The abuse of prescription opioids has gained national attention as a public health “epidemic.” While state and federal health agencies are waging a war aimed at reversing this national health crisis by enforcing stricter policies on prescription painkillers, the mismanagement of opioids in workers’ compensation claims in the construction industry is increasing and putting businesses at risk.
The most significant challenge for construction businesses is the higher costs related to open and legacy claims. A workers’ compensation claim can be open for years, even throughout the lifetime of an injured worker. If the worker becomes dependent on prescription painkillers to control his or her pain, the medical benefits portion of the claim becomes the largest expense as the years progress.
To prevent injured workers’ abuse of opioids and reduce the costs resulting from claims, employers should address this issue by incorporating more stringent drug management protocols. These include educating injured workers about the dangers of opioids and selecting a workers’ compensation panel that is experienced in the proper dosages and dosage duration, as well as drug monitoring programs and other pain management modalities.
The Opioid Epidemic
Opioids are strong controlled substances prescribed by physicians to treat and alleviate pain. Opioids are meant to reduce the intensity of pain signals by attaching to specific proteins called opioid receptors, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract and other organs. When these drugs attach to their receptors, they reduce the perception of pain and create a sense of well-being. The most common prescription opioids are hydrocodone, oxycodone, morphine and codeine. Opioids do not eliminate the source of the pain or the underlying medical condition and, over time, the use of these drugs can result in dependence, addiction and sometimes death if not properly prescribed.
The latest statistics from the Centers for Disease Control and Prevention (CDC) show 40,000 drug overdose deaths take place each year in the United States, and more than half of these are related to prescription drugs. According to the CDC, opioid overdose deaths are on an upward trend and exceed more deaths than those related to heroin and cocaine combined.
The epidemic of prescription painkiller addiction is correlated to the uptick in workers’ compensation claims, with the greatest amount coming from the construction industry. The costs for prescription narcotics per claim are rising in the United States. In fact, medical costs are now approximately 60 percent of workers’ compensation claims costs, according to the National Council on Compensation Insurance. Of those medical costs, narcotic drugs account for approximately 25 percent.
The Workers Compensation Research Institute (WCRI) also revealed the average lost time for workers using opioids can total as much as $117,000 – that’s 900 percent higher than the cost for workers who do not take opioids.
The very nature of construction work exposes workers to many hazards that can result in on-the-job injuries. Many of these work-related injuries are treated by physicians who prescribe the opioids to address both short-term and long-term pain.
While medical guidelines recommend opioids should be used only in the short term, such as during the acute phase of an injury, more workers are taking the drugs for longer periods of time. Administering opioids to treat chronic pain does not yield good results. According to the American College of Occupational and Environmental Medicine, also known as the Official Disability Guidelines, opioid effectiveness plateaus after 60 days of use, by which time other pain management therapies should be introduced.
However, these pain management alternatives may not be offered to workers, so they continue using the prescription painkillers for longer durations. The excessive administration of opioids further escalates costs incurred by the employer because the worker has an extended absence. Not only does this lead to additional claims, but the delay of the worker’s return also negatively affects the company’s productivity and hurts the bottom line. Ongoing disability continues to be an issue of opioid misuse, and injured workers taking the drugs are at double the risk of being disabled a year later.
Increased workers’ compensation costs are not the only costs employers face when an injured worker has been on prescription painkillers for more than the required 60-day guideline. Courts in several states have held employers and insurers financially responsible for overdose deaths related to workers who were addicted to opioids.
Controlling Opioid Misuse in Workers’ Compensation Claims
To prevent the mismanagement of opioids, companies can employ a workers’ compensation panel that can establish safe prescribing protocols to protect injured workers from opioid abuse and reduce costs related to workers’ compensation claims.
Forty-nine states have electronic, state-managed prescription drug monitoring programs (PDMPs) in place to help curb opioid abuse and overprescribing by physicians. Although these databases are meant to allow physicians to check if patients have obtained other controlled-substance prescriptions in their states or have sought out multiple physicians to obtain extra medications to support their addiction, they are not enough to control the opioid epidemic.
The value of PDMPs is hampered by the lack of physician access to information about what prescriptions patients have filled in other states; plus, every state’s system is set up differently. For example, while New York physicians are required to check the state PDMP prior to prescribing a controlled substance (this is not required in most states), there is no information available to New York physicians about prescriptions obtained in any other state.
A workers’ compensation panel can improve the accountability for opioid usage in cases where physicians have prescribed opioids for more than 60 days by using the following methods.
- Physician panel. Employers should select medical providers who take a conservative approach to opioids and who are well versed in treatment guidelines. This applies only to states that allow employers to choose their own physician panel. Pre-screening physicians allows employers to eliminate doctors who are quick to prescribe prescription painkillers without using other methods to treat chronic pain, such as physical therapy, acupuncture and psychological intervention.
- Pharmacy benefits management program (PBM). Pharmacy benefits managers are able to identify injured workers who are getting drugs from more than one prescriber, ensuring the early identification of opioid prescriptions and history. PBMs are having success with decreasing opioid usage through a variety of targeted programs. Some PBMs utilize analytics to predict potential high-cost, high-risk claims to assist payers. By doing this, claims were able to close early on in the acute phase of the injury with less likelihood that the claim would mature.
- Patient education and screening. Organizations should provide education to injured workers about the dangers of opioids. Employees may develop negative side effects when they stop taking the drug, which is a strong motivator for them to continue the medication. Employers need to educate employees about the difference between dependency and addiction. Workers using the medication long term (more than 60 days) should be identified, and employers should intervene to prevent a serious addiction problem. For example, employers can partner with their employee assistance program (EAP) to offer help to employees who may have a problem with opioids. An EAP can provide counseling to the worker that includes positive support, behavioral modification and, if needed, information on drug rehabilitation programs.
Employers also can implement random, periodic and targeted drug testing after prescribing to identify employees who may be abusing opioids past the 60-day prescribing guidelines.
Trust Claims Consultants
Claims consultants partner with the workers’ compensation carrier claims team to target long-term opioid usage, including what the opioid was prescribed for, dosage duration and whether other curative treatments are being used.
The physician also has the responsibility to educate injured workers on opioids when they are prescribed. Physicians should explain the purpose of the medication, as well as the risks involved in taking the opioids long term. Physicians also can share the treatment plan with the injured worker and discuss other treatment modalities, such as physical therapy or alternative curative options, as well as how these are effective in treating the pain versus opioids, which only block the pain and are not recommended for long-term use.
Should the duration of opioid use extend beyond judicious use, the claims team may collaborate with the physician to determine if alternative treatments have been explored. The entire claims management process has a goal for injured workers to receive optimal treatment so they can reach maximum capacity and return to their job duties.
Overutilization of prescription painkillers profoundly increases workers’ compensation costs, the length of worker disability and lost work time. While research shows opioids are not always effective in curing pain, physicians still treat workplace injuries with these drugs. It is the employer’s responsibility to insist all participating health providers involved in workers’ compensations claims follow conservative guidelines for pain treatment to keep the worker healthy.