Chronic pain is by far the most debilitating—and for claimspayers the most costlycompensable condition in workers'compensation, according to a new specialreport from WorkCompCentral.

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The report chronicles the way opioid use greatly expanded inworkers' comp over the last 20 years, then halted and is now inretreat as a result of increased criticism and research into itsefficacy. The report also provides practical suggestions to rethinkthe approach to chronic pain—that is, pain that persists beyondexpected healing time.

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Opioids are defined as medications that relieve pain by reducingthe intensity of pain signals reaching the brain, for example,hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphineand fentanyl. Although some use the term “narcotics” to refer tothese drugs, it's a less precise term.

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Startling statistics

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Generally, most medical care for injured workers poses “trivial”or no iatrogenic risk (risk that medical treatment willinadvertently cause illness or death). This is not the case whenopioids are used for ongoing treatment, however. According to thereport, workers on a medium-to-high dose of opioids for a yearexperience about 1.75 deaths per 1,000 patients per year. Bycomparison, the riskiest jobs in the U.S., such as logging andfishing, incur one death per 1,000 workers per year.

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The California Workers' Compensation Institute reported in 2011that 3% of the prescribing physicians accounted for 55% of allopioid prescriptions. The institute also reported that somepatients found themselves looking for more drugs or increaseddosages. For example, the top 10% of injured workers obtainedprescriptions from an average of 3.3 different physicians. Anunintended consequence of increased opioid sales was an increase inthe number of opioid-related overdoses and fatalities, with nolong-term evidence of effectiveness in relieving pain, the reportpoints out.

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[Related: Workers injured in construction, manufacturing at highest risk forprescription painkiller abuse]

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Tablet-with-words-pain-management-on-display-shutterstock_205649992-Tablet-with-words-pain-management-on-display-shutterstock_205649992-Zerbor

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(Photo: Shutterstock/Zerbor)

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Controlling costs, changing strategy

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Claims payers often use pharmacy benefit managers (PBMs) to helpmanage drug spending. The members of CompPharma, an association ofPBMs, process about three-quarters of drug payments in workers'comp cases, as of July 2015. By using PBMs, employers can integrateclaims and medication payment systems, allowing PBMs to trackopioid use closely. The PBMs have begun to reach out to prescribingdoctors to advise them on alternative drug regimens as well aslaunching early intervention programs.

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As of mid-2015, the report notes, opioid use in workers' comp issubject to much stronger controls and transparency and the medicalcommunity is more cautious in prescribing opioids without followup. But an important issue related to controlling opioid use is theworkers' comp industry's need to develop a “coherent, balancedstrategy” for preventing and treating chronic pain. All partiesinvolved should invest more in conservative care, which includesmultidisciplinary/inter-disciplinary functional restorationprograms, work hardening programs and cognitive behavioral therapyand coaching.

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The report also includes the following recommendations:

  • Get smarter about matching injured workers withinterventions.
  • 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'rebeaating back opioids – Now what?.

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How is your organization handling issues of workers and opioiduse? Let us know in the comment section that follows.

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Rosalie Donlon

Rosalie Donlon is the editor in chief of ALM's insurance and tax publications, including NU Property & Casualty magazine and NU PropertyCasualty360.com. You can contact her at [email protected].