August 3, 2021

How Opioid Policy Impacts Opioid Utilization and Disability

The Workers’ Compensation Research Institute (WCRI) published a new report, Effects of Opioid-Related Policies on Opioid Utilization, Nature of Medical Care, and Duration of Disability, which explores how policies limiting access to opioid prescriptions contributed to changes in opioid utilization and how they altered other medical care related to the management of pain.

The report is available for free for WCRI members, or available for purchase for non-members.

The study analyzes information for workers injured between October 1, 2009, and March 31, 2018, in 33 states, estimating the effects of state-level opioid policies by comparing outcomes in states that adopted such policies against states that did not, while accounting for other factors that could have influenced changes in opioid utilization and the other outcomes studied.

Overall opioid utilization has declined, with opioid utilization varying greatly between all claims and a subset of claims with seven or more days of lost work time.

From 2010-2018, claims with seven or more days of lost work time fell from a high of over 1,000 down to just over 200. Meanwhile, across all claims, MME hovered just over 200 in 2010 and fell to under 100 by 2018. In claims with more than seven days of lost work time, 50% had an opioid prescription in 2010, but that fell to 30% by 2018.

Prescription drug monitoring programs (PDMPs) led to a 12% decrease in the overall MME amount of opioids prescribed. Among injured workers who received opioids, PDMPs also reduced the likelihood that injured workers would stay on opioids long-term by 12%. Meanwhile, limits on initial opioid prescriptions resulted in a 19% decrease in the MME amount of opioids among claims with opioids.

Limited evidence found that workers increased the use of other types of care due to restricted opioid access. Relatively small changes were seen in the prescription for non-opioid pain medications, and for non-pharmacologic treatment, minor changes were seen in whether workers received active physical medicine services and the number of visits for those services.

There is some evidence that PDMPs led to substitutions from opioids towards other kinds of non-opioid pain prescriptions for certain injuries. This was seen in lacerations and contusions, as well as neurologic spine cases.

One interesting note is that neurological spine cases saw a 13% decrease in MME, along with a 14% increase in interventional pain management services, indicating that some substitution was practiced due to restricted opioid access.

PDMPs and limits on initial opioid prescriptions had little impact on the duration of temporary disability benefits captured at 12 months of injury.