State Fund Looks to Put Soma Use to Bed
http://www.wcexec.com/state-fund-looks-to-put-soma-use-to-bed.aspx
Nearly 80 years ago, Aldous Huxley wrote in Brave New World about the wonders of a fictional drug called Soma and its benefits for society, but a real modern-day drug with the same name is anything but a benefit for society and the workers’ comp community, says one prominent medical director. With a host of other drugs available that carry far less baggage, he hopes to get Soma out of the California workers’ comp system, and he’s starting with his own claims first.
Gideon Letz, M.D., medical director for State Compensation Insurance Fund, and a respected leader in California’s workers’ comp medical community, is not necessarily a crusader in the traditional sense, but he is on a mission to end use of the drug Carisoprodol in the California workers’ comp system. Better known by its brand name Soma, the drug is not only one of the most commonly prescribed muscle relaxants, especially for back and neck injuries, it’s also one of the most commonly prescribed drugs overall.
That’s a problem, says Letz, because the drug has a high incidence of abuse and addiction.
“The problem with Soma is that it’s metabolized into another drug called Meprobamate, which has a lot of problems with it, but the primary one is that it’s very addictive,” Letz noted in an exclusive interview with Workers’ Comp Executive. “Meprobamate isn’t used anymore, but when you take Soma it is immediately metabolized in your liver into this Meprobamate drug.”
While it’s termed a muscle relaxant, Letz says it works more like a sleeping pill acting as a central nervous system depressant. “They work, because if you have muscle spasms and you take a central nervous system depressant, it basically makes you so sleepy that you relax,” he noted. But these depressant effects have also created a black-market demand for the drug, which now has a street value of $5 to $10 per pill.
“ … and this is a policy of our UR [utilization review] department, is that we’re not going to authorize any more of this Soma drug.”
— Dr. Gideon Letz,
State Fund
With estimates that 20% of all disability claims in California with a prescription have at least one for Soma — a rate that puts the Golden State among the highest Soma use rates in the nation — Letz says he’s working to reverse the trend.
“Basically, what we have said, and this is a policy of our UR [utilization review] department, is that we’re not going to authorize any more of this Soma drug,” he said. “We will allow for some taper because some of these people have been on it for years and are very addicted to it, but we’re not going to authorize it anymore.”
Alternatives Exist
Letz maintains that a number of other muscle relaxants on the market can do the job without the dangers associated with Soma. He named Flexeril as one likely substitute, pointing out that it’s commonly used “and has zero street value.”
While lauding it as a worthwhile goal, Alex Swedlow is not convinced that a total ban can be implemented under the current rules of engagement in California’s workers’ comp system.
Swedlow, researcher with California Workers’ Compensation Institute, notes that implementing the program is one thing, but getting denials to stand up in a dispute process might prove more difficult to sustain.
“We now have two sets of treatment guidelines and they don’t necessarily agree with each other,” Swedlow says, noting the Division of Workers’ Compensation’s decision to move beyond the American College of Occupational and Environmental Medicine (ACOEM) guidelines to also adopt the ODG chronic-pain guidelines. “How do you run an adjudication system when you have one set of guidelines saying one thing and the other something else?”
But Letz is not dissuaded, maintaining that State Fund’s position is supported by both sets of guidelines.
“As of this moment, I don’t know that we’ve made a dent in it yet. We just started this UR program. This is very recent,” he said. “But I think the word will get out and that within a year or two we’ll see this drug basically disappear.”
He’s already got one convert.
Bill Zachry, vice president of risk management for Safeway Inc., and a member of State Fund’s board, caught a recent presentation by Dr. Letz on the subject and was impressed.
“I wasn’t aware of how the drug metabolized. It may have been part of [Safeway’s] formulary, but to the extent that it was, it won’t be going forward, if there’s no ethical or moral reason for providing it,” he told Workers’ Comp Executive. “What an idea!”
Call Out the Docs
Beyond the UR process, Letz is bringing other pressures to bear to lower use rates not only for Soma but for all narcotics.
“It may have been part of [Safeway’s] formulary, but to the extent that it was, it won’t be going forward, if there’s no ethical or moral reason for providing it.”
— William Zachry,
Safeway
“Soma and narcotics are a major contributor to delayed recovery,” he told Workers’ Comp Executive, noting that studies have shown the longer that workers are off on workers’ comp, the less likely they are to ever return to the job. “ When you take these drugs, you don’t want to do anything, and the best treatment for patients with musculoskeletal pain conditions is activity and exercise, for many reasons, including psychosocial, but also physical.”
He maintains that these drugs, plus drugs such as Valium and Xanax, can be a short-term help, but he maintains that too many injured workers are kept on them for far too long. And to fix that, he says he’s going to target doctors.
Letz says the carrier is beginning to use its prescription benefit manager to help find high-risk cases with a lengthy pattern of prescriptions for Soma and other narcotics, and other counterproductive treatment patterns. In these cases, they’ll target doctors for an intervention to discuss their prescribing habits and treatment patterns.
“The thinking should be that the prescription isn’t working, so we should be trying something different instead of just upping the prescription,” he maintains, noting that many doctors prescribe drugs such as Soma out of habit and aren’t even aware of problems with it.
If the gentle nudges aren’t enough, Letz says State Fund is prepared to notify the Drug Enforcement Agency, the Medical Board of California and the Division of Workers’ Compensation. But such drastic measures are expected to be an uncommon occurrence. “I do know that whenever someone is watching them, then behavior changes,” Letz says of physicians.
Filed under: General Problems
Is the insurance companies prescription drug administrator a medical doctor.
This is one of the stupidest articles I have ever read! So, because a drug works but addicts like it they have to stop prescribing it? I was taking Soma every day , now my dr took me off them &:I have had a miserable month. He has prescribed 4 different meds now & nothing is working like Soma did! Flexeral & Zanaflex both knock me out! If one of these idiots suffered with chronic pain & muscle spasms I guarantee it would be a different story!
“We will allow for some taper because some patients have been on it for years and they are very addicted to it.”
Addiction is not dependence!
Letz, your outlook on quality of life subjects patients to pure torture. Normally I wouldn’t wish that anyone else be stopped at a red light and rearended at an impact of 65 MPH, but I honestly think you need to experience this pain for a while without anything but Tylenol…. Lets let you suffer the agony for 8 years….KARMA BABY!
What about us chronic pain patients that NEED SOMA? Not all of us out there are addicts, dealers, or junkies! Hhmmm? What then when you have more suicides on your hands that get brushed under the rug and counted as an accidental OD when you all know damn well it isn’t. Remember YOU ALL WORK FOR US AND WE’RE GETTING RID OF YOU!!!
Not that I have ever had to utilize Workmans Comp, but for migraines, I have tried both Flexeril and Soma…. One dose of Flexeril even 5mg leaves me like a Zombie and does nothing to relax the occipital stiffness from the migraine while Soma allows me to function as a normal person and relaxes my neck enough with my other migraine rescue meds I can at least be a real person and perform my ADLs. I’ve been through the gambit of muscle relaxers for my migraines and Soma is it when they are bad. God help me when the FDA pulls it….guess I should start stocking up now. Karma would be that these idiots would get one of my combo occipital/temporal migraines and walk in my shoes for a week
Joseph Goebbels might have hired Gideon Letz to write propaganda for him. After all, a de-lousing chamber would keep people healthy, and Zyklon B would, actually, kill lice. With a name like Gideon, the intended victims would never guess at the monstrosity Herr Goebbels was carrying out.
That’s exactly why the Nuremberg court, hung Herr Goebbels by the neck, until dead.
We can keep pretending that forcing people. Into suicide, is good for society. That it “improves the health of the public”, for the sickest people to die. (Jack Kevorkian’s precise words.) Millions of loyal German citizens did exactly that, 80 years ago. One day, the lie will be obvious to all. Will America be the new evil empire, as Nazi Germany once was? The greedy creeping cancer of a nation, that devoured it’s neighbors and burnt millions to ashes, while stealing their land and assets to pay it’s debts?
This campaign to trick the sick into suicide, certainly is just as ominous, as anything Hitler penned in the 1920’s.
I have amassed quite the stockpile of Soma over the years waiting for the day it is banned. Why? It’s the only thing that works for excruciating pain and seizing up of my muscles caused by myositis (one of my favorite Sx of MCTD) w/out knocking me out OR feeling I took a placebo. Myositis can leave ANY muscle feeling like you just had the worst ‘charlie horse’ in history.
A PA for my PM (say that 10x fast) told me just take diazepam for both anxiety attacks and muscle spasm, no need for 2 different Rx. I told him I prefer being able to think over a self induced comatose state. I say let adults decide for themselves, with a consult of course. Repeal the nanny state, and defund his criminal pals at DEA. We did just fine w/out their 1,001 rules and regs regarding meds, not to mention their outright thievery and destruction of the Constitution.
*Interesting take on the suicide Bob. psssssst, u r right, Eugenics is alive and well my friend, but not too loud or you will be shouted down as a conspiracy theorist OR wind up in a river w/ a gunshot to the chest. See Steve’s post on Mr Bradstreet and his ‘suicide’. https://www.pharmaciststeve.com/?p=10992#comments
Bob, also, great work in pain advocacy, but stick w/ that and leave history to the historians. Actually Joe Geobbels never made it to Nuremberg, he died in the Fuhrerbunker (ironically enough by suicide but unlike pain patients he was not tricked into it, he knew what was coming) All that propaganda he spewed must have seeped into his brain. Possibly from the reverb of his microphone inducing osmosis [?] Why else would he poison his 6 children and his wife? Cyanide.
*”On May 1, 1945, the day after Hitler committed suicide, Goebbels and his wife poisoned their six children and then killed themselves.”
*From: http://www.history.com/topics/world-war-ii/joseph-goebbels
Thsnks for the correction, Coonhound!
Read this it is about putting a stop to using soma and about moving it to class 1 narcotcs..not good. They are saying flexeral worse just as well as soma without thE long term side effects of soma
I’d like to see how fast he would change his views if he was in chronic pain himself. When surgery is not an option and you can’t find any relief anywhere. Karma is for people like him.
This is disgusting, these people who have no medical training need to stop attacking people who need these meds and using scare tactics with doctors
Oh the irony… I begged for different treatment than only pills but WC is dening everything but the drugs.
“But these depressant effects have also created a black-market demand for the drug, which now has a street value of $5 to $10 per pill.”
“He named Flexeril as one likely substitute, pointing out that it’s commonly used ‘and has zero street value.’”
What is being described as “depressant effects,” is actually the effect of the drug working. The reason Soma has a street value and Flexeril doesn’t is because Flexeril doesn’t work near as well as Soma. (Yes, I’ve taken both of them.) For me, Flexeril was like taking a sugar pill.
And while worker’s comp wants every worker to return to work, denying medication that works is not the way to do it. What happens when workers are forced to return to work before they’re ready is a worsening of their medical condition over time, ending in long-term disability instead of short-term. Of course, that means disability paid by Social Security, not state-funded worker’s comp. These people should just be honest and say it’s all about the money, not the drugs.