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Opioids and Workers’ Comp – a quick update

The rest of the world is beginning to catch up to the progress workers’ comp has made fighting the opioid scourge.  Kudos to PBMs, payers, regulators, researchers and some physicians for recognizing the incredibly negative effects of opioids years ago, and taking action to mitigate some of these effects.

That is NOT to say we’re anywhere close to getting this solved – far from it.

But we have seen some evidence of decreases in the number of new claims getting opioids in some areas and an overall decline in opioid scripts and morphine equivalents (MEDs).  We’ll have more information in a couple of months when CompPharma (a consortium of work comp pharmacy benefit managers) releases its 13th Annual Survey of Prescription Drug Management in Workers’ Compensation. (note I’m president of the organization and am conducting the research, past reports are available free for download here.)

A few factoids to give some perspective:

From CWCI’s most recent research:

  • Opioids declined to 27.2% of all scripts dispensed to California work comp patients in 2014, down from a peak of 31.8% in 2008.
  • Average number of morphine equivalents per script declined from 550 in accident year (AY) 2007 to 422 in 2012.
  • The % of work comp patients receiving opioids within 24 months of injury increased from 22.4% in 2005 to 27.9% in AY 2012
  • Express Scripts reported overall spend for opioids declined 4.9% in 2015, the fifth consecutive decrease.
  • Helios reported:
    • the percentage of work comp patients getting opioids declined by 1.6% from 2013 to 2014.
    • opioid utilization dropped 2.9% over the same period

What we have NOT seen is any significant progress dealing with the knottiest and most important problem – long term opioid users.

I can’t count the number of erstwhile start-ups, business ventures, and eager entrepreneurs I’ve spoken with who contend they’ve figured it out.

By definition, anyone who claims to have a universal solution most certainly doesn’t understand the problem.  Unlike reducing initial and secondary scripts, addressing patients who’ve been taking opioids for months is very much an

  • individual,
  • patient-by-patient approach
  • requiring flexibility,
  • a deep understanding of the disease state and chronic pain and addiction,
  • a willingness to experiment and fail, and
  • a very long term commitment to a business model that almost certainly will not be hugely profitable.

That’s not to say there isn’t opportunity – there most certainly is.

What does this mean for you?

We’re at the end of the beginning of the work to address opioids.  This will take focus, years, diligence, and unrelenting focus.

4 thoughts on “Opioids and Workers’ Comp – a quick update”

  1. Joe, have you looked into Medical Canabis as an alternative treatment for chronic pain? We are going to have a session on this at the South Florida Case Management Network Annual Conference that will take place July 15, 2016 at the Signature Grand. If anyone is interested email me directly at All case managers, disability specialists and social workers are able to attend at NO Cost.


  2. Great discussion Joe. I agree this is a difficult battle that is fought one case, one patient and one physician at a time. We have embraced the fight and stand strong continuing our efforts.

  3. UCLA has a great program with a focus on Chronic Pain
    and Psych issues that come with Addiction.

  4. A relative of mine was prescribed opioids after serious shoulder surgery. She’s not an addictive personality, and had always kind of “looked down” on opioid addicts as people who must enjoy the feeling the drugs gave them. She didn’t like how they made her feel, but they helped manage her pain. Then she tried to get off them….and that’s when the trouble started. She had every kind of horrible symptom, even stepping down. The withdrawal was excruciating, to the point that she could barely function. It’s now months later and she is still not 100% free of the side effects of withdrawal. Needless to say she no longer has negative opinions of users who cannot stop.

    These are dangerous drugs. I can’t help but wonder if the relief they provide is truly worth the damage they cause.

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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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