Study finds spike in anti-inflammatory drugs, topical medicine in comp

Anti-inflammatory drugs often prescribed for pain and inflammation now represent the largest percentage of prescriptions prescribed to injured workers in California, according to a study released Friday by the California Workers’ Compensation Institute.

Such drugs have replaced opioids as the top drug in comp, one year after the state enacted a drug formulary that limited opioid prescribing to injured workers, according to the study by the Oakland, California-based institute.

Anti-inflammatories accounted for the largest percentage — 31.7% in 2018 alone — of prescriptions in each of the last four service years, 2015-2018, according to the study, while in each of the six years prior to that, opioids were the top therapeutic drug category dispensed, and anti-inflammatories ranked second.

In 2018, opioids accounted for 18% of prescriptions, down from a high of 30.5% in 2009 — representing a 41% decrease over nine years, the study found.

The growth pattern for anticonvulsants — another alternative to opioids for pain — was similar to that of anti-inflammatories. Anticonvulsants consistently accounted for 4.1% to 5.6% of the workers compensation prescriptions from 2009 to 2014, after which their share increased steadily to 9.7% in 2018, “which is also likely associated with the continued decline in opioids,” the study states.

Dermatological medications, which include high-cost topical creams and patches used for pain management, in 2017 surpassed opioids as the most-costly drug group in the California workers comp system, the study found.

Although dermatological prescriptions only increased from 5% of all prescriptions in 2009 to 5.6% in 2018, the study found that over that same period their share of the total drug spend climbed from 10.1% to 17.6%, representing a relative increase of 74.3%, “indicating an increase in the average amount paid for dermatological prescriptions,” the study states.

For the analysis, the study authors compiled a pharmaceutical data sample drawn from CWCI’s Industry Research Information System database and included data on 5.75 million prescriptions dispensed to injured workers between January 2009 and June 2018.