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Opioids and Their Effect on Workers’ Compensation

Employees injured at work are often prescribed powerful – and potentially dangerous – medication in the form of opioids to help relieve their pain.

Opioids are a class of drugs found naturally in the opium poppy plant. Opioids are often used as medicines because they contain chemicals that relax the body and relieve pain. Prescription opioids are used mostly to treat moderate to severe pain.

Common prescription opioids include:

  • Hydrocodone (Vicodin®) and oxycodone (OxyContin®, Percocet®) – commonly called Vikes, Oxy, and Percs
  • Oxymorphone (Opana®)
  • Morphine (Kadian®, Avinza®)
  • Codeine
  • Fentanyl

While opioids can ease a patient’s pain or aid in a speedy recovery from an injury, they can also make a person feel very relaxed and high. This can be very dangerous because opioids can be highly addictive, and overdoses and death are common. Heroin, for example, is one of the world's most dangerous opioids and is never used as a medicine in the United States.

Every day, more than 130 people in the U.S. die as a result of an opioid overdose, according to the Centers for Disease Control and Prevention. The misuse of and addiction to opioids –including prescription pain relievers, heroin, and synthetic opioids such as fentanyl – is a serious national crisis that has reached epidemic proportions affecting public health and social and economic welfare.

How Did This Happen?

In the late 1990s, pharmaceutical companies assured the medical community that patients would NOT become addicted to prescription opioid pain relievers. So, health care providers began to prescribe them at greater rates. As a result, widespread misuse of these drugs occurred before it became obvious these medications could indeed be highly addictive. 

Opioid overdose rates began to increase, and the statistics are more than alarming. According to the CDC:

  • Overdose deaths are four times higher today than they were in 1999.
  • From 1999 to 2015, more than 183,000 Americans died from prescription opioid overdoses.
  • In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl.
  • That same year, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers.
  • Every day, more than 1,000 Americans are treated in emergency departments for misusing prescription opioids.
  • Of patients who receive opioid prescriptions for long-term, non-cancer pain, 25 percent struggle with addiction.
  • Nearly half of all opioid overdoses involve a prescription opioid.
  • And, about 80 percent of people who use heroin first misused prescription opioids.

How Misusing Opioids Can Lead to Overdose

Taken for pain relief, prescription opioids are generally safe when taken for short periods of time and as prescribed by a doctor, but, as shown above, they can be misused. People misuse prescription opioids by:

  • Taking the medicine in a way or dose other than prescribed
  • Taking someone else's prescription medicine
  • Taking the medicine for the effect it causes – to get high

Opioids bind to and activate opioid receptors on cells located in many areas of the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure. When opioids attach to these receptors, they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience. An overdose can be the result.

Number One Workers’ Comp Issue in the U.S.

The CDC estimates that the total "economic burden" of prescription opioid misuse alone in the U.S. is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.

A recent study by the research and consulting institute Altarum revealed that the opioid crisis has exacted a trillion dollar toll on the U.S. economy since the turn of the century, leading the Lockton Companies to state that because of the risks associated with opioids – addiction and overdose – prescription opioids have become the number one workers’ compensation problem in the United States in terms of controlling the cost of indemnity losses. Covering a full one-third of that cost has typically fallen to health insurers and workers’ compensation carriers.

Opioid overdose can be very a complicated risk. The majority of overdoses occur when a person takes a combination of medications that can depress the central nervous system and breathing, causing the person to suffocate. Case law has varied, depending on the state and circumstances of overdose. However, in some situations, employers may be required to pay workers’ compensation benefits to survivors of employees who overdose on opioids that were prescribed to treat work-related injuries.

Hidden Costs

Many claims professionals, CFOs, and employers’ risk managers are unaware of how much the cost of prescription drugs influence their claims costs because of what doesn’t show up on pharmacy reports they receive: data reflecting what’s called “physician dispensing.”

This process allows doctors to sell opioids to injured employees at a markup of 60-300 percent above what a pharmacy benefits manager would charge. And, research indicates when physician dispensing occurs, doctors are prescribing more than three times the amount of opioids they should be prescribing.

Claims Rising Rapidly

According to a recent John Hopkins study, workers who were prescribed just one opioid had total claims costs that were four to eight times greater than workers who had similar claims but were not prescribed opioids. The reason for the difference? The workers who took opioids had more ER visits for addiction treatment, related illness, overdose, and even death.

Prolonged use of opioids is associated with poorer outcomes, longer periods of disability, and higher medical costs for injured employees, putting additional strain on the country’s workers’ compensation setting. 

Curbing Opioid Abuse

Fortunately, employers can develop strategies to help reduce opioid abuse among their employees:

  • Educate employees. People have become more in tune with their person health care needs and treatments. The best way to curb opioid abuse is to prevent it before it starts. Use your employee’s interest in their own health care to educate them about the dangers of drug use.
  • Talk with health care providers. If your organization partners with a health care clinic, talk with the physicians about alternatives to the prescription of opioids to your injured employees.
  • Collect thorough patient histories. Risk factors such as depression, high blood pressure, and obesity dramatically increase the potentially dangerous side effects of opioid use. Collect as much patient medical history as possible to alert doctors and allow them to choose alternative treatment plans for patients who are at a high risk for opioid abuse.

Mitigate Your Risks

Opioids can be powerful tools to assist in the healing process, so eliminating them all together is not an option. However, by understanding the risks that come with opioid use, and making education a high priority, you can help to manage this risk for your business and keep your employees safe.

For more information about your Workers’ Compensation policy and costs, or how to help manage opioid abuse risks, contact your VGM Insurance Account Manager today, or reach out to use at 800-362-3363 or info@vgminsurance.com.

To read Part Two of our two-part series on Opioids and Their Effect on Workers’ Compensation, click here

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