December 7, 2019

How Declining Opioid Use Impacts Claims and Outcomes

The California Workers’ Compensation Institute (CWCI) recently published The Impact of Declining Opioid Use on Lost-Time Claim Development & Outcomes in California Workers’ Compensation.

This report utilized the CWCI’s Industry Research Information System (IRIS) to look at 237,000 lost-time claims from 2008-2017, with payment and prescription data through 2018, to answer three questions:

  • What are the trends in both the frequency and intensity of claims with acute and chronic opioid use?
  • To what extent has decreased opioid use driven changes in medical and indemnity cost trends?
  • What is the impact of declining opioid use on benefit payments, temporary disability (TD) days, and systemwide costs?

The study found that the proportion of injured workers receiving opioids declined 51% over the last decade, from a point where 49% of injured workers received opioids, down to 24%. In fact, the prevalence of claims with chronic opioid use (three or more prescriptions within four consecutive months) fell from 13% of all claims to 3%, while the prevalence of claims with acute opioid use declined from 36% of claims to 21%.

By looking at claims with the same injury type but comparing claims with and without opioid use at 12 months and 120-month intervals, the study found:

  • Average benefit payments were 29.7% lower for claims without opioid use at 12 months, and 37% lower at 120 months
  • Claims without opioid use had 25.2% fewer TD days at 12 months, and 30.2% fewer TD days at 120 months
  • Average benefit payment at 12 months on a claim with acute opioid use were 28.1% lower that claims with chronic opioid use, and 35.9% lower payments at 120 months
  • Acute opioid use claims averaged 27.6% fewer TD days at 12 months than chronic opioid use claims, and 31.3% fewer TD days at 120 months
  • Systemwide savings from the decline in opioid use are projected to reach 16.5% for 2017 claims at 10 years of development
  • Cumulative savings from the decline in opioids are projected at $6.5 billion for 2010-2017 claims
  • 68% of non-opioid claims closed within 24 months, but it took twice as long to reach a similar closure rate for opioid claims

The study concludes that opioid utilization may continue to drop, depending on advances in evidence-based medicine, research, formularies, treatment guidelines, the behavior of medical providers, the adoption of alternative pain management protocols, regulatory developments, and various other factors.

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