Report on opioids, workers comp and where we go from here
Over the last 20 years, an enormous opioid crisis spiked, resulting in addiction, death and a myriad of other problems both in the occupational and public health arena. A 23-page report by Peter Rousmaniere - We're beating back opioids - now what? (PDF) - documents that crisis, particularly in terms of the impact on workers compensation. It also talks about the role that the workers comp industry played in stopping that trend and what needs to be done in the future to be sure it has stopped for good. A long-term solution requires new approaches to managing and treating chronic pain.
The report chronicles the rapid and alarming increase in the use of opioids - hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine, fentanyl, and other drugs - and the associated increase in abuse, addiction and deaths. These types of pain drugs had been tightly controlled due to safety concerns, but "advocates" succeeded in removing many of these restrictions in the 1990s. Rousmaniere says that, " By the late 1990s, at least 20 states passed new laws, regulations, or policies moving from near prohibition of opioids to liberal use, without even dosing guidance."
With the loosening of opioid restrictions and aggressive pharmaceutical industry marketing, demand for opioids skyrocketed. For example, OxyContin sales grew from $48 million in 1996 to almost $1.1 billion in 2000. The growth in opioid use had tragic results:
"The decade of the 2000s was a wake up call about opioid risks. Prescribed opioid-related deaths of all patients, work related or not, rose from 1999 through 2011 by 420% to a shocking 16,917. This steep rise was part of a larger epidemic of risks from all kinds of prescribed drugs. In 2009, deaths from all prescribed drugs exceeded for the first time the number of vehicle-related fatalities nationwide."
One of the first to note the alarming trend in workers comp was Gary Franklin, medical director of the monopolistic state fund in Washington. He and his colleagues were looking at claimant deaths and saw that in a significant number of cases, opioids were a factor. He and others in the industry began raising alarms.
Workers comp may have been the proverbial canary in the coal mine to recognize the issues of opioid abuse and over-prescribing, but public health officials were not far behind as related deaths continued soaring. The abuse reached a point where prescription drugs became the gateway to heroin rather than the reverse. Recently, an investigative task force called opiate abuse in Massachusetts an epidemic.
Various interventions by the work comp industry and by state and public health officials are helping to curb the worst excesses and Rousmaniere points to signs that the crisis may have peaked, at least in the occupations arena. These interventions included:
State crackdown on pill mills
Adoption of dosage and treatment guidelines
Focus in medical professional groups
Prescription drug monitoring programs
Claims payers teaming up with Pharmacy Benefit Managers (PBMs)
As our industry moves away from opioids as a treatment for acute pain, new approaches and treatment modalities will be required. Rousmaniere discusses new approaches in the report, suggesting that work comp payers and claims managers will need a more collaborative approach and may need to embrace alternative treatments such as cognitive behavior therapy and functional restoration programs.
For agents with a large workers comp book, this is a key issue to understand. It's important to learn what insurers are doing to address this issue since only a few claims involving opiates can have a deleterious effect on costs -- and can take a human toll as well.
Credits: The report was produced in cooperation with CompPharma and published as a WorkCompCentral Special Report. The report credits the intelligence and persistence of thousands of workers’ comp professionals, with citations for the California Workers’ Compensation Institute, CompPharma, the National Council for Compensation Insurance, Washington State, and the Workers’ Compensation Research Institute.