The Office of Administrative Law has approved the DWC final version of the Medical Treatment Utilization Schedule (MTUS) regulations that updates the Chronic Pain Medical Treatment Guidelines and adopts Opioids Treatment Guidelines.

Following national reports of opioid misuse, DWC proposed issuing guidelines and began the process with a forum for public comment in 2014. The guidelines that have been added to the MTUS provide best practices in appropriately treating injured workers while also enhancing safety in using these medications to manage pain.

“We welcome this update and addition to the MTUS. The information in these Guidelines should aid in the provision of safer and more effective care for California’s injured workers,” said DWC Executive Medical Director Dr. Raymond Meister. The changes to the MTUS Chronic Pain Medical Treatment Guidelines are set forth in section 9792.24.2, the Opioids Treatment Guidelines are set forth in section 9792.24.4, and the clarifying changes to the meaning of chronic pain are set forth in section 9792.23(b)(1) of the California Code of Regulations. The MTUS regulations went into effect on July 28, 2016 and will apply to any treatment requests made on or after July 29, 2016.

Christine Baker, Director of the Department of Industrial Relations, said, “These guidelines are an important step toward improving appropriate and safe care for workers.”

DWC Acting Administrative Director George Parisotto said, “DWC will move forward shortly to initiate the process to update all of the current MTUS chapters. This process will include new chapters for chronic pain and opioids. Regardless, the new Chronic Pain Medical Treatment Guidelines and Opioids Treatment Guidelines should be consulted and relied upon when making treatment requests and determining the medical necessity of such requests.”

As a result of this regulatory process, claims administrators now have more clearly articulated guidance on when to approve, or send a request for opioid prescription medication to UR for a more comprehensive review. And UR and the IMR reviewers have much better guidance on how to make decisions.

For example, the regulations have precise requirements for prescribing opioids for “sub-acute” pain which is defined as pain beyond one month following an injury. The physician should “screen for risk using validated tools” and “administer a baseline urine drug test (UDT) in the office toward the beginning of the subacute period,” And this section concludes that “a history of opioid use disorder or substance use disorder is a relative contraindication to continued opioid use during the subacute phase.”

The Executive Summary of the new Opioid guideline is 135 pages in length, and it is not a trivial task to understand the nuances of what has now become a more rigorous set of limits on unfettered prescribing of addictive pain medication. On this topic, the new regulation may be a game changer on the administration of medical care for pain patients.