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The abuse of prescription opioids has gained national attention as a public health epidemic. While state and federal health agencies are waging a war aimed at reversing this national crisis by enforcing stricter policies on prescription painkillers, the mismanagement of opioids in workers’ compensation claims in the construction industry is increasing and putting businesses at risk.

The most significant challenge for construction businesses is the higher costs related to open and legacy claims. A workers’ compensation claim can be open for years, even throughout the lifetime of an injured worker. If the worker becomes dependent on prescription painkillers to control his or her pain, the medical benefits portion of the claim becomes the largest expense as the years progress.

To prevent injured workers’ abuse of opioids and reduce the costs resulting from claims, employers should address this issue by incorporating more stringent drug management protocols.

The Opioid Epidemic
Opioids are strong controlled substances prescribed by physicians to treat and alleviate pain. The most common prescription opioids are hydrocodone, oxycodone, morphine and codeine. Opioids do not eliminate the source of the pain or the underlying medical condition. Over time, the use of these drugs can result in dependence, addiction and sometimes death if not properly prescribed.

The latest statistics from the Centers for Disease Control and Prevention show 40,000 drug overdose deaths take place each year in the United States, and more than half of these are related to prescription drugs.

The epidemic of prescription painkiller addiction is correlated to the uptick in workers’ compensation claims, with the greatest amount coming from the construction industry. In the United States, medical costs are approximately 60 percent of workers’ compensation claims costs, according to the National Council on Compensation Insurance. Of those medical costs, narcotic drugs account for approximately 25 percent.

The Workers Compensation Research Institute also revealed the average lost time for workers using opioids can total as much as $117,000—that’s 900 percent higher than the cost for workers who do not take opioids.

The very nature of construction work exposes workers to many hazards that can result in on-the-job injuries. Many of these work related injuries are treated by physicians who prescribe the opioids to address both short-term and long-term pain.

While medical guidelines recommend opioids should be used only in the short term, such as during the acute phase of an injury, more workers are taking the drugs for longer periods of time. Administering opioids to treat chronic pain does not yield good results. According to the American College of Occupational and Environmental Medicine, also known as the Official Disability Guidelines, opioid effectiveness plateaus after 60 days of use, by which time other pain management therapies should be introduced, such as physical therapy, acupuncture and psychological intervention.

However, if these pain management alternatives are not offered to workers, they may continue using the prescription painkillers for longer durations. The excessive administration of opioids further escalates costs incurred by the employer because the worker has an extended absence. Not only does this lead to additional claims, but the delay of the worker’s return also negatively affects the company’s productivity and hurts the bottom line. Ongoing disability continues to be an issue of opioid misuse, and injured workers taking the drugs are at double the risk of being disabled a year later.

Additionally, courts in several states have held employers and insurers financially responsible for overdose deaths related to workers who were addicted to opioids.  

Controlling Opioid Misuse in Workers’ Compensation Claims
To prevent the mismanagement of opioids, companies can employ a workers’ compensation panel to establish safe prescribing protocols that protect injured workers from opioid abuse and reduce costs related to workers’ compensation claims.

Forty-nine states have electronic, state-managed prescription drug monitoring programs (PDMPs) in place to help curb opioid abuse and overprescribing by physicians. However, the value of PDMPs is hampered by the lack of physician access to information about what prescriptions patients have filled in other states; plus, every state’s system is set up differently. 

A workers’ compensation panel can improve the accountability for opioid usage in cases where physicians have prescribed opioids for more than 60 days via the following methods.
  • Physician panel. Employers should select medical providers who take a conservative approach to opioids and who are well versed in treatment guidelines. This applies only to states that allow employers to choose their own physician panel. Pre-screening physicians allows employers to eliminate doctors who are quick to prescribe prescription painkillers without using other methods to treat chronic pain.  
  • Pharmacy benefits management program (PBM). Pharmacy benefits managers can identify injured workers who are getting drugs from more than one prescriber, ensuring the early identification of opioid prescriptions and history. Some PBMs utilize analytics to predict potential high-cost, high-risk claims to assist payers. By doing this, claims were able to close early on in the acute phase of the injury with less likelihood that the claim would mature. 
  • Patient education and screening. Organizations should provide education to injured workers about the dangers of opioids, including the difference between dependency and addiction. Employees may develop negative side effects when they stop taking the drug, which is a strong motivator for them to continue the medication. Employers can partner with their employee assistance program to provide counseling to the worker that includes positive support, behavioral modification and, if needed, information on drug rehabilitation programs.  
Employers also can implement random, periodic and targeted drug testing to identify employees who may be abusing opioids past the 60-day prescribing guidelines.

Trust Claims Consultants
Claims consultants partner with the workers’ compensation carrier claims team to target long-term opioid usage, including what the opioid was prescribed for, dosage duration and whether other curative treatments are being used.   

Should the duration of opioid use extend beyond judicious use, the claims team may collaborate with the physician to determine if alternative treatments have been explored. The entire claims management process has a goal for injured workers to receive optimal treatment so they can reach maximum capacity and return to their job duties.

It is the employer’s responsibility to insist all participating health providers involved in workers’ compensations claims follow conservative guidelines for pain treatment to keep the worker healthy. 

Shane Riccio is a producer at The Graham Company focusing on business development for the firm’s Construction and Health & Human Services divisions. For more information, email sriccio@grahamco.com. Kara White is a claims consultant at The Graham Company. For more information, email kwhite@grahamco.com.

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