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Drop in California WC Opioid Use Reducing Costs and Lost Time

Oakland, CA – The prevalence of opioids in California workers’ comp lost-time claims has dropped 51% over the past decade, reducing both average benefit payments and average days away from work on those claims, so 10-year costs on 2010 through 2017 claims systemwide are projected to decline by an estimated $6.5 billion according to a new study by the California Workers’ Compensation Institute (CWCI).  

The study’s authors analyzed 273,106 lost-time claims in which treatment was initiated within a 10-year period (2008 through 2017), with payment and prescription data on the claims valued through 2018.  The authors found that over the 10-year span of the study, chronic opioid use (defined as three or more opioid prescriptions, each filled at least three weeks apart, and all filled within four consecutive months) declined from 13% to 3% of all lost-time claims (a relative decline of 77%); while acute use (i.e., all other opioid use) declined from about 36% to just over 21% of the claims (a relative decline of 40%).  The study also showed that the strength of the opioids dispensed within the first 12 months of treatment, measured in cumulative morphine milligram equivalents, declined 59% for chronic opioid use claims, and 36% for acute opioid use claims. Regression models were used to estimate the impact of opioid use versus non-use on benefit costs per claim.  Applying these estimates against the declining opioid trend, the authors projected that savings will reach 16.5 percent for 2017 claims after 10 years of development, with a cumulative savings of $6.5 billion for 2010 to 2017 claims.

The opioid epidemic is a well-documented public health concern.  Research studies have shown that prolonged opioid use is associated with both delayed recovery from workplace injuries and increased medical costs.  The workers’ compensation industry has responded to the crisis with a multitude of policy and medical management interventions, including increased application of evidence-based medicine treatment and pain management guidelines, drug formularies, prescription drug monitoring programs (PDMPs), and targeted law enforcement against opioid manufacturers and “pill mills.”  These interventions have been instrumental in fueling the decline in opioid use in California as well as workers’ compensation programs in other jurisdictions.

How much lower can opioid utilization fall?  The Institute study concludes that future declines will depend on advances in evidence-based medicine research and treatment guidelines, medical providers’ continued adoption of alternative pain management protocols, continued elimination of fraudulent and abusive provider practice patterns, increased general awareness of the dangers of opioid use, and the growing number of class action lawsuits against opioid manufacturers.

CWCI’s Report to the Industry report “The Impact of Declining Opioid Use on Lost-Time Claim Development & Outcomes in California Workers’ Compensation” is available at www.cwci.org.