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Should workers’ comp pay for med to counteract drowsiness from opioids?

An employee takes opioids for chronic back pain following a workplace injury. His doctor prescribed another drug to counteract drowsiness from taking opioids. Does workers’ comp have to pay for the second medication? 

Jack Barnhart injured his back while working for Tremont Borough in Pennsylvania. After several operations, Barnhart still suffered from chronic back pain and saw Dr. Chawluk, a neurologist.

Dr. Chawluk prescribed OxyContin, an opioid. To counteract the sedative effects of the opioid, Dr. Chawluk prescribed Provigil, a medication that promotes wakefulness.

Tremont requested a review to determine whether Barnhart needed all the medications he was taking for his work-related injury. Dr. Glass, a neurologist, reviewed Barnhart’s case and concluded the Provigil wasn’t reasonable and necessary because “there is no evidence in medical literature that Provigil is effective for this indication,” specifically to treat drowsiness caused by opioids. Dr. Glass cited the website, Prescribers’ Digital Reference, which says Provigil is used to treat obstructive sleep apnea hypopnea syndrome, narcolepsy or shift work sleep disorder. Barnhart sought review of Dr. Glass’s findings.

When the case went before a workers’ compensation judge (WCJ), Dr. Chawluk testified there is medical literature to support using Provigil to counteract drowsiness from taking opioids. However, when he was asked for the name of the literature, he said, “I can’t quote it by verse.”

The WCJ agreed with Dr. Glass that Provigil wasn’t a reasonable and necessary treatment for Barnhart. The WCJ found Dr. Chawluk’s opinion on the reasonableness and necessity of Barnhart continuing to take Provigil lacked credibility.

The Workers’ Compensation Appeal Board upheld the WCJ’s decision. Barnhart appealed to a state court.

‘Opioids make me sleepy, so … ‘

Barnhart argued on appeal that since he has to take opioids to treat his severe pain from the workplace injury and the opioids cause drowsiness, he has to take Provigil to counteract the pain medication.

The court noted Dr. Glass backed up his claim about Provigil by citing a reference website. Dr. Chawluk, on the other hand, provided no evidence that Provigil was widely and successfully used for this off-brand purpose.

Therefore, the court found there was substantial evidence for the WCJ to conclude Barnhart’s use of Provigil wasn’t reasonable and necessary.

(Jack Barnhart v. Tremont Borough, Commonwealth Court of Pennsylvania, No. 66 C.D. 2017, 8/16/17)

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