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The true cost of opioids

A workers’ comp claim with no opioid scripts costs about $13,000.  Those with long-acting opioids like Oxycontin?  $117,000.

This and other factoids were reported in yesterday’s NYTimes in a revealing piece by Barry Meier; you may recall Meier was responsible for two articles last year in the Times on opioids and workers’ comp physician dispensing.

  • There were 16,651 deaths associated with opioids in 2010. My best guess is several hundred of those were workers’ comp claimants.
  • The price-per-pill for Vicodin dispensed by docs was roughly three times that of Vicodin purchased at a retail pharmacy.
  • Opioid sales more than doubled to $8.34 billion in 2012; workers’ comp accounts for about 18% – 20% of total opioid costs
    (remember workers’ comp medical is less than 2 percent of total US medical expense…)
  • The number of patients in drug treatment – inpatient, outpatient, or using drugs intended to address addiction – has increased dramatically over the last ten years.

What does this mean for you?

Do you have any idea what opioids do to your claim costs?  Not just the cost of the drugs; the other medical expenses, extended disability duration, legal expense, and settlement costs?



6 thoughts on “The true cost of opioids”

  1. As someone who spent years being addicted to opiate based medication, I can add other “true costs” starting with the loss of self and the loss of self respect, the loss of family and the loss of friends, the loss of employment the loss of hope (3 suicide attempts). There was no reduction in pain, nor was there are reduction of injury, just the removal of my ability to function. Now I talk about other ways to deal with the impact of pain etc without requiring long-term opiate based medication.

  2. A neighbor recently discovered I work in the WC industry and vented: “Can you help my wife? She has had a work-related back injury for years, and rather than fixing the problem, our insurance just wants her to be drugged up.” It is unfortunate that so many claimants find themselves stuck in this position.

  3. Co-incidence is not causation.

    The lead-in is a statement that implies opioids cause claims to run nearly 10x as much as claims without.

    Injured workers requiring opioids are more likely to have sustained injuries that cost more to treat than those not requiring pain treatments.

    Even though WC only accounts for 2% of total national medical care spend, the other 98% is stacked with primary care visits, vaccinations, physicals and other treatments not requiring pain medication. Trying to tie 2% (of total spend) to 18%-20% (of opiod costs) is apples and oranges.

    There are three types of lies: “Lies, damned lies, and statistics”.

    I am not saying we don’t have a problem with over-prescriptions of certain medications, but better effort needs to be put forth to highlight the issue; not this.

    1. Allen – You may have missed all the other research that shows opioids are used far too often to treat non-surgical back claims, driving costs up several times higher than the same claims without opioids. Case-mix adjusting has long been used to make apples-apples comparisons, especially in regards to opioids of late.

      Moreover, opioids are used far more often to treat back strain/sprain in WC than in other lines of coverage.

      I’d suggest that opioids absolutely do increase claim costs – and that is borne out by research from CWCI, NCCI, Accident Fund, and others.

      I’d further suggest you read up on all the other research before asserting “better effort needs to be put forth to highlight the issue”; perhaps you can start by reading the scores of posts I’ve written over the past nine years, many citing specific research.

      Pooh-poohing the problem is exactly the wrong response, and it is what got us here. Gary Franklin, MD, Medical Director of Washington L&I, said it best: “This is a hair-on-fire issue.”

  4. A friend of mine is going through a divorce because her husband became addictied to opioids after his physician prescribed AND DISPENSED a high amount of narcotics to him for a work injury (non-surgical low back strain). They have 3 children. She had to put a restraining order on him and his “friends” (other drugggies) who come around her house trading and exchanging pain meds. The children are in therapy due to the stress the family is going through. Her husband was one of the nicest people I knew (loving father, hard-worker, never used alcohol or street drugs)…unfortunately he “trusted” his doctor and became addicted to the opioids…sad, sad story all around. A family of 5 (more if you count the extended family) ruined just to benefit the physician dispensing chain…

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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