Managing Opiod Use in Workers Compensation Claims

Date: Sep 21, 2017
By: Basi Insurance
In: ,


Employees typically have peace of mind that while a workplace injury may cause pain or disrupt their lives, they’ll be treated as quickly and effectively as possible through their employers’ workers’ compensation programs. Employees also know they’ll have treatment options that best fit their conditions and medical needs. One potential treatment, however, presents unique challenges for employers: opioids.1

Every day, more than 90 Americans die after overdosing on opioids.2 The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids, such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.3.

The Rise of Opioids in Workers’ Comp

Doctors and nurses must ask patients to rate their pain on a scale of one to 10, and treat it accordingly. That subjectivity, in part, has given rise to the over-prescription of opioids. “Historically, opioids were used appropriately to alleviate pain associated with cancer and similar severe pain conditions. Over time, physicians prescribed opioids for far less severe pain conditions. The resulting rise in availability has also contributed to the current epidemic in the United States,” said Maureen McCarthy, SVP and Manager, Workers’ Comp Field Claims, Liberty Mutual Insurance.

The Centers for Disease Control and Prevention (CDC) estimate that nearly half of all U.S. opioid overdose deaths involve prescription opioids – in 2015, there were 15,000 prescription-related opioid deaths1.

Its impact is also being felt in the workers’ comp space. Seventy percent of injured workers take some form of an opioid painkiller – and workers’ comp claims involving opioids cost, on average, $20,000 more than claims without.1

Employers’ Proactive Approach

So what can employers do to address this exposure? The key points are to have a Drug Free Workplace Program and to work with healthcare benefits providers and worker’s compensation carriers.

Drug Free Workplace Programs are cost-effective programs that can help address drug impairment in the workplace. Effective programs should consist of these 5 components:

  1. A clear, written policy. The program can also include a prescription drug workplace policy. (Consult with your company’s legal team to ensure all federal and state-specific guidelines are reflected in your policy).
  2. Employee education including (but not limited to) employee training that address topics such as being informed at the point of prescribing (are there non-opioid prescriptions that can be used?) and how opioid medication may affect their work.
  3. Supervisor training. With the changes in drug use over the past several years, it is important for managers to be current on their workplace policy for prescription drug use, understanding potential signs of impairment, and the updated process and scope of drug testing.
  4. An employee assistance program. It is in the employer’s best interest to identify opioid abuse and to support confidential access to treatment.
  5. Drug testing. Drug tests can be perceived as being highly intrusive, but they can be invaluable tools for preventing drug-related incidents and reducing risk.

Company healthcare benefits providers and worker’s compensation carriers are critical to employee safety and prevention programs for prescription opioid use. Working closely with these important partners helps employers understand the extent of opioid use and the need for programs to prevent and manage opioid use. Find out what your provider’s/carrier’s program of opioid management is and whether they utilize Prescription Benefit Manager’s (PBMs) technology to identify “flags” when prescription medicine abuse or misuse is occurring.

The prescription opioid epidemic – overprescribing, misuse, abuse, and overdose – is impacting the workplace. Evidence demonstrates serious risk to employees and substantial costs for employers.4 But there are proactive steps that can be taken to try and prevent your employees from becoming a statistic.

  1. Risk Insurance – Treating Injuries without Employer Pain: Managing the Challenges of Opioids and Marijuana (July 2017)
  2. National Institute on Drug Abuse – Addressing America’s Fentanyl Crisis (April 2017)
  3. National Institute on Drug Abuse – “All Scientific Hands on Deck” to End the Opioid Crisis (May 2017)
  4. National Safety Council – The Proactive role employers can take: Opioids in the workplace –

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