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Combating Overutilization of Opioids to Treat Workplace Injuries

The opioid addiction epidemic among Americans has been getting a lot of play in the news in the last several years, even more so on the heels of a few high-profile deaths. Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus. Medications that fall within this class include hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza), codeine, and related drugs. In an effort to educate the public about the potential risks of opioid use, in March the U.S. Food and Drug Administration (FDA) announced class-wide safety labeling changes for immediate-release opioid pain medications. Among the changes, the FDA is requiring a new box warning about the serious risks of misuse, abuse, addiction, overdose, and death. These steps, according to the agency, are aimed at reversing the opioid epidemic, while still providing patients in pain access to effective relief.

The insurance industry and employers are also concerned about the widespread use of opioids and their effects when treating employees after a workplace injury. How big is the opioid problem in the workforce? According to the National Council on Compensation Insurance (NCCI), medical costs are now approximately 60% of Workers’ Compensation claims costs. Of those medical costs, narcotic drugs account for approximately 25%. Furthermore, a report released this month by the California Workers’ Compensation Institute (CWCI) indicates that opioids continue to be the state’s number one prescribed drug in its Workers’ Comp system.

Additionally, another new report released by San Francisco-based health care information company Castlight Health Inc. stated that nearly one-third of opioid prescriptions paid for by employers are abused. Abuse is defined as receiving greater than a cumulative 90-day supply of opioids and receiving an opioid prescription from four or more providers within a four-year period (2011-2015 in the report). Of all Workers’ Compensation claimants, individuals who abuse opioids cost employers about $19,450 in medical expenses on average annually, which is nearly twice as much as the $10,853 that non-abusers cost, says the report.

Moreover, prescribing opioids to manage chronic pain often does not yield hoped-for results. According to several medical guidelines, opioid effectiveness plateaus after 60 days of use, by which time other means, including cognitive and physical therapies, should be employed. Indeed, research shows that for types of pain related to common workplace-related injuries, including soft-tissue injuries and musculoskeletal problems, opioids are not any more effective than non-opioid alternatives such as Tylenol, Advil or generic ibuprofen. Although opioids are widely prescribed for back injuries and chronic back pain, they should not be the ­first line of treatment. Not only are opioids not curing patients, including workers suffering from chronic pain, they are creating new complications that can extend a worker’s absence and lead to added suffering and more claims. Ongoing disability is a frequent result of opioid misuse. Addiction to the opiate is another, and death yet another.

In fact, many businesses, including manufacturers, are being hit with legacy Workers’ Compensation claims because of the opioid epidemic. A Workers’ Comp claim can be open for years, even throughout the lifetime of an injured worker. And when an injured worker becomes addicted or dependent on prescription painkillers, the medical benefits portion of the claims increases. This results in higher expenses for the business.

What Can You Do to Control Workers’ Comp Claims Involving Opioids?

To prevent workers from abusing opioids, employers should address the issue by providing greater employee education, instituting stricter drug management protocols, and implementing an effective claims management process.  Following are some recommendations your manufacturing shop should consider:

  • Educate your employees on the dangers of opioid abuse. Employers should provide injured workers with information about the dangers of opioid usage, including the serious risks it can create at work. Employees need to be clear about the danger of, and your shop’s policy on, potential impairment from prescription medications. Making job descriptions available to employees to share with medical providers is helpful. While illegal drugs used to be the focus, it is now important to offer frequent reminders of the prescription drug policy for your workplace.
  • Encourage employees to seek help for dependency and addiction. Employees who are taking opioids may become dependent more quickly than they realize. They may experience certain negative effects when they stop taking the drugs, which is a strong motivation to continue the medication. This is the point at which employees need to work with their physician about their dosage and continued use. There needs to be education around the difference between dependency and addiction and about the importance of intervening before employees develop a serious addiction. The employee’s medical provider or company Employee Assistance Program (EAP) are critical resources in getting help.
  • Supervisor training. With the changes in drug use over the past several years, it is important for managers to be current on their workplace policy for prescription drug use, as well as understand the potential signs of impairment and the updated process and scope of drug testing. Managers should communicate this information regularly with employees during individual and team meetings.
  • Reevaluate employee drug testing. The National Safety Council (NSC) recommends that employers expand drug testing to include detection of opioid painkillers. According to the NCS, a survey found that while 87% of employers conduct drug testing, only about 52% test for synthetic opioids. Any drug testing in the workplace must be consistent with legal and policy requirements. Consult with a lawyer to develop testing policies and procedures.
  • Take advantage of a pharmacy benefits management program (PBM). Pharmacy benefits managers can identify injured workers who are obtaining drugs from more than one prescriber, ensuring the early identification of opioid prescriptions and history. Industry research has shown that PBMs are effective in decreasing opioid usage.
  • Call on your claims consultant. A claims consultant teams up with your Workers’ Compensation insurance carrier to target long-term opioid usage, including what the opioid was prescribed for, dosage duration and whether other pain management treatments are being administered. If an injured worker is on the opioid for an extended period of time, the claims team can work with the physician to explore alternative treatments for the worker.

You can help reduce the costs of Workers’ Compensation claims by incorporating these and other protocols in your claims management process. At Precision Manufacturing Insurance Services (PMIS), we specialize in providing manufacturers with Workers’ Compensation coverage and can assist you with improving your claims management process, return-to-work program and safety initiatives to gain greater control over costs. To learn more about our manufacturing insurance programs, contact us at 855.910.5788.

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