Drop in California Workers’ Comp Opioid Use Reducing Claims $6.5B, Report Shows

November 12, 2019

The prevalence of opioids in California workers’ compensation lost-time claims has dropped 51% over the past decade, reducing both average benefit payments and average days away from work on those claims, according to a new study released by the California Workers’ Compensation Institute on Tuesday.

The CWCI study shows 10-year costs on 2010 through 2017 claims systemwide are projected to decline by an estimated $6.5 billion.

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 declined from 13% to 3% of all lost-time claims, while acute use declined from about 36% to just over 21% of the claims.

The study also showed that the strength of the opioids dispensed within the first 12 months of treatment declined 59% for chronic opioid use claims, and 36% for acute opioid use claims.

The authors projected that savings will reach 16.5% for 2017 claims after 10 years of development, with a cumulative savings of $6.5 billion for 2010 to 2017 claims.

The workers’ comp industry has responded to the opioid 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 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’ comp programs in other jurisdictions, according to CWCI.

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 on the group’s website.

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