Tag Archives: Opioid Abuse

WCRI Annual Conference: Opioid Crisis Still Very Much Top of Mind

Unsurprisingly, the opioid crisis was a major topic of conversation at the 2019 Workers’ Compensation Research Institute’s (WCRI) Annual Issues and Research Conference.

Workers’ compensation insurance has been particularly affected by the crisis. Opioid use can, perversely, increase a worker’s risk of disability. Opioid use can lead to dependency, which results in increased dosages and higher costs. Dependency can lead to abuse; abuse can result in on-the-job performance impairment and further injuries – or it can delay a worker’s ability to return to work. In the worst case scenario, abuse leads to addiction and death.

These are just some of the reasons why opioid use can significantly increase the costs of workers’ compensation claims.

The crisis continues

The Centers for Disease Control and Prevention (CDC) found that 70,327 people died from fatal drug overdoses in the U.S. in 2017.

That’s up from 63,632 in 2016 and 23,518 in 2002, a three-fold increase in absolute terms in 15 years. But of course, the U.S. population grew over that time – and the death rate per 100,000 people is also alarming, rising from 8.2 in 2002 to 21.7 in 2017.

Source: Centers for Disease Control and Prevention

More alarming yet, the opioid epidemic continues to drive a significant portion of total drug overdose deaths. 47,600 people died from an opioid-related drug overdose in 2017, making up fully 68 percent of total overdose deaths. That’s up from 11,920 in 2002.

Source: Centers for Disease Control and Prevention

As Dr. Alan Krueger of Princeton University noted, the problem is most concentrated among men and women with lower levels of education: “Americans with diminished economic expectations are particularly vulnerable to the opioid epidemic.”

But no one is immune, he added. “Essentially no group has been spared from this crisis in the U.S.”

Blue-collar trades especially impacted

Dr. Vennela Thumela of the WCRI presented recent findings about the correlates of opioid abuse and overdose. She found that mining and constructions workers were most impacted, representing the highest percentage of opioid prescriptions among all workers receiving pain medications. Higher rates of opioid prescriptions also correlated with workers who are older, male, and live in rural areas.

Dr. Letitia Davis, of the Massachusetts Department of Public Health, found Massachusetts-specific evidence agreeing with Dr. Thumela’s findings. The highest opioid overdose death rates in the state are for construction/mining workers and farming/fishing/forestry workers. Construction workers overdosed at six times the rate expected based on average experience.

In fact, per Dr. Davis, 24 percent of all opioid deaths in the state between 2011 to 2015 were construction workers.

The costs are staggering

Dr. Krueger put it bluntly: “This is a human tragedy.”

It has also been a tremendous tragedy to the U.S. economy. Dr. Krueger cited a 2017 Council of Economic Advisers (CEA) report, which estimated that in 2015 alone, the economic cost of the opioid crisis was over $500 billion – or 2.8 percent of GDP. Dr. Krueger noted that the number of opioid-related overdoses in 2017 increased by at least 50 percent since 2015 – implying a cost in 2017 alone of about $750 billion.

As Dr. Krueger put it, “We have not done enough to address the scale of the crisis. Even if it has reached a peak, it has reached a peak of an unacceptably high level.”

Opioid abuse by auto insurance claimants — a serious problem

 

Auto insurance may become an inviting target for people seeking opioids, as Medicare is implementing  controversial restrictions on painkillers’ prescriptions.

Opioids were already the largest category of drugs paid for by auto insurers in 2017, according to a recent Auto Insurance Report article citing data from Optum, a pharmacy benefit management firm.  The narcotic represented 19 percent of medications paid for by auto insurance, down from nearly 24 percent in 2016. There were 7.5 opioid prescriptions per claim in 2017 up from 6.7 in 2016.

Tron Emptage, Optum’s chief clinical officer for the Workers Comp and Auto No-Fault division, notes that auto related prescriptions have been rising where workers comp related prescriptions have been falling. The auto related prescriptions also tend to be of a higher dosage than workers compensation.

It’s useful to compare the two types of claims, says Emptage, because injury types tend to be similar. But unlike workers compensation, which has many rules and fee schedules regulating prescription drug use, auto insurers have been on the receiving end of medical cost shifting as well as the abuse of the medical system to support lawsuits and general fraud, says the article. Challenging medical bills can be problematic when first-party claimants are involved, not to mention third-party claimants.

The article concludes that auto insurers in PIP states can establish pharmacy management programs to gain at least a small degree of control over what they pay for.

 

Some states make progress in tackling opioid epidemic

Prescription opioid use among injured workers decreased in many states, but not all, according to the Workers Compensation Research Institute (WCRI).

Find out which states saw the largest decreases in this new WCRI study.

The National Safety Council (NSC) has developed a new industry specific online calculator that informs employers how much the opioid epidemic is costing companies each year.

The tool provides business leaders with specific information about the cost of substance use (including prescription drug abuse and misuse, alcohol abuse and misuse, opioid and heroin addiction as well as abuse of other illicit drugs and marijuana) in their workplace based on size of employee base, industry and state.

Posted here, the NSC calculator combines latest government and private sector research to estimate annual costs in three categories: time lost form work, job turnover and retraining, and health care costs.

A new NSC survey found only 39% of employers view prescription drug use as a threat to safety, and only 24% feel it is a problem, despite 71% saying they have experienced an issue.

Too Few Aware of Opioid Risk

I.I.I. chief actuary Jim Lynch brings us some surprising numbers on America’s addiction to opioids:

Americans are grossly misinformed about the dangers of opioid drugs, according to a recent survey by the National Safety Council (NSC).

Opioids are commonly prescribed painkillers like Vicodin, OxyContin and Percocet. The drugs are meant to mimic the nervous system actions of heroin and morphine and all too often lead to similar levels of addiction and suffering. More than 170,000 Americans have died from opioid overdoses this century, nearly triple the number of U.S. military deaths in Vietnam (see my earlier post).

I wrote about the epidemic in Contingencies magazine, focusing on the toll the drugs have taken in the workers compensation system.

Too few Americans are aware of this risk, according to the survey of 1,014 adults, reported in the March 24 edition of Workers’ Compensation Report. Just one in five considered opioids to be a serious safety threat. Only 12 percent said addiction was a concern; two-thirds were unconcerned about any side effects from the drugs.

Education is part of the problem. Only 29 percent of respondents said they had taken or been prescribed an opioid in the past three years, though the number jumped to 42 percent once they were provided with a list of common opioids.

Nearly 60 percent of users had at least one addiction risk factor. Common risk factors include alcoholism, depression, use of psychiatric medication or being the victim of physical, mental or sexual abuse.

Users held opioids in high esteem. For example, 78 percent said they were the fastest method of pain relief, 74 percent said they were stronger pain relievers than alternative prescriptions, and 71 percent said they were the best way to relieve pain.

They underestimate the risk. Though 16,235 people died from prescription drug overdoses in 2013, just 19 percent of survey respondents said they had major concerns about the risk of injury or death from the drugs.

That’s less concern than they had about injury or death from severe weather or a natural disaster, from which 586 people died in 2013, and about the same level of concern as riding in a commercial airliner in the U.S., an activity that in 2013 killed eight, roughly 0.5 percent as many as opioids.

Details on the NSC survey can be found here.

Opioid Battlefield

Here’s a simple chart that compares the number of people killed in the opioid epidemic from 2000 to 2013 with the number of soldiers killed in the Vietnam theater, writes I.I.I. chief actuary Jim Lynch.

2015.03.20 LYNCH opioid graphic

Opioids are legally prescribed drugs designed to safely mimic the painkilling effects of heroin and morphine. They have not proved as safe as had been hoped.

The drugs killed more than 170,000 over 14 years, about three times as many as this country lost in Vietnam. The Centers for Disease Control and Prevention (CDC) provides the data for opioids, and Vietnam statistics come from the Congressional Research Service (CRS) and National Archives.

I compare the epidemic to warfare because I became aware of the issue at a 2014 Workers Compensation Research Institute (WCRI) conference, when a Boston poll noted (if memory serves) that for every Massachusetts fatality in Iraq or Afghanistan, there were eight opioid victims. It’s also valuable, I think, to compare the War on Drugs with the more traditional battlefront.

Sometimes opioids like OxyContin, Vicodin and Percocet are referred to with the general term narcotics, as I did in an article for Contingencies magazine that traced the epidemic’s impact on workers compensation insurance:

Chances are good that if you’ve made a workers comp claim, you’ve had opioids in [your] medicine cabinet. Narcotics made up 25 percent of workers comp drug costs, according to the National Council on Compensation Insurance (NCCI), and more than 45 percent of narcotics costs pay for drugs containing oxycodone.”

There is some relatively good news. Opioid deaths appear to have peaked in 2010 at 16,917, the CDC reported last month. In 2013 the toll was 16,235.

By contrast, 16,899 died in Vietnam in 1968, the most violent year of the war. So the opioid epidemic has leveled off to deliver tragedy as frequently as the worst year of the Vietnam War.

On another front the news is not good. Opioid addicts often turn to heroin when their prescriptions run out, and the number of heroin-related deaths rose 39 percent last year, to 8,257, the CDC reports. That’s in addition to the opioid toll.

Together, opioids and heroin killed 215,031 between 2000 and 2013, about 80 percent more than the approximately 120,000 U.S. military deaths since World War II.

Insurers Making Headway On Opioid Abuse Problem

I.I.I. chief actuary James Lynch brings us a grim story on drug abuse and how it affects insurers:

This week Contingencies magazine published my article tracing how America’s latest drug epidemic has affected workers compensation insurance.

The epidemic comes from 20 years of gradually increasing use (and abuse) of opioids, a special class of prescription drugs that mimic many of the effects of heroin. Some you may have heard of, like Vicodin or OxyContin. Prescribed legally but highly addictive, they have become the most commonly abused class of drugs in America.

More people die from drug overdoses in America than from car accidents, and opioids lead the tragic parade. In 2010, for example, 16,652 people died from opioid overdoses, more than from heroin and cocaine combined. Opioids toll has tripled since the late 1990s.

My article shows how the growing epidemic played out in workers comp. Narcotics make up 25 percent of workers comp drug costs, and more than 45 percent of narcotics dollars pay for drugs containing oxycodone, according to the National Council on Compensation Insurance.

Insurers have acted as the crisis emerged, and now they as well as federal, state and local officials may be making headway against the problem.

Last week, after my article went to press, AIG’s new chief executive, Peter Hancock, noted his company had teamed with Johns Hopkins University to study opioid abuse among the company’s 23 million workers compensation claims.

“It is a terrible cost to the industry, a terrible cost to employers, and it’s a terrible cost to society,” Hancock told The Wall Street Journal. AIG has medical professionals working with doctors to find ways to alleviate pain without turning to opioids.

The most recent federal action reclassifies any drug containing the opioid hydrocodone as a Schedule II drug, meaning its prescriptions are more tightly controlled than before.

Unfortunately, these actions may be too late to prevent many opioid addicts from switching to heroin. Opioids tantalize the same brain receptors as heroin, and there are signs that addicts deprived of their Oxys switch.