WSIB Narcotic Strategy- Where is the alternative?

The WSIB has introduced a new narcotics strategy, which limits narcotic authorization to short-acting narcotics in the first 12 weeks after injury or recurrence. This strategy does not apply to workers in the Serious Injuries Program or with occupational disease. The attempt to avoid long-term narcotic dependence, while laudable, has not come with a recognition of the need for increased non-narcotic treatment, and in particular alternatives such as physiotherapy, chiropractic, massage therapy and acupuncture.

The WSIB considers these alternatives when rendered after 12 weeks as maintenance treatment. Maintenance treatment is allowed sometimes by the Board, but a concerted effort is usually required to obtain authorization for maintenance treatment. Even more important, the fees paid to these practitioners is usually less than one-half the typical fee, so many do not accept WSIB cases or are reluctant to provide long-term treatment and the concerted effort to obtain authorization for "maintenance treatment" is usually about a small amount of reimbursement. Physiotherapists and acunpuncturists are paid $24 and $38.78 per visit respectively. Massage therapists are paid $50 per visit. Chiropractors are paid $25 per visit, after the initial visit.

There are consequences to the Board's approach to long-term treatment. The inadequate pain control mechanisms lead to increased incidence of depression and other psychological conditions for workers. This does not benefit anyone. Another effect is a tricky one. If a worker suffers a recurrence years after the accident, the Board will look at documented evidence of visits to doctors or other health care practitioners as significant evidence of continuity. Workers often prefer to not see doctors on a regular basis, for any number of good reasons, but the Board's practices results in a powerful incentive for workers to regularly meet with a busy family doctor to discuss ongoing long-term problems. This is an unhealthy situation for both the worker and the family doctor.