By Dwight Robertson, M.D., Medical Director, EMPLOYERS
The U.S. opioid crisis has riddled news headlines, impacted healthcare policy, influenced political debate and discourse, and affected thousands of lives across the country. Every day, more than 130 people die from an opioid overdose. Opioids are among the most commonly prescribed painkillers for injuries covered by workers’ compensation insurance. As the implications of opioid addiction become more apparent, it’s imperative for insurers to use evidence-based medical guidelines to educate healthcare providers and injured workers on opioid overuse to reduce the rates of addiction and death.
Prescription opioid misuse costs an estimated $78.5 billion per year due to addiction treatment, healthcare costs, and criminal justice involvement.1 According to the National Council on Compensation Insurance, prescription drugs account for nearly 25% of workers’ compensation medical costs. However, the expenses are just the tip of the iceberg.
As reported by the Centers for Disease Control and Prevention (CDC), workers with a current substance use disorder miss an average of 14.8 days of work per year. The subset of those with a pain medication use disorder miss an average of 29 days per year. In contrast, most employees miss an average of 10.5 days of work per year.
The longer an employee is on opioids, the less likely he or she is to return to work or be fully functional upon return. This loss in productivity ends up costing businesses $42 billion per year.
Today, workers’ compensation insurance providers like EMPLOYERS are leading the way in reducing and preventing chronic opioid use by implementing three types of aggressive and successful intervention programs.
1. Physician Engagement
Peer-to-Peer Programs allow prescribing doctors and medical experts on the insurance side to collaborate on the injured worker’s treatment plan. Together, they can discuss what medications are being prescribed and for how long. While physician reviews have been occurring for more than a decade, having a conversation with the doctor specifically on the opioid prescription plan – chiefly, when the injured worker will be weaned off highly addictive drugs — is key to preventing chronic opioid use. While opioid use can be appropriate after various treatments like surgical procedures, the continuation of opioids is usually not recommended for any time beyond the very acute stage. As such, having specific conversations with doctors can reduce the likelihood of creating another long-term abuse case.
2. Shorter Case Review
Opioid addiction, per the CDC, can happen in as little as five days. However, the typical timeframe for identifying and reviewing workers’ compensation claims is between 60 and 90 days. Reducing this timeframe to 30 days or less can greatly reduce the number of chronic users. During these early reviews, focusing the conversation with physicians specifically on the patient’s opioid prescription plan is also vital. By doing so, physicians are encouraged to develop a proactive and focused plan for how and when the patient will be weaned off opioids. Lower cost is an additional benefit of conducting a prescription plan review earlier in the treatment process.
3. Present Alternative Therapies
Alternative therapies such as Lyrica, a non-opioid pain management drug, Cognitive Behavioral Therapy (CBT), aqua therapy, physical therapy and other interventions can all help injured workers get back to full functionality without depending on opioids. More treating physicians are moving away from opioids and prescribing alternative therapies, which has a direct impact on reducing the number of opioid-related deaths.
By continuing to diligently find patients who have been on opioids for 30 days or longer, closely tracking new cases, and urging alternative therapies, the opioid crisis will claim fewer and fewer victims. In fact, by incorporating these three elements into its own program, we’ve seen 97% of our claimants discontinue all new opioid use within 12 months and 100% of claimants stopping new opioid use within 24 months—one hopeful step towards preventing chronic opioid use.
About Dr. Robertson
Dr. Dwight Robertson, M.D. is the Medical Director for EMPLOYERS®, America’s small business insurance specialist®, which offers workers’ compensation insurance and services through Employers Insurance Company of Nevada, Employers Compensation Insurance Company, Employers Preferred Insurance Company, and Employers Assurance Company. It also offers a suite of services, including Loss Control Connection®, EMPLOYERS’ web-based loss control platform, a 24/7 Injured Employee Hotline and managed care services. Not all insurers do business in all jurisdictions. EMPLOYERS® and America’s small business insurance specialist® are registered trademarks of Employers Insurance Company of Nevada.
The information provided is intended to provide a general overview. This information is not legal advice and should not be relied on as such. EMPLOYERS® makes no warranties for the accuracy, adequacy, or completeness of the information provided, and will not be responsible for any actions taken based on the information contained herein. If you have legal questions or need legal advice, please consult an attorney.
1National Institute on Drug Abuse, “Opioid Overdose Crisis” at https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis (visited November 5, 2019).
2National Safety Council, “How Prescription Opioids May Be Affecting Your Workers Compensation Program” at https://www.nsc.org/Portals/0/Documents/RxDrugOverdoseDocuments/RxKit/EMP-How-Prescription-Opioids-May-Be-Affecting-Workers-Compensation-Program.pdf (visited November 5, 2019).
3National Institute for Occupational Safety and Health, “Opioids in the Workplace” at https://www.cdc.gov/niosh/topics/opioids/data.html (visited November 5, 2019).
4National Safety Council, “Prescription Drug Abuse: What Employers Can Do” at https://www.nsc.org/Portals/0/Documents/RxDrugOverdoseDocuments/RxKit/EMP-Prescription-Drug-Abuse-What-Employers-Can-Do.pdf (visited November 15, 2019).
5Centers for Disease Control and Prevention, “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016” at https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm (visited November 15, 2019).
6 Centers for Disease Control and Prevention, “Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use” at https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm#F1_down (visited November 5, 2019).