The Face and Cost of Opioid Addiction

The face of addiction is often perceived as not a pretty sight. The "normal" people of the world stand in judgment scoffing at what "those" people are doing.  In reality, the face of opioid addiction in workers’ compensation can look just like you, your neighbor, your best friend, or any average employee that had an accident at work. 

 

This honest, “average Joe” employee has never had a major injury, and has never been prescribed narcotics. 

 

 

Just Make the Pain Go Away

 

The pain from the injury is severe, so the treating physician prescribes a powerful opioid.  What the physician doesn’t know is that this injured worker is also facing a number of personal problems above and beyond his injury and has been looking for a magic bullet to make those go away.  Instead of using the opioid as prescribed, he starts to take more of it and more often, sometimes in combination with other medications or alcohol. 

 

When the magic bullet doesn’t work, the patient may tell stories of increased pain to convince the doctor, in good faith, to increase the strength of the pills or to prescribe more of them.  He may start seeing different doctors to obtain more drugs or even get drugs from friends and family.    His focus of recovery from the injury is replaced with a focus on obtaining more of the opioid, even though his problems continue to mount.   If his primary doctor does not continue to prescribe opioids as he requests, he may keep searching for a new doctor until he finds one that does.  This approach will only work for so long, as the injured worker continuously has to increase either the frequency of consumption or increase the potency of the opioid to find that euphoria. His craving intensifies and his motivation changes to seek the drug, even as his life spins out of control. He has become addicted to opioids.

 

 

Average Lost Time Claim with Long Acting Opioid 900% Higher than Without

 

This unfortunate story has become all too common in recent years.  The New York Times published an article on the subject titled “The Soaring Cost of the Opioid Economy.”  While the article does not address the cost within any particular company, the information gives us a scope of the opioid problem.

 

The cost of workers' compensation claims skyrockets when injured employees start using opioids.  The average workers’ comp claim with lost time costs $13,000 when no opioids are used.  When an employee is prescribed a short-acting opioid like Percocet® (oxycodone and acetaminophen), the average lost time claim cost triples to $39,000.  When an employee is prescribed a long-acting opioid like Oxycontin, the average lost time claim costs explodes to $117,000, an increase of 900% over the average lost time claim without the use of any opioids.

 

If an injured worker progresses from patterns of misuse to addiction, the treatment for addiction adds to the overall cost of the worker’s compensation claim.  The opioid addiction may be treated with…additional drugs, buprenorphine and naltrexone, as well as a comprehensive behavioral health and psychosocial model.  The use of buprenorphine and naltrexone has risen from near zero prescriptions in 2002 to nearly 8 million prescriptions in 2012.

 

Overall overdose deaths where prescription opioids were involved have also risen sharply along with the cost.  In 1999, there were 4,030 deaths due to opioid overdose.  By 2010, that number had more than quadrupled to 16,651.

 

 

Real Time Intervention Can Prevent Addiction and Decrease Costs

 

Whether an employer is self-insured for workers’ compensation, or has a work comp insurance company, the numbers clearly show how the cost of opioids can have a significant impact on the employer’s overall workers’ compensation costs.  To avoid the cost and employee health concerns of inappropriate opioid use, the employer or insurance company should utilize a comprehensive set of tools from their PBM to screen for patterns of misuse).  PBM best practices for early intervention screening for opioid utilization patterns should include: 

 

• Implement real time flagging of inappropriately high doses of opioids with tools like a Morphine Equivalent Dose management program
• Screen for early refill patterns to identify patients who may be taking medications more frequently or at higher doses than prescribed
• Limit the number of doctors who can prescribe narcotics for an injured worker
• Screen for opioid prescriptions from multiple pharmacies

 

 

Summary

 

NCCI research shows that while the number of workers' compensation claims has decreased, costs associated with these injuries continue to increase- especially for those on chronic opioids.  This cost is magnified if the injured worker misuses the medication or becomes addicted.  Aside from the huge cost to payers, addiction is very difficult to treat which negatively impacts the life of the worker.  Best practices to control opioid overutilization require systems to identify the issues in real time, educate the parties, and have a proven plan to implement steps that will improve the claim outcome.