California’s Workers Compensation Insurance Rating Bureau (WCIRB) released a study on the high-risk use of opioids and potential early indicators as well as alternative treatments. The study, “Early Indicators of High-Risk Opioid Use and Potential Alternative Treatments” outlines the overall trends in opioid use and early indicators that may help identify claims that involve high-risk opioid use.

Since 2012 the use of opioids has significantly and continuously declined in California’s workers’ comp system. The share of claims with at least one opioid prescription 12 months after the injury decreased from 42% of all claims that had any drug prescription in 2013 to 20% in 2017. The average cost of opioid prescriptions per 100 claims in 2017 was down 80% from 2013.

The downward trend of opioid prescriptions may also be leading to an increase in utilization of alternative treatments, so the early identification of workers who may be using high doses could facilitate earlier use of alternative treatments.

Claims involving high-risk opioid use in workers’ comp are those that are using 50 Morphine Milligram Equivalents (MME) or more for at least 30 consecutive days. They found that 2.5% of Accident Year 2013 claims with any opioid prescriptions involved high-risk opioid use within 12 months of the date of injury, compared to 1.4% of Accident year 2016 claims.

High-risk opioid use claims took on significantly higher medical and indemnity costs than lower-dose use claims of the same age and injury type, and they tended to remain open longer. By the fourth year after the injury, high-risk use claims had about three times higher indemnity costs than those of similar lower-dose claims and were almost twice more likely to be open than lower-dose claims. High-risk opioid use claims were also more likely to involve permanent disability benefits than similar lower-dose claims, four years after the date of injury three-quarters of high-risk opioid use claims involved permanent disability benefits compared with one-half of lower-dose claims. During the first six months of treatment after the date of injury, the number of opioid prescriptions per AY2013 claim was 50% lower on lower-dose use claims compared to high-risk use claims, contributing to 50% lower total drug payments per claim.

Early indicators of high-risk opioid use include obtaining similar opioids from multiple dispensers, overlapping opioid prescriptions, using extended-release/long-acting opioids and concurrently using opioids and benzodiazepines. Potential alternative treatments include physical therapy, acupuncture and chiropractic services as well as nonsteroidal anti-inflammatory drugs and non-narcotics. These alternative treatments were used significantly more on lower-dose opioid use claims than on high-risk use claims.

Read the full study here.