Addiction at Work: Workers’ Comp Claims and the Opioid Epidemic

The opioid epidemic has received a lot of attention recently: presidential candidates are semi-regularly asked about their strategies for handling the crisis, op-eds and think pieces have been written about the nature of addiction, and last month, President Obama’s budget proposal allocated $1.1 billion to fight opioid and heroin abuse.

But though the general public is just beginning to realize the full scope of the issue, the opioid epidemic is not a new phenomenon.

Opioids are extremely potent pain relievers: as such, they can be a useful pain management tool. According to medical guidelines, opioids should be prescribed infrequently, as a short-term method to mitigate acute pain. In fact, the Food and Drug Administration (FDA) has only ever approved the use of opioids to manage pain in three scenarios – for cancer, AIDS, and surgical patients.

Unfortunately, doctors have historically prescribed opioids far more broadly than is medically advisable, often as a method of managing chronic pain. One of the unintended consequences of this practice is the above average rate of long-term opioid abuse among patients on workers’ compensation (workers’ comp).

It can be difficult to assess the true scope of the opioid epidemic as it pertains to the workers’ comp population, in part because the electronic databases responsible for collecting data on controlled substances like opioids are of limited practical use. However, studies conducted by the Workers’ Comp Research Institute (WCRI) suggest that among the worst-offending states:

  • 55-85% of patients with a work-related injury are prescribed opioids.
  • 14-17% of these patients become long-term opioid users (a typical long-term user takes opioids regularly for at least a year).

Not only is this hugely detrimental to patients, it also imposes an enormous financial burden on the workers’ comp system. Generally speaking:

  • When an opioid prescription is included in a workers’ comp claim, costs are four times more likely to exceed $100,000 than they’d be otherwise.
  • The costs associated with opioids make up between 15% and 20% of medical costs in long-term claims.

Because the opioid epidemic disproportionately affects the workers’ comp industry, stakeholders have been on the forefront of the fight to raise awareness of the issue and develop innovative solutions to it. One of the more interesting solutions proposed is predictive modeling – the use of analytics to identify claims that are high-risk (and as such, high-cost).

Studies have demonstrated that claims managers armed with this information are better able to focus their energies and intervene in high-risk claims before serious problems develop. Some of these interventions include: proactively meeting with injured employees to discuss return-to-work strategies, opioid education seminars with both employees and prescribing physicians, and deliberate avoidance of physicians who prescribe and distribute opioids themselves in favor of those who partner with pharmacies (who generally provide a level of oversight).

Obviously, predictive modeling will not be enough to solve the opioid epidemic on its own, but it’s certainly a step in the right direction. Through its use, workers’ comp stakeholders have a real opportunity to potentially reduce the rate of future opioid abuse among a hard-hit segment of the population.