Stopping the Opioid Drug Epidemic In Workers’ Compensation

pillsThe opioid-based drug epidemic is causing havoc across the United States.  It is also leading to increased costs in workers’ compensation programs and is a main driver in negative patient outcomes in our healthcare system.


The cost of this epidemic affects not only injured workers, but also employers and their bottom line. In fact, at least $60 billion is lost every year due to decreased productivity. It was reported in the 2015 Express Scripts Workers’ Compensation Drug Trend Report the average cost to workers’ compensation payers per opioid prescription in 2015 was $154.66


The stakes are high.  Now is the time to take action.



Treating Chronic Pain in the United States


The term “chronic pain” can have different meanings to patients, caregivers and prescribers. This has resulted in a common misunderstanding of what type of pain meets this definition and how to best treat it.


According to the National Institutes of Health, chronic pain is defined as pain that lasts more than 12 weeks following an injury. This pain can be the result of any type of incident and the level of severity is subjective and unique to the individual. For many years, the primary goal of therapy was to relieve pain and there was an emphasis on escalating doses of opioid-based medications as a mainstay of treatment. This has led to an over-use of opioid-based medications to treat pain beyond the recommend acute phase of care, often without a documented improvement in the patient’s function. Notably, roughly 6,600 people in the United States become addicted to medications intended to treat chronic pain every year.


In late 2015, the Obama Administration took steps to address this pressing issue. It was suggested that the medical community take a fresh approach to treating people suffering from pain, including individuals receiving care following work-related injuries. This approach includes both pharmacologic and nonpharmacologic methods to address pain, as well as a specific focus on guidance for prescribing opioids. An additional focus of this new approach included the use of medication-assisted treatment to avoid dependency issues if use of opioids becomes problematic.



Team Efforts in Combatting Opioid-Based Drug Abuse


Everyone involved in the treatment of patients in pain has a role when it comes to battling the “legal” drug epidemic in the United States.


Prescribers: The focus of all medical care and treatment should be on improving the patient’s functional ability post-injury. This includes the establishment of pain-management goals and promoting healing and the avoidance of merely masking pain. This is a delicate balance that must be struck to ensure adequate pain relief for the patient, yet not promoting reliance on opioid analgesics.


Payers/Employers: There has been a concern within the insurance industry regarding the reliance on Schedule II and III controlled substances for pain relief. Members of the claim management team play an important role as they monitor medical claims and urge compliance with applicable workers’ compensation treatment parameters. They should also ensure that claimants are receiving the care they need, including nonpharmacologic therapy. They should also address the issue of possible abuse as it arises and provide treatment where necessary.



Solutions to Avoid Abuse


In order to address the opioid abuse epidemic in this country, it is recommended that payer organizations partner with a pharmacy benefit manager (PBM) to monitor opioid utilization and detect potential instances of abuse among a patient population. Through a PBM, proactive prescription monitoring is enhanced through various comprehensive tools and triggers at the pharmacy. Your PBM should offer multiple point-of-sale programs that detect opioid utilization and allow payers to make real-time decisions on whether patients can obtain opioid medications from the pharmacist based on various criteria. Solutions to detect fraud, waste and abuse, as well as educational outreach to physicians and patients are also critical components.


It is also recommended that prescribers and pharmacies leverage the data found in prescription drug monitoring programs (PDMPs) prior to prescribing opioids. Prescribers should perform appropriate risk screening for substance abuse and use opioid contracts with clear expectations for prescribing opioids and urine drug testing.





The battle against the abuse of opioid-based prescription medications needs to be taken seriously. Failing to do so impacts injured workers and their employers. Interested parties need to take a proactive approach and seek out unique tools to reduce negative outcomes due to opioids in workers’ compensation claims.



Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact:



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