Monday, January 18, 2021


By Joe Paduda – Managed Care Matters

I'm in DC for a couple of meetings focused on the use, abuse, and impact of narcotics in workers comp. To say this is starting to get major traction would be an understatement; payers, policymakers, employers, and pharma are all recognizing the issue for what it is - one of the biggest problems in comp today.

For now, here's a few numbers to help put things in perspective.

- workers comp payers spent about $1.4 billion last year on narcotics. That's 'billion' with a 'B'.

- A study in Washington state determined that there between eight and twelve deaths were associated with workers comp claimants' use of opioids each year from 1999 - 2002.

- over a third of claimants who start using narcotics are on them for more than a year.

- a fifth are on for more than two years.

- a seventh are on for more than three years.

- this despite well-recognized treatment guidelines that suggest narcotics should be used for a limited dime during the acute phase of an injury.

- in a Washington study, only 16% of the low back claimants taking opiates saw an improvement in functionality; only 30% saw a reduction in pain.

- the extended use of opiates doubles the risk of duration exceeding one year.

The elephant in the room is the issue of addiction. Many payers don't want to hear about the likelihood that many of their long-term claimants are - in fact - addicted to or dependent on narcotics. For some reason, they appear content to ignore the issue; a couple claims people I've spoken with have said "we don't want to 'buy' the addiction."

Well, here's a news flash; You already have.

Whether you choose to acknowledge this or not, claimants who have been getting opiates (and/or opioids, the synthetic version) for more than 90 days at a dosage exceeding 120 morphine equivalents per day are are at high risk for dependency/addiction.

And the ones who are addicted are 'treating' their addiction by consuming drugs which:

a) employers are paying for - directly or indirectly

b) are preventing return to work

c) increase total medical costs and require claimants to take other drugs to address the side effects of narcotics

d) may be sold, given away, or taken by family, friends, or other users.

What does this mean for you?

It's time to get real, folks. Here are a few ways to get started.

Begin identifying the claimants at risk for addiction; develop a scientifically - and jurisdictionally - sound approach to addressing the risk; partner with your PBM on a comprehensive strategy; work with regulators to change rules where necessary and possible; task your medical director with developing - and implementing - a solution.

Joseph Paduda is a nationally recognized expert, speaker, media source and author on managed care in group health and in workers’ compensation. He translates complex data into actionable knowledge and is able to take an aerial view or to drill down into intricate niches. He writes the popular weblog Managed Care Matters attracting more than 1500 unique visitors a day and a good deal of comment in the health care world. His blogs are frequently republished on other sites. Mr. Paduda also conducts industry surveys, including one focused on managing pharmacy costs within workers’ compensation.