Chronic pain is by far the most debilitating—and for claims payers the most costlycompensable condition in workers’ compensation, according to a new special report from WorkCompCentral.
The report chronicles the way opioid use greatly expanded in workers’ comp over the last 20 years, then halted and is now in retreat as a result of increased criticism and research into its efficacy. The report also provides practical suggestions to rethink the approach to chronic pain—that is, pain that persists beyond expected healing time.
Opioids are defined as medications that relieve pain by reducing the intensity of pain signals reaching the brain, for example, hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine and fentanyl. Although some use the term “narcotics” to refer to these drugs, it’s a less precise term.
Generally, most medical care for injured workers poses “trivial” or no iatrogenic risk (risk that medical treatment will inadvertently cause illness or death). This is not the case when opioids are used for ongoing treatment, however. According to the report, workers on a medium-to-high dose of opioids for a year experience about 1.75 deaths per 1,000 patients per year. By comparison, the riskiest jobs in the U.S., such as logging and fishing, incur one death per 1,000 workers per year.
The California Workers’ Compensation Institute reported in 2011 that 3% of the prescribing physicians accounted for 55% of all opioid prescriptions. The institute also reported that some patients found themselves looking for more drugs or increased dosages. For example, the top 10% of injured workers obtained prescriptions from an average of 3.3 different physicians. An unintended consequence of increased opioid sales was an increase in the number of opioid-related overdoses and fatalities, with no long-term evidence of effectiveness in relieving pain, the report points out.
Controlling costs, changing strategy
Claims payers often use pharmacy benefit managers (PBMs) to help manage drug spending. The members of CompPharma, an association of PBMs, process about three-quarters of drug payments in workers’ comp cases, as of July 2015. By using PBMs, employers can integrate claims and medication payment systems, allowing PBMs to track opioid use closely. The PBMs have begun to reach out to prescribing doctors to advise them on alternative drug regimens as well as launching early intervention programs.
As of mid-2015, the report notes, opioid use in workers’ comp is subject to much stronger controls and transparency and the medical community is more cautious in prescribing opioids without follow up. But an important issue related to controlling opioid use is the workers’ comp industry’s need to develop a “coherent, balanced strategy” for preventing and treating chronic pain. All parties involved should invest more in conservative care, which includes multidisciplinary/inter-disciplinary functional restoration programs, work hardening programs and cognitive behavioral therapy and coaching.
The report also includes the following recommendations:
- Get smarter about matching injured workers with interventions.
- Get away from talking only about drugs.
- Embrace open collaboration.
- Maintain an open culture in the workplace.
- Adapt a systems engineering model.
To download a copy of the report, see We're beaating back opioids - Now what?.
How is your organization handling issues of workers and opioid use? Let us know in the comment section that follows.