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A New Report Looks at the Early Data in 25 States to See How Opioid Abuse Reform Efforts are Faring in Workers' Compensation Claims
In light of the epidemic in deaths caused by prescription opioid overdoses and abuse building since at least the 1990s, reforms targeting the abuse of opioids for pain management have been taking place for several years now, both at the state and federal levels, and the question arises as to how effective these efforts have been so far in curtailing this abuse. A new report, “Interstate Variations in Use of Opioids, 3rd Edition,” by authors Vennela Thumula, Dongchun Wang, and Te-Chun Liu, provides some evidence to assist in answering this question. This report examines data from 25 states looking for variations and trends in opioid use and prescribing patterns and finds noticeable decreases in prescription opioid use in most of these states, at least in the treatment of workers' compensation claimants.
The authors of that report examined carrier and payor data for over 330,000 nonsurgical workers' compensation claims that had at least seven days of lost time and that received at least one pain medicine prescription. The claims followed worker injuries sustained in years 2010 through 2012 and included prescriptions through March 2014. The data used represented between 40 and 75 percent of workers' compensation claims in each state. In order to achieve a standard measure of both quantity and strength for different opioid products, opioid use was measured by the average morphine equivalent amount per claim.
Most Recent Data
For claims filed for year 2012, with prescriptions filled through the end of March 2014, the report found that between 60 and 80 percent of injured workers with pain medications received opioids in most of the studied states, with outlier states at the high end that included Arkansas (86%) and Louisiana (85%) and at the low end New Jersey (54%) and Illinois (56%). California was high in the bottom third, coming in at about 67%.
During that same time period, the average amount of opioids received per claim ranged from a low of around 1000 milligrams of morphine equivalent opioids in Missouri to a high of approximately 3400 milligrams in Louisiana and New York. As described by the authors, "a morphine equivalent amount of 3,400 milligrams per claim is equivalent to an injured worker taking a 5-milligram Vicodin tablet every four hours for nearly four months continuously." Pennsylvania was almost as high, coming in at over 2800 milligrams per claim. California was a distant fourth at about 2000 milligrams per claim, and all other states were distributed throughout the 1000s. The authors note that while the three states with the highest dosage amounts per claim have enacted reforms to address opioid concerns, the data in this study predates the effective dates of some of those reforms.
Comparison to Earlier Data
Those numbers only paint a picture of the latter half of the study period, however. Comparing those numbers with data from the 2010 claims year, with prescriptions filled through March 31, 2012, the authors found some encouraging signs. Most states have experienced decreases in the number of injured workers receiving opioids for pain relief. For example, Florida and New York, both states with reform measures that went into effect between 2011 and 2013, saw 4% reductions. Conversely, one state, Iowa, saw a 5% increase. California saw no appreciable change in the percentage of claims with opioid usage, although it did see a modest 1% decrease in the number of claims that had two or more opioid prescriptions.
The amount of opioids received by injured workers per claim also decreased in most states. Michigan, Oklahoma, and Massachusetts each saw decreases between 24 and 31% per claim, which translates to more than 500 milligrams less per claim on average. The authors noted that each of these states had made changes in recent years to curb opioid use, including changes to strengthen the effectiveness of state prescription drug monitoring programs, for example, by increasing access to private payors (Michigan) or requiring real-time reporting of scheduled opioids (Oklahoma). Maryland, North Carolina, and Texas were close behind with reductions per claim of about 20%. California saw a 13% reduction in the morphine equivalent amount per claim during this period. Three states, Wisconsin, Iowa, and Missouri saw increases in this metric, although even with these increases, those three states were among the lowest states in the study in morphine equivalent amount per claim.
Related Prescription Practices
Their data also revealed other tendencies in prescription practices, not all of which were consistent from state to state. For example, injured workers using opioids were often using other drugs like benzodiazepines and muscle relaxants, an inherently dangerous practice as all three classes can "have a sedating effect and the additive effect could lead to respiratory depression." For the most recent two years of the study period, concurrent use (within one week) of opioids and muscle relaxants was found in about 30 to 45% of opioid-using claims in all of the study states, with Florida and Louisiana coming in at the high end of that spectrum and Massachusetts, Missouri, New Jersey, and Wisconsin at the low end. California was also near the top of that list at about 42%. Concomitant with a general decrease in opioid use in most states, the authors not surprisingly also saw an increase in prescriptions for non-opioid pain medications in most of the states, although none of these increases was greater than about 6%.
The authors also found substantial variation in the mix of opioids being prescribed, with stronger opioids such as oxycodone being favored in some states and comparatively weaker opioids such as hydrocodone getting greater use in others. For example, oxycodone was prescribed in only 1 to 2% of claims in California, Illinois, and Texas, while it was prescribed in 29% of claims in Massachusetts, although that high Massachusetts prescription rate in 2014 still constituted a 6% reduction from 2012. Connecticut, Minnesota, Pennsylvania, and Wisconsin were in the 18-19% range for oxycodone prescriptions.
While the authors of this particular report provide some interesting data about the admittedly early impacts of recent reform efforts, they do not focus in detail on the policy factors that might cause the interstate differences in the workers' compensation claims data they studied, as that was beyond their intended scope. However, they do note, in general terms, factors both within and without the workers' compensation system that probably played at least some role in causing the variations, such as different state workers' compensation policies for pharmaceuticals, differences among state prescription drug monitoring programs and pain policies, and variations in industry practices. But they acknowledge that further research would be necessary to properly examine those issues.
There is, of course, much more detail to be found in the report than the relatively cursory description provided here, and interested readers are encouraged to look at the report to see how their state fares in comparison to others. While the data was limited to nonsurgical workers' compensation claims, the findings might be of interest not just to workers' compensation policy makers, but to other policy makers or participants interested in pharmaceutical abuse reforms.
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