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The 2017 WCRI Report Looks at Data in 26 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, 4th 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 26 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 432,000 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 September 2013 and included prescriptions through March 2015. The data used represented between 36 and 69 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 (MEA) per claim.
Most Recent Data
For claims filed for injuries occurring between October 1, 2012 and September 30, 2013, with prescriptions filled through the end of March 2015, the report found that between 65 and 75 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 (85%), Louisiana (80%), and South Carolina (80%), and at the low end New Jersey (52%) and Illinois (56%). California was high in the bottom third, coming in at about 66%.
During that same time period, the average amount of opioids received per claim ranged from a low of around 900 milligrams of morphine equivalent opioids in Missouri to a high of approximately 3500 milligrams in Louisiana. Pennsylvania was next highest, coming in at about 2600 milligrams per claim, with New York at about 2400. California was seventh highest at about 1700 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, much of 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 most recent 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, New York and Florida, both states with reform measures that went into effect between 2011 and 2013, saw 9% and 3% reductions, respectively. One state, Iowa, saw a 4% increase through the 2012 claims period, although that increase had completely dissipated when the 2013 claims period was added. California saw a modest 2% decrease in the percentage of claims with opioid usage, as well as a 2% 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. New York led the way with an average decrease of about 1300 milligrams of MEA per claim in the 2013 claims year compared to the average amount in the 2010 claims year, while Maryland saw a decrease of almost 1000 milligrams, Kentucky about 800, and Michigan 700. 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 prescribers to check the prescription drug monitoring program database when prescribing opioids (New York). California and Massachusetts were close behind with average reductions of about 600 milligrams per claim, while Texas, Georgia, Nevada, and Connecticut showed reductions of about 500 milligrams. Two states, Indiana and Wisconsin, saw increases in this metric, although even with these increases, those two states were among the lowest states in the study in MEA 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 have a sedating effect and when combined are “associated with a heightened risk of respiratory depression and death." For example, for the 2013 claims year period, concomitant use (within one week) of opioids and other central nervous system depressants was found in about 30 to 45% of opioid-using claims in all but one of the study states, with Louisiana coming in higher at about 51%. Florida and Georgia were next highest at about 43%, while Missouri and New Jersey were at the low end at 30%. California was also near the top of that list at about 42%. Compared to the numbers for the 2010 claims year, most states showed a decrease in concomitant use of opioids and other central nervous system depressants for 2013 claims, with Kentucky (-7%) and Texas (-5%) showing the most improvement, although three states, Nevada (7%), Indiana (2%), and Louisiana (2%) showed increases during that period and six other states showed no appreciable change.
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 30% of claims in Massachusetts, although that high Massachusetts prescription rate in 2015 still constituted a 5% reduction from 2012. Connecticut, Minnesota, Pennsylvania, New York, and Wisconsin were in the 17-20% range for oxycodone prescriptions in 2015.
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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