Opioid misuse and abuse is a huge problem in the workers’ compensation field, contributing to an increase in deaths and medical costs.
Meant to be prescribed after major surgeries or major trauma, these drugs are intended for short-term use or end-of-life cancer pain. “Short-term” is meant to signify a span of a few days or weeks—not years, as the current trend indicates.
The Institute of Medicine has reported that chronic pain affects more than 116 million American adults—more than the total affected by heart disease, cancer and diabetes combined—and costs up to $635 billion a year in medical treatment and lost productivity.
Yet drug companies continue to mass-produce opioids, and Americans are buying them. The Centers for Disease Control and Prevention (CDC) recently cited supporting statistics from the National Vital Statistics System, reporting that drug companies produced approximately 96 mg of opioids per person in 1997.
By 2007, however, they were producing 698 mg per person. This is enough for every American to take 5 mg of Vicodin every 4 hours for 3 weeks, resulting in an astonishing 627 percent increase in manufacturing. The reality is that people are dying from opioid overuse and overdose.
According to Michele Leonhart, administrator of the U.S. Drug Enforcement Administration, overdose deaths from prescription opioids increased 300 percent from 1999 to 2007.
A 2011 update to the Workers’ Compensation Prescription Drug Study, reported by the National Council on Compensation Insurance (NCCI), says that drugs were 2 percent of total medical costs in 1990, and there was minimal use of opioids. By 2000, however, pharmacy increased to 10 percent of medical costs, with growing use of opioids.
By 2011, the pharmacy spend has increased to 19 percent of total medical costs—and we are seeing exploding use of opioids within workers’ comp.
It is extremely common to see injured workers abusing opioids or pain relievers, and these drugs also cause a variety of side effects that end up becoming part of the workers’ comp claim.
Treatment for these side effects results in more drugs being prescribed. According to our claims data, some injured workers are taking 20-30, maybe 40 or more pills a day. This can include different pain medications, laxatives and sleeping aids.
One of the major issues with opioids is the lack of regulation and oversight from workers’ comp regulators. For example:
- There are no regulations that require monitoring or accountability by prescribers for their patients. While several states have initiated prescription-drug-monitoring programs (PDMPs), these programs are typically voluntary on the part of the physician.
- There is no mandatory drug monitoring or drug testing of claimants being prescribed opioids. The standard of care calls for random urine drug testing to ensure that the patient is actually taking what is prescribed and not taking anything that wasn’t prescribed. This drug testing only occurs in about 10 percent of our cases.
The California Workers’ Compensation Institute (CWCI) has identified that a small percentage of physicians account for the majority of the opioid prescriptions in workers’ comp. It’s clear we can identify who is overprescribing these drugs, but where is the action on the part of regulators to stop this abuse? Why aren’t the state medical boards looking into this? Opioids are controlled substances, but what is the Drug Enforcement Agency (DEA) doing to stop the widespread diversion of these drugs?
Oversight of opioids in workers’ comp also needs to include a system to monitor the injured worker. The CWCI found that the patients receiving the most opioids received them from an average of 3.3 different physicians—creating an even greater risk for abuse and misuse of these drugs.
So what do we do to address opioids in workers’ comp? Partnering with a good pharmacy benefit manager (PBM) is a start. Your PBM should focus on appropriate utilization of pharmacy, not just the price paid per prescription fill. It is critical that utilization—not the cost per fill—becomes the cost driver.
Claim handlers also must consider the psycho-social factors that could lead to prescription misuse. Does the injured worker have a history of addictive behavior, such as smoking or alcohol abuse? Such individuals are at greater risk for developing an addiction to opioids.
Additional regulatory support is also needed. The states of Washington and Texas are making great strides in controlling opioid misuse. The strict controls instituted by Washington have resulted in significantly reduced opioid utilization—and more importantly, a significant reduction in deaths from opioid overdose.
According to the CDC, about 40 people die each day in the United States from prescription-drug overdoses. Most of these deaths are associated with opioids. The time for action on this issue is now.
Sherri Hickey is Director/Medical Management with Safety National in St. Louis, Mo.