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Workers’ comp opioid usage in California…

Schedule II opioid scripts in California increased 557% from 2005 to 2012.  

According to a study released by CWCI yesterday, growth seems to have topped out, with S-IIs accounting 7.2 percent of all drugs prescribed in the 4th quarter of 2012 after hitting 7.1 percent in 2011.

Some may see this as progress.  If “progress” is defined as not getting any worse, perhaps that’s accurate.  I’d suggest that stabilizing at 7.2 percent of scripts and 19 percent of drug spend for drugs that have little place in treating workers’ comp injuries is only good news if one doesn’t consider the long-term impact of opioids.

Claimants taking opioids over the long term are not going back to work, aren’t going to settle claims, and are going to cost far more than claimants – with the same diagnoses – that aren’t on opioids.  Lest you think this another “insight” from Captain Obvious, ask your actuaries if they have projected future costs factoring in the impact of opioids.

Fact is there is precious little research into the impact of opioids on financials over the long term. I’ve asked many industry experts, insiders, and thought leaders, along with several comp actuaries, if they’ve heard of or done much in the way of analysis.  With some notable exceptions, the answer is “not really”.

In defense of actuaries, they’re using historical data to predict the future.  So, the financial effect of a pentupling of opioid usage hasn’t revealed itself in the data yet; or more accurately, the impact has yet to be fully realized.

When it is, the stuff is going to hit the fan.

I’d note that these data refer to California’s experience and may not be – and in all likelihood are not – representative of the entire country.  I’d hazard a guess that some states have yet to reach their “opioid peak” while others may be close to stabilizing growth.  Scary thing is, outside of California and Texas, payers just don’t know.

We do know that initial opioid usage in Texas has decreased thanks to the closed formulary and tough UR standards.  We also know that payers using PBMs have seen declines in opioid usage (see here and here).

What does this mean for you?

Do you KNOW the financial impact of opioids?

2 thoughts on “Workers’ comp opioid usage in California…”

  1. Wow! That is some rate of increase. WC reminds me of the game of “Whack a mole” … once you hit one problem on the head, another pops up.

  2. Nice article, Joe. Slightly scary, but interesting that after so much research on health effects of opioids, nobody has done a proper research on its effects on finance.

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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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