Substance Use and Work

Opioids and Workers' Compensation

Key points

  • Workers' compensation systems can help monitor prescribing and injury trends.
  • Previous research findings led to opioid prescribing guidelines that are impacting these trends.
  • Listed below are trends happening at the intersection of opioids and workers' compensation.
Laptop with graphs on the screen

Background

Workers' compensation systems provide medical care and partial wage replacement for workplace injuries and illnesses. Data from these systems can be used to monitor:

  • The prescribing trends for opioids and other drugs
  • The impact of medical care
  • The working conditions that can lead to work-related pain

In 2005, Franklin et al. published a study that identified an unusual increase in unintentional opioid-involved overdose deaths. It also determined that these deaths occurred among workers who received opioid prescriptions for non-catastrophic injuries. These include carpal tunnel syndrome or low back pain. Over half of these workers received prescriptions for a schedule II opioid.12

These findings contributed to the development of the first US opioid prescribing guidelines.123 Since that time, states have made substantial progress in limiting opioids in workers' compensation systems. However, efforts continue. Below is a summary of key study findings.

Facts

Workers' compensation claims with opioids have declined.

In 2022, 32% of workers' compensation claims with prescriptions had at least one prescription for opioids. This figure has declined since 2012, when 55% of claims with prescriptions included opioids. This is based on data from the National Council on Compensation Insurance for 39 states and DC.45

Average amount of opioids prescribed per claim has decreased.

The opioid amount prescribed per opioid claim decreased in most states from 2012 to 2016.6 This is based on data from the Workers Compensation Research Institute from 27 states. More recently, the opioid amount prescribed per opioid claim has continued to decrease from 2018 to 2022. This is based on data from the National Council on Compensation Insurance for 39 states and DC.5

Many opioids claims are associated with injuries from several years prior.

In 2016, 15% of workers' compensation claims with at least one prescription for opioids were for injuries that occurred 6 or more years prior. 30% of opioid claims had a date of injury that was 2-5 years prior. 55% of opioid claims had an injury date less than 2 years prior. This is based on data from the National Council on Compensation Insurance data for 39 states and DC.7

Longer-term opioid prescriptions are associated with longer temporary disability.

A study examined low back injuries causing over 7 days away from work. Results showed that longer-term opioid prescriptions in claims were associated with temporary disabilities that were more than three times longer than claims without any opioid prescriptions.8 This is based on data from the Workers Compensation Research Institute from 27 states.

Prescribing guidelines can help.

Workers' compensation opioid dosing guidelines may significantly decrease chronic and high-dose prescription opioid use among injured workers. In Washington State, the average monthly prevalence of opioid use among all workers with open claims* declined by 25.6% between 2004 and 2010 after instituting dosing guidelines.910

*In Washington State, claims typically stay open until a provider certifies that a worker's injury has healed. Otherwise, they certify that the injury would not likely benefit from further medical care.

Many states are making changes.

Many states have taken steps to address opioid use in their workers' compensation systems by:

  • Limiting opioid availability.
  • Educating healthcare providers on responsible opioid prescribing.
  • Increasing awareness among injured workers.

This is based on several research studies.1112131415

Dispensing rates differ by several factors.

NIOSH sponsored a study16 by the Workers Compensation Research Institute that examined opioid dispensing data from 27 states for 2014-2015 and found that dispensing varied by the following factors:

  • Industry.
  • Company Size.
  • Age of injured worker.
  • Type of injury.
  • County-level factors.

Mining (including oil and gas) and construction had the highest rates. Smaller companies had higher opioid dispensing rates than larger companies. Older workers had higher rates. Fractures and carpal tunnel syndrome had the highest rates followed by neurologic spine pain. Rural areas had higher opioid dispensing rates than urban areas.

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Content Source:
National Institute for Occupational Safety and Health
  1. Quinones, S. (2015). Dreamland: The True Tale of America’s Opiate Epidemic. Bloomsbury Press. Pgs 202-205, 232-235, 310.
  2. Franklin, G. M., Mai, J., Wickizer, T., Turner, J. A., Fulton-Kehoe, D., & Grant, L. (2005). Opioid dosing trends and mortality in Washington State workers' compensation, 1996-2002. American journal of industrial medicine, 48(2), 91–99. https://doi.org/10.1002/ajim.20191
  3. Franklin, G., Sabel, J., Jones, C. M., Mai, J., Baumgartner, C., Banta-Green, C. J., Neven, D., & Tauben, D. J. (2015). A comprehensive approach to address the prescription opioid epidemic in Washington State: milestones and lessons learned. American journal of public health, 105(3), 463–469. https://doi.org/10.2105/AJPH.2014.302367
  4. Colón, D., Chadarevian, R. (2020). COVID-19's Impact on Medical Treatment in Workers Compensation—A First Look at 2020. National Council on Compensation Insurance. https://www.ncci.com/Articles/Documents/Insights_COVID-19sImpact-Medical-TreatmentWC-AFirstLook2020.pdf
  5. National Council on Compensation Insurance. (2022).
  6. Wang, D., Thumula, V., Liu, T-C. (2019). Interstate Variations in Dispensing of Opioids. National Council on Compensation Insurance, 5th Edition. Cambridge, Massachusetts: Workers' Compensation Research Institute, Update, July 31, 2019, WC-19-26. https://www.wcrinet.org/reports/interstate-variations-in-dispensing-of-opioids-5th-edition
  7. National Council on Compensation Insurance. (2017). Medical Data Report Opioid Utilization Supplement For the state of: New Mexico. Update, September 2017. https://workerscomp.nm.gov/sites/default/files/documents/publications/NM_Opioid_Supplement_2017.pdf
  8. Neumark, D., Savych, B., Lea R. (2018). The Impact of Opioid Prescriptions on Duration of Temporary Disability. Workers' Compensation Research Institute, Cambridge, Massachusetts. Update, March 6, 2018, WC-18-18. https://www.wcrinet.org/reports/the-impact-of-opioid-prescriptions-on-duration-of-temporary-disability
  9. Garg, R. K., Fulton-Kehoe, D., Turner, J. A., Bauer, A. M., Wickizer, T., Sullivan, M. D., & Franklin, G. M. (2013). Changes in opioid prescribing for Washington workers' compensation claimants after implementation of an opioid dosing guideline for chronic noncancer pain: 2004 to 2010. The journal of pain, 14(12), 1620–1628. https://doi.org/10.1016/j.jpain.2013.08.001
  10. Franklin, G. M., Mai, J., Turner, J., Sullivan, M., Wickizer, T., & Fulton-Kehoe, D. (2012). Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline. American journal of industrial medicine, 55(4), 325–331. https://doi.org/10.1002/ajim.21998
  11. Ben-Shalom, Y., McIntyre, M., Pu, J., Shenk, M., Zhu, W., Shaw, W. (2020). Workers' Compensation and the Opioid Epidemic – State of the Field in Opioid Prescription Management. https://www.dol.gov/sites/dolgov/files/OASP/evaluation/pdf/OWCP_OpioidPrescriptionManagement1_FinalReport_Aug2020.pdf
  12. Rothkin, K., Hopkins, E. (2020). Workers' Compensation Prescription Drug Regulations: A National Inventory, 2020. Update, June, 2020, WC-20-261. https://www.wcrinet.org/reports/workers-compensation-prescription-drug-regulations-a-national-inventory-2020
  13. Moss R., Colón D. (2021). Drug Formulary Implementations – A Look at Impact on Workers Compensation Prescription Drug Experience. https://www.ncci.com/Articles/Pages/Insights-Drug-Formulary-Implementations.aspx
  14. Neumark, D., Savych, B. (2021). Effects of Opioid-Related Policies on Opioid Utilization, Nature of Medical Care, and Duration of Disability. https://www.wcrinet.org/reports/effects-of-opioid-related-policies-on-opioid-utilization-nature-of-medical-care-and-duration-of-disability
  15. Sears, JM, Haight, JR, Fulton-Kehoe, D, Wickizer, TM, Mai, J, Franklin, GM. Changes in early high-risk opioid prescribing practices after policy interventions in Washington State. Health Serv Res. 2021; 56: 49– 60. https://doi.org/10.1111/1475-6773.13564
  16. Thumula, V., Liu, T-C. (2018). Correlates of Opioid Dispensing. Workers' Compensation Research Institute, Cambridge, Massachusetts. Update, December 2018, WC-18-48. https://www.wcrinet.org/images/uploads/files/wcri8394.pdf