Random Drug Screening Urged for FECA Program Patients

During a Capitol Hill hearing May 8 on the opioid epidemic's implications for the Federal Employees' Compensation Act, one witness said the program must build an approach that includes random screening for all patients who are prescribed opioids.

The U.S. House Committee on Education and the Workforce's Subcommittee on Workforce Protections held a hearing May 8 on the opioid epidemic's implications for the Federal Employees' Compensation Act, which provides workers’ compensation benefits for federal civilian employees for injuries or illnesses sustained in the performance of duty. The program paid $2.946 billion in disability, medical, and death benefits to 222,616 beneficiaries between July 1, 2016, and June 30, 2017, Dr. Scott D. Szymendera, an acting section research manager for the Congressional Research Service, testified.

The subcommittee's chairman, U.S. Rep. Bradley Byrne, R-Ala., said DOL in May 2017 announced changes to the FECA program to limit opioid prescribing practices and deter opioid abuse, calling them "good first steps," but he added that the subcommittee members needed to learn what steps can be taken to ensure the opioid epidemic isn't being perpetuated through use of federal resources.

Ramona P. Tanabe, executive vice president and counsel for the Workers Compensation Research Institute, outlined in her testimony actions taken by several states to reduce unnecessary opioid use, including Prescription Drug Monitoring Programs, limits on opioid first fills, and mandatory continuous medical education on appropriate opioid prescribing and chronic pain management.

Joe Paduda, president of CompPharma, LLC, a consortium of pharmacy benefit managers in workers' compensation, testified that FECA is "five or six years" behind the rest of the workers' comp industry when it comes to dealing with the opioids crisis. He described the initial effort by DOL's Division of Federal Employees' Compensation as too permissive and "wildly inconsistent with all credible opioid guidelines," as it allows prescribers to prescribe two different opioids for up to 60 days without any letter of medical necessity, any pre-screening or drug testing, opioid agreement, or functionality impact evaluation. Most guidelines allow no more than seven days, he explained.

"FECA can and must move now to build an approach to prevent further needless deaths among its 20,000+ chronic opioid using patients," he said in his prepared testimony, saying the approach should:

  • Institute random drug screening for all patients who are prescribed opioids.
  • Require a prescriber to use a written screening tool for all potential opioid patients to assess risk prior to writing a prescription.
  • Require opioid agreements that are signed by the prescriber and the patient that commit the patient to one prescriber and one pharmacy.
  • Require documentation of the changes in functionality and pain status for all opioid patients.
  • For chronic users, follow California's lead – understand that each patient is unique, each may require a slightly different approach, and recognize that being open and creating is essential to saving lives and keeping families together.

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