The opioid crisis has ravaged communities throughout the United States and taken the lives of thousands of people. In fact, the U.S. Department of Health & Human Services (HHS) estimates that more than 130 people die every day from opioid overdoses. According to the Centers for Disease Control and Prevention (CDC), opioids were responsible for about 400,000 overdose deaths in the United States from 1999 to 2017.
The economic cost of the crisis is staggering as well, estimated at $631 billion from 2015 to 2018, according to the Society of Actuaries (SOA). These costs are borne by individuals in the form of lost wages; the private sector in lost productivity, health care expenses, and workers’ compensation costs; and federal, state and local governments in lost tax revenue and additional spending on health care, social services, education and criminal justice.
Opioid Use & Abuse
Opioids are synthetic narcotic painkillers that work by preventing pain signals from reaching the nerve centers in the brain. They include prescription pain relievers such as Hydrocodone, Oxycodone, and Percocet; heroin; and synthetic opioids such as Fentanyl. For on-the-job injuries, physicians have prescribed opioids for everything from soft-tissue/musculoskeletal injuries to back, shoulder and chronic pain injuries. Pat Edwards, Area Sr. Vice President and Workers’ Compensation Practice Leader for RPS, discussed the opioid crisis and the impact it has had in the workplace and on workers compensation.
“For years people have been overprescribed opioids fueled by Big Pharma and a distribution system that rewarded physicians for prescription volume,” said Edwards. “In fact, America’s largest drug companies distributed 76 billion Oxycodone and Hydrocodone pain pills across the country between 2006 and 2012. When it comes to on-the-job injuries, workers are prescribed opioids for soft-tissue injuries when Tylenol, Advil or Ibuprofen would be just as effective. Moreover, the duration of opioid prescriptions has caused other issues such as addiction and substance abuse. The majority of opioid prescriptions should be issued for three days but instead were being prescribed for 30 days—exacerbating the problem and causing drug dependency and, in many cases, individuals turning to more powerful, illicit drugs such as Fentanyl and Carfentanil or heroin.”
Indeed, a 2016 survey reveals that 99% of doctors were prescribing opioids for longer than the three-day period recommended by the CDC. Additionally, statistics show that opioid effectiveness plateaus after 60 days of use, and 23% of opioid users eventually become addicted to heroin.
The Workers’ Comp Effect
The most recent numbers available show that more than $1.54 billion was spent on opioids by workers’ compensation insurers in 2015, although this number may now be going down because of measures being taken by the government, physicians, state workers’ comp bureaus and others (see below). “The cost of a claim is four to eight times higher when opioids are prescribed than similar claims with no opioid prescription,” Edwards noted.
In addition to higher workers’ compensation claims costs involving opioids to treat job-related injuries, the work environment is also impacted. You have loss of productivity; negative employee performance; prolonged employee absences and the inability to recover and return to work, resulting in higher wage-loss benefits; staff turnover as a result of shifting high-performing employees out of production to train new hires; and safety hazards to both the drug-dependent employee and his/her co-workers. “You may have an individual with an opioid addiction working in a warehouse or other setting who becomes drowsy or is difficult to work with, creating a hazardous environment for everyone. He or she is not only at risk but is also risking the health and safety of co-workers,” noted Edwards. “As a result, we have seen a higher degree of co-claims.”
What Is Being Done on the Opioid Front?
The federal government and state legislatures as well as state workers’ compensation bureaus and others are taking measures to deal with the opioid epidemic. For example, U.S. drug distributors and pharmaceutical companies are negotiating a settlement valued at about $50 billion that would allow them to resolve 2,600 lawsuits brought nationwide, according to a recent article in Reuters; and a Virginia doctor who prescribed more than 500,000 doses of opioids in two years was sentenced to 40 years in prison for leading what prosecutors called an interstate drug distribution ring.
In early September, the HHS announced more than $1.8 billion in funding was awarded to states to continue the Trump administration’s efforts to combat the opioid crisis by expanding access to treatment and supporting near real-time data on the drug overdose crisis. This is part of the State Opioid Response grants from the Substance Abuse and Mental Health Services Administration, secured in 2018. The grants provide flexible funding to state governments to support prevention, treatment, and recovery services in the ways that meet the needs of their state.
Physicians are scaling back on opioid prescriptions in light of the crisis, and some have even stopped prescribing opioids altogether.
State workers’ compensation bureaus are also taking measures to stem opioid overprescribing. For example, the Massachusetts Division of Industrial Accidents initiated a voluntary program for people who have settled claims but are still on opioids to receive an expedited hearing process to resolve medication disputes with insurers and assign a care coordinator to guide workers to alternative treatments. The New York Workers Comp Bureau (WCB) allows insurers to request hearings to determine whether a claimant should be ‘weaned off’ opioids. The Ohio Bureau of Workers’ Compensation (BWC) can deny opioid prescription reimbursement if it is believed that physicians are overprescribing. The BWC can also provide treatment for opioid dependence to workers who became addicted post getting hurt on the job. What’s more, in February the BWC announced that OxyContin would no longer be newly prescribed for injured workers in its system beginning this past June 1.
Workers’ comp carriers are looking to better manage the claims process in terms of how an injured worker is being treated. “For example, nurse triage services are increasingly being implemented in workers’ compensation cases to evaluate injured individuals upfront and offer guidance on the next treatment steps to take,” said Pat. “Vendors are working with carriers as the first line of evaluation in the medical process. This benefits carriers as they can determine if an injured worker should go to the hospital or urgent care and then manage the process from there.”
Businesses are also looking at how they can manage the opioid epidemic. Pat provided several practices and measures businesses should implement:
- Create concise policies and procedures to include an Employee Assistance Program (EAP)
- Don’t be judgmental and reconsider zero-tolerance drug-testing policies
- Gather information before taking action (be sure to comply with ADA and other regulations)
- Implement pre-employment and post-injury drug testing
- Create an environment where employees can disclose opioid issues
- Monitor workers compensation claims
- Educate employees on responsible prescription opioid use and about the potency/ dangers of abusing prescription medications
- Train supervisors to recognize signs of potential impairment and to be knowledgeable about the company’s drug-testing policy
- Be extra vigilant in safety-sensitive positions or with heavy machinery
- Ensure any information obtained is confidential and protected
- Make sure employees take the appropriate time off for medical reasons
- Integrate employees returning from medical leave into the workplace in a positive manner; support a safe return-to-work program for injured employees
We are seeing some positive results as a result of the measures being taken by all the stakeholders involved in the opioid crisis. For example, according to myMattrix, a subsidiary of Express Scripts Holding Co., the average opioid spending among its comp payers has dropped by 15% due to a decline in utilization and overall cost per prescription. Overall, 65.9% of comp payers spent less on opioids in 2018, with 17.7% of injured workers reportedly prescribed opioids, down from 21% in 2017, according to the report. In addition, according to the most recent study (2018) of injured worker claims from 27 states by the Workers Compensation Research Institute (WCRI), fewer injured workers are receiving opioids to treat pain than in previous years. Medical providers are increasingly turning to non-opioid medications and physical therapies such as NSAIDs (nonsteroidal anti-inflammatory drugs) and non-pharmacologic treatments. The WCRI study does note, however, that opioid prescribing continues to be prevalent among nonsurgical claims with more than seven days of lost time and there still remains substantial interstate variation in opioid dispensing.
Sources: HHS, Society of Actuaries, Altarum, Washington Post, Reuters, CDC, IRMI, Insurance Journal, WCRI