Compensation Judge: Stacy Bouman
The employee, Alia Black (formerly Alia Jordan), suffered an admitted lumbar back injury in 2002 while working for the employer as a registered nurse. After undergoing several failed back surgeries and a wide variety of conservative treatment, the employee began taking opioid medication to address her chronic back pain, starting prior to December 2004. She would continue to use prescription medications for the next 10+ years.
In March 2011, the employee was seen at a follow-up evaluation regarding her pain medication. A drug screen showed the employee had a blood alcohol concentration of 0.08 (the legal limit for operating a motor vehicle). The employee admitted to drinking before the visit and she was counseled on the hazards of consuming alcohol while using opioids. The employee smelled of alcohol in a subsequent visit in June 2011, when she sought a refill of her opioid medication. In July 2017, the employee pled guilty to gross misdemeanor driving while impaired (DWI) with a measured blood alcohol concentration of 0.226.
On May 22, 2019, the employee underwent an IME on behalf of the employer and insurer. Dr. Gurin noted that the employee smelled of alcohol at the examination. When asked about her alcohol consumption, the employee indicated that she typically drinks three to four beers, about four times per week. The employee’s medical record was reviewed and Dr. Gurin noted references to the employee’s alcohol use while she was taking opioid medications. Dr. Gurin concluded that the employee’s continued use of opioid medication was not reasonable, necessary, or safe. Dr. Gurin also concluded that Dr. Trobiani’s management of the employee’s opioid medications did not meet the requirements of the treatment parameters by failing to document functional activities, pain levels, physical examinations, and results of assessment tools. Dr. Gurin recommended that the employee be tapered off of opioid medication with small reductions occurring every two weeks. Dr. Gurin directly contacted Dr. Trobiani’s office to inform him of the employee’s unsafe practices regarding alcohol consumption in conjunction with use of opioid medications.
On July 19, 2019, the employer and insurer sent Dr. Trobiani and the employee a letter, accompanied by the IME report of Dr. Gurin and a copy of Minn. R. 5221.6110. The letter noted Dr. Gurin’s recommendation of a taper, indicated the employer would not pay for OxyContin after August 5, 2019, and stated that the employer would pay for referral to a pain specialist. The letter expressly requested that Dr. Trobiani provide the tapering plan within 30 days. Additionally, the letter requested compliance documentation for assessment of function, opioid risk assessment, a written opioid contract with the employee, and monitoring of the employee’s long-term opioid use, as required by Minn. R. 5221.6110, subps. 3, 6-8.
On August 26, 2019, Dr. Trobiani initiated a reduction in the employee’s opioid dosage, from 80 mg to 60 mg. On October 14, 2019, he concluded that the taper was not successful and resumed prescribing the employee’s opioid medication at the 80 mg dosage. The employer and insurer refused to pay for continued opioid medication, relying on the opinion of Dr. Gurin. The employee filed a medical request seeking approval of her ongoing opioid medication.
The judge found that continued opioid medication was not reasonable and necessary, the treatment parameters applied, the prescription did not comply with the treatment parameters, departure from the parameters was not appropriate, the rare case exception did not apply, and the employer and insurer complied with the notice requirement. The judge denied the employee’s medical request.
Under the circumstances of this case, the notice provided by the employer and insurer adequately informed the employee and Dr. Trobiani of the treatment parameters that were considered out of compliance. The compensation judge’s determination that the notice met the requirements of Minn. R. 5221.6110, subp. 9, is supported by substantial evidence.
The compensation judge determined that continued prescription of opioid medication was not reasonable and necessary to treat the employee’s chronic pain condition. This determination was largely based on the judge’s findings that the employee was consuming alcohol, sometimes to excess, while using opioid medications. This behavior increases the risk of serious harm or death by overdose or misadventure. The record contains adequate evidence to show that the employee has consistently consumed alcohol over the period that she has been prescribed opioid medication, contrary to the warnings against such behavior.