Tag Archives: Opioid Crisis

Workers Compensation

Opioids and Workers’ Compensation

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By Max Dorfman, Research Writer, Insurance Information Institute

As the opioid epidemic continues to roil the country, it’s easy to forget the number of issues that contribute to its severity. Indeed, for workers injured on the job, compensation can include opioid treatments—which can lead to opioid dependence. With this subject in mind, I spoke to Dr. Vennela Thumula, an author and policy analyst with the Workers Compensation Research Institute (WCRI), who was able to provide insight into opioid dispensing for injured workers.

This interview was modified for clarity.

What are you seeing as far as general trends in prescribing opioids for workers injured on the job, particularly as the opioid epidemic has become a more visible issue?

Our study – Interstate Variations in Dispensing of Opioids, 5th Edition – examined recent trends in opioids dispensed under workers compensation for workers from 27 states who had more than seven days of work loss due to their injury but who did not have a major surgical procedure related to the work injury.

Opioid dispensing to injured workers has decreased substantially in recent years in all 27 state workers’ compensation systems studied. Between 2012 and 2016 injuries followed for an average two years postinjury, the percentage of injured workers with prescriptions receiving opioids decreased by 8 percentage points (in Illinois) to 25 percentage points (in California). Among injured workers receiving opioids, the average morphine milligram equivalent (MME) amount of opioids dispensed per worker in the first two years of a claim decreased in nearly all study states, with 30 percent or higher reductions seen in 20 of the 27 states studied.

Which states are you still seeing higher-than-average prescribing rates for workers injured on the job? Why do you think these states are still seeing such high rates?

After the declines, opioid dispensing continues to be prevalent in some states. At the end of the study period, the percentage of injured workers with prescriptions receiving opioids ranged from 32 percent in New Jersey to 70 percent in Arkansas and Louisiana across the 27 states, and the average MME per worker in Delaware, Louisiana, Pennsylvania, and New York continued to be the highest among the 27 study states.

For instance, in Delaware and Louisiana, the average MME per claim was more than three times the amount in the median (middle) state and over five times that in the state with the lowest amount, Missouri. We should note that although New York is among states with the higher-than-typical amount of opioids, there were substantial decreases in opioids dispensed to New York workers over the study period. We should also caution that these four states have implemented other opioid reforms towards the end or after the study period whose impact could be monitored with more recent data.

I see non-pharmacologic treatments are being used more often for workers injured on the job. What are the most common non-pharmacologic treatments utilized under workers’ compensation?

We see that providers have switched from multi-pronged pain treatments, which involve pain medications (including opioids) and other restorative therapies, to a treatment protocol that more frequently relies solely on non-pharmacologic services. The most frequent non-pharmacologic services billed and paid under workers compensation were physical medicine evaluation; active and passive physical medicine services such as electrical stimulation and hot and cold therapies; and passive manipulations such as manual therapy and massage.

How are these non-opioid pain treatments changing the landscape of workers’ compensation for patients and insurance companies? Are these treatments now prioritized over opioids?

Our first look at the data suggests a shift in treatment patterns away from opioids to non-pharmacologic services, which conforms to the recommendations of opioid prescribing and pain treatment guidelines and policies implemented in a number of states. Many questions remain answered, including the impact of these changing treatment patterns on claim outcomes. We will be talking more about alternatives to opioids for pain management at WCRI’s 36 Annual Issues & Research Conference, March 5 and 6, 2020, in Boston, MA.

 

Workers Compensation

WCRI Annual Conference: Opioid Crisis Still Very Much Top of Mind

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Unsurprisingly, the opioid crisis was a major topic of conversation at the 2019 Workers’ Compensation Research Institute’s (WCRI) Annual Issues and Research Conference.

Workers’ compensation insurance has been particularly affected by the crisis. Opioid use can, perversely, increase a worker’s risk of disability. Opioid use can lead to dependency, which results in increased dosages and higher costs. Dependency can lead to abuse; abuse can result in on-the-job performance impairment and further injuries – or it can delay a worker’s ability to return to work. In the worst case scenario, abuse leads to addiction and death.

These are just some of the reasons why opioid use can significantly increase the costs of workers’ compensation claims.

The crisis continues

The Centers for Disease Control and Prevention (CDC) found that 70,327 people died from fatal drug overdoses in the U.S. in 2017.

That’s up from 63,632 in 2016 and 23,518 in 2002, a three-fold increase in absolute terms in 15 years. But of course, the U.S. population grew over that time – and the death rate per 100,000 people is also alarming, rising from 8.2 in 2002 to 21.7 in 2017.

Source: Centers for Disease Control and Prevention

More alarming yet, the opioid epidemic continues to drive a significant portion of total drug overdose deaths. 47,600 people died from an opioid-related drug overdose in 2017, making up fully 68 percent of total overdose deaths. That’s up from 11,920 in 2002.

Source: Centers for Disease Control and Prevention

As Dr. Alan Krueger of Princeton University noted, the problem is most concentrated among men and women with lower levels of education: “Americans with diminished economic expectations are particularly vulnerable to the opioid epidemic.”

But no one is immune, he added. “Essentially no group has been spared from this crisis in the U.S.”

Blue-collar trades especially impacted

Dr. Vennela Thumela of the WCRI presented recent findings about the correlates of opioid abuse and overdose. She found that mining and constructions workers were most impacted, representing the highest percentage of opioid prescriptions among all workers receiving pain medications. Higher rates of opioid prescriptions also correlated with workers who are older, male, and live in rural areas.

Dr. Letitia Davis, of the Massachusetts Department of Public Health, found Massachusetts-specific evidence agreeing with Dr. Thumela’s findings. The highest opioid overdose death rates in the state are for construction/mining workers and farming/fishing/forestry workers. Construction workers overdosed at six times the rate expected based on average experience.

In fact, per Dr. Davis, 24 percent of all opioid deaths in the state between 2011 to 2015 were construction workers.

The costs are staggering

Dr. Krueger put it bluntly: “This is a human tragedy.”

It has also been a tremendous tragedy to the U.S. economy. Dr. Krueger cited a 2017 Council of Economic Advisers (CEA) report, which estimated that in 2015 alone, the economic cost of the opioid crisis was over $500 billion – or 2.8 percent of GDP. Dr. Krueger noted that the number of opioid-related overdoses in 2017 increased by at least 50 percent since 2015 – implying a cost in 2017 alone of about $750 billion.

As Dr. Krueger put it, “We have not done enough to address the scale of the crisis. Even if it has reached a peak, it has reached a peak of an unacceptably high level.”