WCRI: Opioid Prescribing Down; Alt Pain Treatment Up

Sarasota, FL - (WorkersCompensation.com) – A new report shows that opioid prescribing rates for workers’ compensation claims is trending downward, following actions in several states to curtail the use of the drug and hopefully decrease the incidents of addiction as well.

The use of non-pharmaceutical alternatives to pain medicine are also on the rise, the report from the Workers’ Compensation Research Institute found earlier this month.

According to the report, not only did the rate of opioid prescribing go down, but the morphine equivalency rate went down as well. Over a two-year period from 2016-2017, researchers found that opioid prescribing went down in almost all of the 27 states in the study. In some states, the reduction was as low as 8 percent, but in others, like California, the reduction was as high as 25 percent.

In previous years, the studies had found high rates of opioid prescribing. In California, in 2012/2014, the study showed as many as 62 percent of all workers’ compensation claims were prescribed opioids. In the most recent study, that rate had dropped to 38 percent. Other states saw similar, but smaller reductions in the opioid prescribing rate.

And when looking at the average morphine milligram equivalent, the study found that the rate had dropped in some cases as much as 50-52 percent.

But the responses varied wildly from state to state, the report said. In some states, like Delaware, Louisiana, Pennsylvania and New York, the average MME was more than 3,200 milligrams – three times the average level across all states and five times the level in the state with the lowest average MMR, Missouri.

“Opioid dispensing decreased in all study states but the magnitude of reduction varied across the states,” said Dr. Vennela Thumula, the study’s author. “Fewer injured workers received at least one opioid prescription in all study states. The percentage of injured workers with prescriptions receiving opioids decreased by 8 percentage points (in Illinois) to 25 percentage points (in California) across the study states. Among injured workers receiving opioids, the average morphine milligram equivalent (MME) amount of opioids dispensed per worker in the first two years of a claim decreased by 30 percent or higher over the four-year period in 20 of the 27 states. The changes in average MME per claim were not statistically different from zero in 3 states. In 4 other states, the changes were under 30 percent.”

The study found that there were several reasons for the decrease.

“The reductions may be correlated with the multitude of reforms implemented by states during the study period,” Thumula said. “Some examples are mandatory check of the state prescription drug monitoring programs at the point of prescribing, limits on the amount or duration of initial opioid prescriptions, workers compensation drug formularies, and opioid prescribing and chronic pain treatment guidelines.”

The study also found an increase in the incidents of non-opioid prescriptions, as well as non-pharmacological treatments for workers’ pain. Where opioid prescribing was down, researchers found a similar increase in the number of prescriptions for nonsteroidal anti-inflammatory drugs, and in the use of alternative pain management such as chiropractic care, acupuncture, and physical medicine, the study found.

The study looked at 24 months of data from workers’ compensation claims from 27 states. Looking at each claim’s medical treatment for an average of 2 years, the study constituted about 32-36 percent of workers’ compensation claims in the states studied.

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