Exploring the Link between Workers’ Compensation and Opioid Addiction

Topics: Opioids

Chronic pain. Too many workers are far too familiar with it. In fact, a recent study by the Centers for Disease Control and Prevention (CDC) found that 15% of our nation’s workforce struggles with long-term pain.

Suffering from pain brought on by strains, sprains and fractures – all common workplace injuries – millions of injured employees are turning to opioid analgesics for relief. Available through most workers’ compensation programs, prescription opioids can open the door to addiction and all the dangers that come with it.

While chronic pain sufferers are at the highest risk for addiction and dependency, opioids can also be prescribed for traumatic injuries, presenting risks for short-term opioid use as well.

Is Workers’ Comp Contributing to the Opioid Crisis?

injured worker taking opioids for pain relief

Big Pharma. Physicians. Pharmacists. Politicians. Data suggests that each of them has played a role in the opioid crisis. Additionally, experts across the insurance industry believe work comp insurers are also contributors.

“It’s an issue that has those in the workers’ comp space concerned,” said AmTrust Financial Senior Vice President Matt Zender, who oversees the company’s workers’ compensation product.

Substantiating Mr. Zender’s viewpoints is the National Council of Compensation Insurance (NCCI), which shows that injured workers who were issued at least one opioid prescription in 2016 received three times as many opioid prescriptions as the U.S. opioid prescribing rate.

A Complex Puzzle

While workers’ comp insurers are strong advocates for safe pain management, the best use of prescription opioids has been a difficult puzzle for the workers’ comp system to solve.

“When you look at who is receiving the opioids, how it complicates recovery, the difference between what the evidence base suggests is prudent use of opioids, and how they are immediately prescribed upon the actual moment of injury, these are all things that are complicated because of the differences in the controls within workers’ comp,” explains Alex Swedlow, president of the California Workers Compensation Institute.

The Cost of Pain Relief

According to John Ruser, president and chief executive officer of the Workers Compensation Research Institute in Cambridge, Mass., the greater prevalence of payments for opioids in work comp is the result of the types of injuries – often debilitating – involved in work comp claims.

Opioids like fentanyl, oxycodone and morphine have long been the go-to medications for managing pain from traumatic injuries and major surgeries, providing relief on both a short- and long-term basis.

Less Time with Patients Leads to Higher Risks

Some industry experts see a correlation between the time doctors spend with work comp patients and the risk of opioid dependency. Physicians tend to spend significantly more time with Group Health patients than with work comp patients, according to a recent article published by Carrier Management. Having more one-on-one time with their treating physician, Group Health patients are often better educated about the types of treatment available to them, including opioid alternatives. As a result, these individuals are less likely to get a prescription that may not be the best treatment option for them.

Uncovering the Connection

Compiled by the National Institute of Occupational Safety and Health, the CDC and the National Safety Council, the following statistics reveal a strong link between workers’ compensation and opioid addiction:
  • In 2016, 44 percent of all workers’ compensation claims with prescriptions had at least one prescription for opioids.
  • As of 2016, 15 percent of workers’ compensation claims with at least one prescription for opioids had a date of injury going back six or more years.
  • Receiving more than a week’s supply of opioids – or two or more prescriptions – soon after an injury doubles a worker’s risk of disability one year after the injury. In the interest of safety and long-term health, several states now place limits on the number of days patients can be on an opioid prescription for acute pain.
  • Based on data for low back injuries that kept workers out of work for more than seven days, longer-term workers’ compensation opioid prescriptions resulted in longer durations of temporary disability compared with claims with no opioid prescriptions.

Adding Insult to Workplace Injuries

Affecting both the worker and the workplace, high doses of prescription opioids, when taken over an extended period, can:

Delay the injured employee’s return to work.

A 2008 study conducted by the California Workers’ Compensation Institute revealed that injured workers receiving high doses of opioid painkillers stayed off work three times longer than those with similar injuries taking lower doses. The longer a recovering employee is away from work, the higher the claims costs for the employer. Moreover, workers who take opioids for more than three months usually don’t return to work at all, due to dependence or other side effects, per the American Psychiatric Association Foundation.

Compromise the safety of the recovering employee – and his or her co-workers.

Opioids can make a person less alert and slow reaction time. Consequently, employees taking opioid painkillers could put themselves – and their coworkers – at risk when operating heavy machinery, working from higher elevations or driving.

Lead to lower productivity, greater absenteeism and a higher risk of workplace violence.

According to the CDC, workers with a substance use disorder miss an average of nearly 15 workdays per year, while those with a pain-medication use disorder miss an average of 29 days a year.

Result in higher claims costs for employers.

Studies have shown that claims costs for injured workers using prescription opioids are significantly higher, on average, than the claims costs of similar injuries sustained by workers who are not taking these painkillers. A 2016 study by FAIR Health, a nonprofit organization that manages the nation’s largest database of privately billed health insurance claims, found that opioids account for one-quarter of all workers’ compensation prescription drug costs. Extended recovery time, treatment for drug addiction and long-term dependency can all drive up claims costs.

A Prescription for Change

When it comes to successfully managing the use of prescription opioids, claims professionals focus on five key elements:

  • Early identification of risk factors. Recognizing those who are at greater risk of addiction – including injured workers recovering from traumatic injuries or illnesses – is a key to preventing addiction before it happens.
  • Continuous monitoring of the injured worker throughout the life of the claim. Communication between the insurance carrier’s claims department and the employee’s treating physician is paramount. Research has shown that regular communication between the two parties increases the likelihood of a favorable claims outcome – one that includes a healthy employee.
  • A team approach to pain management. Collaboration between the claims professional(s), nurse case manager, treating physician, recovering employee and even his or family is critical for a successful treatment plan.
  • A regulatory environment conducive to managing prescribing practices. Drug formularies, treatment guidelines and early employer engagement with the injured employee and treating physician can greatly reduce the number of opioid scripts written.
  • Healthcare literacy. There is no one-size-fits-all plan for treating chronic pain. No matter the pain, there are many alternatives to opioid treatment ranging from acupuncture and cognitive behavioral therapy to physical therapy and yoga.

Breaking the Cycle

Realizing the risks injured employees face when struggling with pain management, AmTrust has partnered with Optum Workers' Comp and Auto No-Fault, a pharmacy care management company, to help break the dangerous cycle of overprescribing, misuse and addiction. The initiative has already prevented nearly 13,000 prescriptions that could have been unnecessary or unsafe.

As the number one workers’ comp insurance carrier for small businesses in the U.S., AmTrust has the tools and resources to help educate your insureds about the dangers of opioid addiction. Additionally, our experienced underwriters will work closely with your agency to build a workers’ comp coverage program that best fits each client.

The bottom line: Opioid addiction can consume the life of an employee suffering from chronic pain, resulting in the battle of a lifetime – one with potentially devastating costs. Support is an injured employee’s greatest ally. Both the employer and its work comp insurer are a critical part of that support system.

For more information about our small business insurance solutions, contact us today.

This material is for informational purposes only and is not legal or business advice. Neither AmTrust Financial Services, Inc. nor any of its subsidiaries or affiliates represents or warrants that the information contained herein is appropriate or suitable for any specific business or legal purpose. Readers seeking resolution of specific questions should consult their business and/or legal advisors. Coverages may vary by location. Contact your local RSM for more information.


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