The Texas Division of Workers’ Compensation (DWC) published audit findings for a review to evaluate prescribing practices involving gabapentin or pregabalin in combination with opioids.
These drug combinations can be harmful, as evidence shows limited benefit of gabapentinoids for chronic pain and increased risks, including respiratory depression and overdose, when combined with opioids, with no proven opioid-sparing effect.
The audit looked at claims with dates of injury between January 1, 2020, to December 31, 2022, looking for providers who co-prescribed opioids with gabapentin or pregabalin between June 1, 2022, and May 31, 2023. The audit specifically focused on ten prescribers with the highest number of claims within the selection criteria and the highest average of total days supply.
The audit did not identify any issues requiring referral to Enforcement. Three of the reviews were closed without further action, while seven reviews were closed with letters of education.
However, the audit revealed opportunities to improve prescribing practices. The DWC provided the following recommendations for providers:
- Avoid routine co-prescription unless benefits are clearly documented
- Start with low doses and increase gradually as needed
- Monitor patients every 4–6 weeks for effectiveness, side effects, and misuse
- Use EHR alerts to flag high-risk combinations
- Consider non-pharmacologic options like physical therapy or cognitive behavioral therapy
- Stay current through CME sessions on pain management and opioid stewardship
Audit results such as these could potentially shape future rule changes that impact prescribing practices, utilization review processes, and service delivery. The DWC is maintaining its focus on prescribing practices and is currently seeking stakeholder input to shape its 2026 Medical Quality Review Annual Audit Plan, which will determine whether the audit focuses on either topical analgesics or utilization review compliance with ODG. Stakeholders may submit comments by January 16, 2026, at OMA@tdi.texas.gov.
