States’ efforts to reduce the overuse and misuse of opioids are experiencing mixed results, with some states showing a decrease in the use of prescription opioids among injured workers, while others are actually indicating higher utilization of opioids and other high-risk utilization patterns.
That’s according to a new study from the Workers Compensation Research Institute, which finds although a majority of states in the study have reduced the frequency and amount of opioids dispensed to injured workers, other states have instead seen an increase.
Using data from more than 430,000 nonsurgical workers’ compensation claims and nearly 2.3 million prescriptions associated with those claims from 26 states, researchers’ analysis indicates reductions in the average amount of opioids provided to injured workers in several states. For workers injured in 2010 and 2013, over an average two-year period following the injury, states with the biggest reductions were Kentucky (16 percent), New York (9 percent), Maryland and Michigan.
However, opioid use was still prevalent among nonsurgical claims with more than seven days of lost time. In the period between 2013 and 2015, approximately 65 percent to 75 percent of injured workers with pain medications were given at least one opioid prescription in most of the study states. Those with the highest proportion were Arkansas (85 percent), Louisiana (80 percent), and South Carolina (80 percent).
While the average amounts of opioids received in Louisiana, New York, and Pennsylvania remained the highest among the 26 study states for claims with opioids, New York did bring about a substantial decrease in both frequency and amount of opioids prescribed/used over the study period.
Opioids weren’t used alone in a substantial number of cases. Among claims with opioids, at least one other sedating drug was prescribed simultaneously for a third to a half of injured workers across the 26 states. Muscle relaxants and opioids were dispensed together in 28 percent to 48 percent of claims with opioids, while the use of both opioids and benzodiazepines at the same time was seen in 0 percent to 9 percent of claims.
Another finding is that Louisiana and Pennsylvania continued to have a higher average amount of opioids per claim compared with the other study states. In addition, some states’ prescribing patterns (which drugs are prescribed along with opioids) can put patients at risk; the study says, “Further investigations are needed to better understand the reasons underlying these variations in prescribing patterns.”
And even though the reductions in opioid prescriptions for treatment of workplace injuries have been substantial, the report says, “the most recent trends in opioid-related overdose deaths published by the CDC raises concerns,” since “[b]etween 2010 and 2015, drug overdose deaths increased or remained the same across all states. Overdose deaths related to opioids increased by 15.6 percent from 2014 to 2015, driven by methadone and fentanyl.”
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