The use of opioid medications, particularly long-acting opioid medications, is an independent risk factor for the development of catastrophic claims.
Public concerns surrounding the use of opioids to treat chronic pain, not involving cancer or terminal illness, have grown as the number of prescriptions for opioid analgesics has continued to increase.1,2 Prescribing patterns have shifted with more Schedule II and sustained-release opioids being prescribed today than ever before, particularly in the workers’ compensation setting.2 Escalating problems such as overdose, addiction, and even death are now reported in association with workers’ compensation catastrophic claims with 55% to 85% of injured workers across the country now receiving narcotics for chronic pain relief.3,4 This increase in the use of opioids is further complicated because individuals with chronic pain often take these medications in the presence of comorbid mood, anxiety, or somatization disorders. The presence of these disorders increases the risk that these individuals will exhibit substance-use disorders or aberrant drug-taking behaviors.5,6 According to the most recent National Epidemiologic Survey on Alcohol and Related Conditions data, 18% to 20% of the US population with a substance-use disorder has a co-occurring independent anxiety or mood disorder.7 For patients with occupational injuries having chronic pain, more frequent and longer-term use of narcotics may lead to addiction, increased disability, work loss,8 or even death.9 Consequently, the health risks and financial impact of workers’ compensation catastrophic claims resulting from the use of opioids to treat chronic pain are a significant issue. Historically, the workers’ compensation industry has measured the impact of opioids on workers’ compensation catastrophic claims costs by only quantifying opioid-related medication cost focusing on the pharmacy share of total medical cost and the dynamics of utilization, drug mix, and cost inflation. For instance, the most recent report from the National Council on Compensation Insurance indicates that the most significant factors driving medical cost today are due to physician dispensing and pharmaceutical utilization patterns. This study was conducted to determine alternative methods for measuring the impact of medications, particularly opioid medications, beyond inflation and utilization, by evaluating the overall effect of opioids on medical and total workers’ compensation claims’ costs. To this end, we utilized claim and pharmacy billing data from Accident Fund Holdings, Inc, for the State of Michigan. The pharmacy billing data was mapped to aggregate claim data to determine the financial impact of short- (SA) and long-acting (LA) opioids on claims controlling for case mix complexity, lost time, litigation, sex, and age. Our aim was to identify actionable trends that would allow for early interventions or prevention of behaviors that ultimately would improve care, reduce cost, and minimize the risk to injured workers.The Effect of Opioid Use on Workers Compensation Claim Cost in the State of Michigan