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.
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 to 30—perhaps 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:
J There are no regulations that require monitoring or accountability by prescribers for their patients. While several states have initiated prescription-drug-monitoring programs, these programs are typically voluntary on the part of the physician.
J 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.
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.
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.
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