Data from the National Council of Compensation Insurance shows that injured workers who were issued at least one opioid prescription in 2016 received three times as many opioid prescriptions as the U.S. opioid prescribing rate. (Credit: Iryna Imago/Shutterstock)

The insurance industry is no stranger to responding to crises. Its inception dates back to the Great Fire of London in 1666, and there has been no shortage of disasters since then.

One of the latest catastrophes to capture the industry's attention and resources is the ongoing opioid crisis.

Many in the property & casualty insurance industry, particularly those in the workers' compensation space, have seen firsthand how opioids have dismantled individual lives and businesses alike. Starting in the late 1990s, a wave of opioids were prescribed in increasing numbers. Today, on average, 130 Americans die every day from an opioid overdose.

This is an alarming figure for a myriad of reasons, but especially for insurers looking to help injured workers get back to work. As information about the addictive nature of opioids became more mainstream, a number of insurers reconsidered their pain treatment plans. Workers' compensation insurer AmTrust was among those that did just that.

The company partnered with Optum Workers' Comp and Auto No-Fault, a pharmacy care management company, to implement processes that reduced overall opioid prescriptions for injured employees. Opioid prescriptions deemed possibly unsafe or unnecessary were flagged and sent to nurses for review, reducing the percentage of prescription claims that include opioids to 25% in the fourth quarter of 2018 from 60% in the fourth quarter of 2017 — resulting in 13,000 less opioid prescriptions over the last six months of 2018.

The big picture

Opioids like oxycodone, hydrocodone and morphine are often prescribed to combat chronic pain. But such prescriptions are often handed out to deal with a range of ailments; everything from low back sprains and migraines to multiple sclerosis and numerous forms of cancer can result in an opioid prescription.

For workers in labor-intensive industries, an injury has greater implications for their livelihood when an opioid prescription is in the picture. For businesses, opioids affect their ability to retain workers and keep those still on the workforce safe as new, less experienced workers are brought on to deal with employee shortages.

“Every day 130 individuals die from an opioid overdose, but what does this mean to workers' compensation?” asks Dr. Melissa Burke, head of managed care and clinical at AmTrust Financial. “Studies show that injured employees that are prescribed longer-term opioids take longer to return to work, and those that take opioids for more than three months are less likely to ever return to work.”

The workers' comp connection

The impact of opioids on the workers' compensation segment has been established for some time, but data paints an even starker picture.

Data from the National Council of Compensation Insurance shows that injured workers who were issued at least one opioid prescription in 2016 received three times as many opioid prescriptions as the U.S. opioid prescribing rate.

AmTrust's report also noted that data from the Centers for Disease Control and Prevention and National Safety Council also reveals a link between workers' compensation and opioid addiction:

In 2016, 44% of all workers' compensation claims with prescriptions had at least one prescription for opioids.
As of 2016, 15% of workers' compensation claims with at least one prescription for opioids had a date of injury going back six or more years.
Receiving more than a week's supply of opioids — or two or more prescriptions — soon after an injury doubles a worker's risk of disability one year after the injury.
Based on data for low back injuries that kept workers out of work for more than seven days, longer-term workers' compensation opioid prescriptions resulted in a longer duration of temporary disability compared with claims with no opioid prescriptions.

As the dangers of opioids garner more attention, many in the industry are looking to alternative forms of treatment to manage pain. Physical therapy, non-opioid medications like ibuprofen and cognitive behavioral therapy are a few of the current alternatives to opioids.

The opioid crisis is likely to persist for some time. The question of when it will be resolved remains to be seen, but insurers like AmTrust are doing their part to tackle the question of how.

Special Reports /

AmTrust initiative lowers opioid prescriptions among injured workers

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