The Canadian Medical Association remains concerned about the potential harms of opioids, including dependence, overdose and death. Opioids are a class of medication that are highly addictive and have the potential to cause more harm than good in some situations.
Under ss. 41(1), WorkSafeNB may provide medical aid that it considers necessary as a result of a worker’s work-related injury.
As such, WorkSafeNB manages, monitors and controls the use of opioids as a medical treatment by:
When opioids are prescribed for treatment of terminal cancer, due to a workplace injury or disease, this policy will not apply.
1.0 Designating Opioids as an Effective Treatment
WorkSafeNB includes opioids on a default formulary when the injured worker is:
When opioids are not included on an injured worker’s default formulary or when prescription limits are exceeded, WorkSafeNB reviews the request to pay for prescribed opioids on a case-by-case basis using the guidelines in section 2.0 of this policy.
1.1 Standards for the Responsible Management of Opioids
Prior to approving payment for opioids, WorkSafeNB requires that opioids be:
WorkSafeNB uses recognized standards for approving use of opioids, which includes:
When opioids are prescribed outside the standards and guidelines in this policy, WorkSafeNB will contact the prescriber and offer support to ensure an appropriate opioid prescription for the injured worker.
To assist health care providers with meeting these standards, WorkSafeNB has developed the WorkSafeNB Opioid Review Process handbook.
1.2 Controls for the Responsible Management of Opioids
WorkSafeNB has developed controls to verify that prescribed opioids are within the established quantity, dosage and duration limits established for the injured worker by the treating health care provider. It allows WorkSafeNB to limit:
In addition, WorkSafeNB requires health care providers to regularly report to WorkSafeNB on treatment goals and progress and to identify any potential misuse or abuse.
WorkSafeNB requires pharmacies to ensure that any injured worker must return their previously prescribed opioid patches, both used and unused, to the pharmacy prior to receiving their next opioid patches.
2.0 Approving and Managing Opioid Treatment for an Individual Injured Worker’s Rehabilitation
When opioids are prescribed outside the circumstances outlined in section 1.0, WorkSafeNB makes decisions to pay for prescribed opioids on a case-by-case basis. For opioids to be approved for payment, there must be:
When opioids are prescribed beyond the initial two weeks or are not part of the injured worker’s default formulary, dosing limits apply in keeping in line with the College of Physicians and Surgeons of New Brunswick guidelines. These dosage limits are as follows:
Any opioid prescription beyond 12 weeks requires completion of a validated functional assessment tool every 12 weeks which must be reviewed by a medical advisor.
Ongoing approval is subject to demonstration of functional improvement after the initial 12-week review and thereafter, at the discretion of a medical advisor, with a minimal frequency of once per year. The WorkSafeNB Opioid Review Process handbook must be completed for ongoing approval.
WorkSafeNB will continue to apply best practices in the management of opioids for injured workers. For injured workers with prescriptions outside the guidelines prior to the effective date of this policy, continued funding of the prescription requires a harm reduction plan in keeping with the Canadian Medical Association guidelines.
2.1 Monitoring Treatments and Suspending Payment
WorkSafeNB periodically reviews injured workers’ treatment plans and goals and may offer a harm reduction program, suspend or discontinue payment for opioids prescribed for the treatment of a compensable injury or disease when, in its opinion, the prescribed opioids are:
2.2 Excessive or Illegal Use of Opioids
In addition to the controls and standards outlined in section 1.0 of this policy, WorkSafeNB has adopted the following controls:
Under the Controlled Drugs and Substances Act it is illegal to unlawfully give, sell, administer or lend opioids to anyone or to falsely attempt to obtain opioids. If there are reasonable grounds to suspect that the use of opioids is contrary to the Controlled Drugs and Substances Act, WorkSafeNB is obligated to notify the appropriate authorities.
2.3 Harm Reduction (Dependency and Addiction)
Even when administered properly, the use of opioids can lead to opioid use disorders, previously referred to as dependence or addiction.
When there is reasonable evidence that opioid use disorder resulted from the treatment of a compensable injury or disease, WorkSafeNB pays for the costs of harm reduction programs. WorkSafeNB works with the treating physician and injured worker to determine the appropriate course of action and modifies the treatment plan accordingly. The following conditions apply:
When there is no indication that the injured worker has opioid use disorder, it is appropriate to reduce the amount and frequency of the opioid, also referred to as tapering, as part of a harm reduction plan.
If the injured worker refuses to participate in a WorkSafeNB-approved harm reduction program without a reasonable explanation, WorkSafeNB will continue to work with the injured worker and the prescriber to ensure the injured worker’s safety. WorkSafeNB may also determine whether to reduce or suspend benefits under ss. 41(16) and Policy 21-214 Determining Continued Eligibility for Loss of Earnings Benefits.
College of Physicians and Surgeons of New Brunswick, Guideline for Prescribing Opioids
The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain
Addiction – a compulsive and maladaptive dependency on a substance such as opioids. The dependency typically produces adverse psychological, physical, economical, social or legal ramifications (Adapted from Taber Cyclopedic Medical Dictionary, 2005).
The College of Physicians and Surgeons of New Brunswick – Professional association with responsibility within the province of New Brunswick, Canada for the licensing of physicians, monitoring standards of medical practice, and investigating complaints against physicians.
Custom Formulary – a list of prescribed drugs and other medical or surgical supplies that are approved on special authorization by WorkSafeNB.
Dependence – a craving for a drug that may or may not be accompanied by physiological dependency (Adapted from Taber Cyclopedic Medical Dictionary, 2005).
Default Formulary – a list of pre-approved prescription drugs and other medical or surgical supplies generally approved by WorkSafeNB as effective for treating a compensable injury or disease.
Generic brand – low-cost versions of brand-name medications that have been approved by Health Canada. This means they have been designated to be as safe and effective as their brand-name equivalent (Canadian Generic Pharmaceutical Association).
Medical aid – includes medical, surgical and dental aid, hospital and skilled-nursing services, services of a registered chiropractor within his legal jurisdiction, artificial members and apparatuses including the repair and replacement thereof, transportation, clothing allowances with respect to damage caused to clothing as a result of the use of an artificial apparatus or as a result of any accident and such other treatment, services or attendance as are necessary as a result of any injury (WC Act).
Medical aid may also include primary physiotherapy, work recovery, work conditioning and gradual/transitional return to work initiatives.
Opioid use disorder – a problematic pattern of opioid use that causes significant impairment or distress. A diagnosis is based on specific criteria such as unsuccessful efforts to cut down or control use, or use resulting in social problems and a failure to fulfill obligations at work, school, or home, among other criteria (Adapted from the Centers for Disease Control and Prevention).
Opioids – a class of medications that act on the brain to decrease the sensation of pain. They can include either natural or synthetic pain medications and may also be referred to as an analgesic or narcotic (Adapted from Taber Cyclopedic Medical Dictionary, 2005).
World Health Organization Pain Relief Ladder – a three-step approach that encourages the use of non-steroidal, anti-inflammatory and non-opioids (NSAIDs) as the preferred treatment option. Stronger drugs (those with higher incidences of side effects and/or addiction) are typically only approved when other pain management options are determined ineffective.
WorkSafeNB – means the Workplace Health, Safety and Compensation Commission or "the Commission" as defined by the WHSCC & WCAT Act.