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Painkillers in Workers’ Compensation

Author: Peter Rousmaniere

One of the most dramatic stories in workers' compensation in the last two decades is the rise in the use of painkillers, followed by their leveling off and decline. Painkillers remain a big problem in treatment of injured workers, but it appears the worst years of over-use are behind us, but the problem still exists.

On any given day in the United States, perhaps 500,000 injured workers are under treatment for chronic pain; a great majority ingest opioids. There may well be 100,000 injured workers on long-term opioid treatment, some extending over two decades.

Opium has been used for medicinal purposes for millennia and may be the world's oldest painkiller. Opioids are man-made chemicals that act like opium and are the most powerful form of painkillers. They relieve pain by reducing the intensity of pain signals reaching the brain. Medications that fall within this class include drugs such as hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine, and fentanyl. Heroine is also a form of opioid. These are all controlled “Schedule II" drugs in the United States, due to health risks and potential for abuse. (“Narcotics" is a less precise term.)

The use of opioids in general patient care grew quickly after Purdue Pharma, which had been creating pain medications for decades, introduced OxyContin. That drug's sales grew to almost $1.1 billion in 2000 from only $48 million in 1996. In fact, total opioid sales are expected to reach $18.4 billion by 2020, according to Informa - Pharma Intelligence.

Among injured workers, the National Council on Compensation Insurance (NCCI) reported that opioid prescribing in the first year post-injury jumped 75 percent from 1999 to 2004.

In workers' comp, a relatively small number of physicians accounted for an extremely high share of prescriptions. In California, for example, three percent of the prescribing physicians accounted for 55 percent of all “Schedule II" prescriptions in 2011. Those workers who were heavy users wangled prescriptions from an average of 3.3 different physicians. Many hundreds, perhaps thousands, of injured workers died due to some misadventure in their prescribed drugs.

Opioid prescribing to injured workers reached a high-water mark in approximately 2010 or 2011. Due to this “epidemic," nearly every state took action, from closing down pill mills to specific reforms in workers' compensation. Washington State, which has been the leader among states in tackling over-prescribing opioids to injured workers, began to report reductions in deaths and in the potency of prescriptions. ​


Peter Rousmaniere is a journalist and consultant in the field of risk management, with a special focus on work injury risk. He has authored 200 articles on many aspects of prevention, injury management and insurance. As a consultant, he has advised claims payers, managed care firms, and medical providers on improving workers' compensation outcomes. He is a MBA graduate of Harvard. He lives in Woodstock, Vermont and can be reached at pfr@rousmaniere.com.​

Last Updated: December 22, 2017


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