system – established a special task force to “study and recommend solutions for the problems arising from the intersection of the opioid epidemic and related issues in workers’ compensation claims.” North Carolina’s General Assembly passed a new law “authoriz[ing] the Commission to adopt rules and guidelines, consistent with [other state laws], for the utilization of opioids, related prescriptions, and pain management treatment.”
Less than one year later, in December 2017, the NCIC issued a press release announcing “the proposal of rules for the workers’ compensation system addressing the opioid crisis.” The stated purpose of these rules was twofold: (1) curb opioid abuse, and (2) prevent injured workers from becoming addicted – and potentially, losing their lives.
The Commission’s reasoning follows: “Many injured workers are prescribed opioid medications as part of treatment for their injuries, creating a [link] between the problems affecting the general population and the workers’ compensation system.”
In March 2018, a public hearing was held to review the proposed rules, which were published in January in the North Carolina Register. Members of the general public were invited to make their own suggestions until a March 19 deadline. The following day, March 20, the Commission voted to officially adopt nine of the proposals, which can be viewed in full here. (Notably, one of the rules allows the new rules to be waived, provided certain criteria are met, on a case-by-case basis.)
Under the new rules, there are separate (though similar) guidelines for the opioid-based management of:
- Acute Pain – Acute pain typically has a sudden onset following injury, and lasts for six months or less. For example, the sharp and immediate pain you feel when you break a bone or step on glass is acute pain. Unlike chronic pain, acute pain eventually stops.
- Chronic Pain – Chronic pain is pain that lasts for more than six months, even if the underlying cause has healed. Arthritis, back pain, and headache pain are common examples.
The rules impact many aspects of opioid prescription, including the quantities that may be prescribed, which drugs may be prescribed for certain injuries, and how many drugs can be prescribed simultaneously. For example, under 04 NCAC 10M .0201(d), which deals with the management of acute pain from work-related injuries, “A health care provider shall prescribe the lowest number of days’ supply of a targeted controlled substance necessary… to treat an employee’s pain, not to exceed a five-day supply,” with some exceptions. There is a similar provision for the management of chronic pain, which states, under 04 NCAC 10M .0203(d), that a physician “shall prescribe the lowest number of days’ supply of a targeted controlled substance necessary… to treat an employee’s pain.” (Note that, unlike the equivalent provision for acute pain, 04 NCAC 10M .0203(d) does not specify limiting the patient to a “five-day supply.”)
For more information, you may be interested in exploring the NCIC’s comprehensive, 42-page companion guide, which covers subjects such as:
- Disputes over recommended treatments
- Limitations on specific drugs, including fentanyl and methadone
- Requirements for waiving the new rules
Finally, it is worth noting that the new rules do not apply to claims where all three of the following statements apply:
- The injured worker was treated with Schedule II opioids (such as hydromorphone, or Dilaudid) or Schedule III opioids (such as medication containing certain amounts of codeine).
- The worker was treated with this drug for at least 12 consecutive weeks (three months).
- This treatment was rendered before May 1, 2018.
Charlotte Workers’ Compensation Attorneys Offering Free Consultations
The workers’ comp attorneys of the Ramsay Law Firm have been representing injured and disabled employees in the workman’s compensation claims and disputes for over 25 years. Whether a worker needs help filing a claim after a workplace accident, needs aggressive appeals representation due to a workers’ comp claim denial, has questions about the financial impacts of returning to work after an injury, or is concerned about benefits being reduced or cut off, our Charlotte work injury attorneys can step in to protect the worker’s rights and ensure that all avenues for pursuing compensation are fully explored. To set up a free consultation about a work injury claim in Charlotte or the surrounding suburbs, contact the Ramsay Law Firm online, or call our law offices at (704) 461-0750.