An Aging Workforce, Workers’ Compensation & Opioids: Trends & Tactics  

26 Jun, 2024 Shawn Deane

                               

Shawn Deane 

General Counsel & Vice President of Claims Solutions | J29 

Shawn.Deane@j29inc.com    

The demographics of our workforce are shifting, with the number of older workers expected to rise over the next decade. It is anticipated that those aged 65 and older will comprise 8.6% of the workforce in 2032, up from 6.6% in 2022. An aging workforce presents distinct challenges in workers’ compensation claims, including issues related to opioid use.  

State of the Opioid Crisis  

The Centers for Disease Control and Prevention (CDC) released data in May of 2024 that showed overdose fatalities involving opioids decreased slightly, from 84,818 in 2022 to 81,083 in 2023. Several states saw decreases while some, like Alaska, Washington, and Oregon saw dramatic increases of nearly 30% over the same period the year prior. While overall overdose death rates have dropped, the figures are still staggering. Compare the above statistics with the 3,442 deaths from prescription opioid overdoses in 1999. 

Last week, the New England Journal of Medicine reported that communities involved in a federal program implementing evidence-based interventions, such as distributing naloxone (which rapidly reverses opioid overdoses) and other health strategies, did not see a statistically significant reduction in opioid overdose fatalities.  

Recent historic settlements between opioid manufacturers, pharmacies, and state governments have sparked disagreements regarding the optimal allocation of settlement funds. Key concerns include transparency and tracking, potential misuse of funds, the balance between local and state control, and ensuring effective utilization. 

The opioid crisis continues to pose a public healthcare challenge despite ongoing initiatives at the federal, state and local levels that focus on treatment and prevention. A complex problem like the opioid epidemic will necessitate comprehensive measures involving all levels of government, and that include community-based interventions, as well as changes in healthcare, policy, and legislation. On a smaller scale, worker’s compensation has a part to play as well.  

Opioid Utilization in Workers’ Compensation Down but Risks Persist  

As of 2022, 32% of workers’ compensation claims involving prescription drugs included a prescribed opioid. Overall, that figure has declined since the preceding decade, when in 2012, 55% of claims with a prescription included opioids. In 2023, opioid utilization per workers’ compensation claim dropped by 9.7%.  

While prescribing of opioids in workers’ compensation is down, opioid-related health and safety concerns persist for those who’ve sustained a work injury. A recent study in Massachusetts found that individuals who had a workers’ compensation injury were 35% more likely to have died from an overdose associated with opioids. In the workers’ compensation community, it’s recognized that, “[o]pioid use long-term or in high doses can lead to addiction and can substantially delay an injured worker’s ability to return to work.” 

Older Claimants Susceptible  

Treating chronic pain can be more complicated in older individuals and those 65 years of age and older are more likely to be prescribed opioids.  

While opioid abuse can affect individuals of all ages, older adults are most impacted due to several factors. These include higher prescription rates for chronic and post-surgical pain, a stronger impact / effect due to metabolic processes, and the potential for multiple adverse medication interactions. 

Medicare beneficiaries have some of the highest and fastest-growing rates of opioid use disorders of any demographic, at roughly 6 out of every 1,000 beneficiaries. A recent study involving multiple federal agencies examined a large group of Medicare beneficiaries who experienced a nonfatal overdose in 2020 and found that over 17% of that group had a subsequent nonfatal overdose.  

Tactics to Help Avoid Issues with Opioids  

The following are not exhaustive but aim to provide a broad overview of the various possibilities for addressing opioid abuse among injured workers, and considerations around those who are in an older demographic.   

Alternative Treatment Modalities  

In pain management, there are various treatment options available as alternatives to opioids. These include non-pharmacological therapies as well as non-opioid medications (where appropriate and not contraindicated). Moreover, there is a growing trend towards complementary and integrative approaches such as massage therapy, yoga, the use of transcutaneous electrical nerve stimulation (TENS) and bio feedback. 

In 2020, Medicare began covering acupuncture, under certain circumstances, for chronic lower back pain. This decision was aimed, in part, at reducing opioid dependence in the treatment of chronic lower back pain. In Pennsylvania’s guide to, “Safe Prescribing for Workers’ Compensation,” it is indicated that, “[p]hysical and other supportive pain treatment modalities, such as short-term rest, ice, elevation, reassurance, music, physical therapy, exercise, chiropractic treatment, cognitive-behavioral therapy, and mindful meditation may provide significant symptom control.”  

Early Intervention & Behavioral Health  

Since even short-term opioid use can lead to addiction, early intervention is critical in stemming possible misuse and abuse. Getting in front of an injured worker early and identifying factors that may contribute to the potential for addiction can inform prescribing practices and stem the potential for opioid abuse later during the claim. Deploying targeted medical management, offering behavioral health services, and addressing underlying psychosocial and psychological issues can lead to better outcomes, especially when opioids are involved.   

Adoption of Treatment Guidelines & Drug Formularies 

Implementing treatment guidelines around opioid utilization has the potential to decrease long-term and high-dose usage for injured workers. For example, in Washington, the average monthly prevalence of opioid use amongst workers with open claims decreased by 25.6% between 2004 and 2010 following the implementation of opioid dosing guidelines. 

In addition to treatment guidelines, adoption of drug formularies may have an impact on prescribing and reimbursement for drug classes like opioids, and could  include limits on the duration of use and mandate additional oversight and utilization review.  

Legislative, Regulatory & Policy Measures  

In 2016, forty states signed a compact to address the opioid crisis and to reduce inappropriate prescribing, research opioid addiction and address recovery and treatment. This resulted in legislative and regulatory mechanisms that were geared towards curbing the opioid epidemic. Certain states have also conducted detailed studies on the use of opioids in workers’ compensation, which have led to policy changes and recommendations to state legislatures and regulators.  

Monitoring  

Prescription Drug Monitoring Programs (PDMPs) are databases that track prescriptions for controlled substances and play a role in improving opioid prescribing. PDMPs can also assist clinicians in identifying patients that may be at risk for opioid misuse, abuse or potential overdose.  

As of January 1, 2022, Medicare required that all Part D sponsors maintain a Drug Management Program (DMP), and “…to include beneficiaries with a history of opioid-related overdose in their DMP pursuant to the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.” In 2019, Medicare implemented strategies to assist Part D sponsors in the prevention of opioid misuse that included safety alerts at the time of dispensing.  

With respect to workers’ compensation settlements and Medicare Set Asides, Medicare indicates that they, “…highly recommends professional administration where a claimant is taking controlled substances that CMS determines are ‘frequently abused drugs’ [which include opioids] according to CMS’ Part D Drug Utilization Review (DUR) policy.”  

Stakeholder Engagement  

Addressing the intertwined issues of an aging workforce, workers’ compensation, and opioid use requires a multifaceted approach. We must adopt proactive strategies that include comprehensive pain management programs, preventive healthcare, and support for alternative therapies to opioids. Lawmakers need to ensure that workers’ compensation systems are equipped to handle the unique needs of older workers, promoting their health and productivity while minimizing reliance on opioids. By fostering collaboration between stakeholders, we can create a safer and more supportive environment for aging employees, ultimately mitigating the impact of the opioid abuse on the workforce. Workers’ compensation can play a small but important role in ending the opioid crisis. 

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Author Bio 

Shawn Deane 

General Counsel & Vice President of Claims Solutions | J29 

Shawn.Deane@j29inc.com    

(866) 529-6771 

www.j29inc.com  

As General Counsel & Vice President of Claims Solutions, Shawn Deane leads J29’s legal and Medicare Secondary Payer (MSP) services team. Shawn is a practicing attorney and has over 16 years of experience in Medicare compliance, workers’ compensation, and insurance claims. He was previously General Counsel & Senior Vice President of Risk Management & Compliance at the nation’s largest professional administrator of Medicare Set Asides. Prior to that he was Vice President of Medicare Compliance & Policy at one of the country’s largest Medicare Set Aside vendors. He’s an industry expert and thought leader in workers’ compensation, Medicare Set Asides (MSAs) and Medicare compliance.  

About J29 

J29 is a women-owned business that offers Medicare Secondary Payer (MSP) compliance services providing Medicare Set Asides (MSAs), conditional payment / lien services and related solutions to all workers’ compensation stakeholders – including carriers, self-insureds, third-party administrators, and attorneys. 


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