Opioid drugs can provide short-term relief to individuals suffering from severe pain. But the high cost and high rates of opioid abuse and misuse can create problems for employers.
The Problem
“There’s very little credible evidence that long-term opioid (narcotics) use is appropriate treatment for workers comp injuries.”
The problem of opioid misuse starts in physicians’ offices. Medical experts recommend using opioids only for short-term pain relief due to acute conditions such as cancer, when a patient does not respond to other therapies. According to the National Institutes of Health, “Almost always, you should limit their use to no more than 3 to 4 months.” However, between 55 and 86 percent of all workers’ compensation claimants receive opioids for chronic pain relief, said Keith E. Rosenblum, a senior risk consultant with Lockton Companies.
Opioid drugs used in workers’ compensation cost employers $1.4 billion in 2012, estimated Joseph Paduda, president of CompPharma, LLC, a consortium of workers’ compensation pharmacy benefit management (PBM) firms. Today, pharmaceuticals account for about 19 percent of all workers’ compensation medical costs, and opioid drugs about 21 percent of all drug costs, reports NCCI Holdings.
In a white paper called “Wasted Dollars, Wasted Lives—How Opioid Overprescribing and Physician Dispensing Are Harming Claimants and Employers,” Paduda also noted, “There’s very little credible evidence that long-term opioid use is appropriate treatment for workers comp injuries….there is ample evidence that long-term opioid use leads to longer claim duration, long-term disability, higher costs, and higher medical expenses.”
Other experts support that view. Ameritox, a drug-testing company, found that many workers’ compensation claimants taking opioids for more than three months are not taking their medication as prescribed. Misuse and abuse ranges from not taking their medication to “…taking too much medication because of inadequate pain control, abuse or addiction.”
Many studies show that after 90 days of continuous use, opioid treatment is more likely to become lifelong. When used long-term, opioids can create changes in a person’s opioid receptors. This can diminish a person’s natural abilities to modulate pain and creates a tolerance for the drug. Over time, a person will require higher doses for effective pain relief, which can lead to abuse, addiction and increased risk of overdose.
The number of accidental deaths associated with the use of prescription opioids has increased dramatically since 1999. In fact, the number of accidental deaths resulting from prescription opioid use now exceeds the number of deaths from heroin and cocaine overdoses, reported the Centers for Disease Control. The misuse and abuse of prescription painkillers led to more than 475,000 emergency room visits in 2009, twice the figure for 2004.
Researchers have also linked long-term opioid use to poor workers’ compensation claim outcomes. A study published in the Journal of Bone and Joint Surgery in 2009 reported that chronic opioid use after a work-related injury predicted “less successful outcomes.” The researchers found that higher dose levels were associated with higher costs for indemnity and medical costs for disability. Opioid users were also less likely to return to work. Among injured workers completing a functional restoration program, those who were using opioids at the time of admission were half as likely as the non-users to return to work during the year after treatment. They were also more than 2.6 times as likely to not be working at the one-year follow-up point.
The Solutions
Promote the use of alternatives to opioids. The American College of Environmental and Occupational Medicine recommends that physicians treating occupational injuries consider other treatments before prescribing opioids. “Depending on the exact diagnosis, these treatments may include exercise, topical medications, distractants (e.g., heat), NSAIDs, low-dose heterocyclic anti-depressants, anti-convulsant agents, and self-applied palliative modalities such as transcutaneous electrical nerve stimulation (TENS).” It also stresses the importance of active exercise and return to work in conjunction with opioid use.
Although medical treatment guidelines recommend periodic drug testing and psychological evaluation for long-term users of opioid drugs, studies have found few physicians observe the guidelines. Only 24 percent of long-term opioid users in one study received at least one drug test.
Ideally, treating physicians should screen workers’ compensation claimants for prior opioid use before prescribing, since prior use increases the risk of tolerance and addiction. Second, treating physicians should require drug testing at regular intervals to monitor patients for compliance. Are they using the drug, and at the level prescribed? Many opioid users will stop using the drug on their own initiative, while those who become dependent will “doctor shop” and obtain prescriptions from more than one physician.
Better management of prescription painkillers can lead to better coordination of care among multiple providers, earlier intervention with patients at risk of addiction or overdose, and better treatment outcomes. All of these can reduce unneeded costs for employers and make valued workers more likely to return to work after an injury.
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