The Ohio Bureau of Workers' Compensation (BWC) released a report that details declines in opioid dependency within their workers' compensation system. The BWC attributed these drops to the success of various efforts to counteract the opioid epidemic over the last few years, including the creation of a formulary, a Pharmacy & Therapeutics (P&T) committee, and opioid prescribing rules.
In 2011, the BWC officially defined "clinically dependent" individuals as those who took at least the equivalent of 60 mg of morphine a day for 60 days or more, finding that over 8,000 injured workers met that threshold.
The number of opioid dependent individuals began to decrease year-after-year as the BWC began implementing their programs targeting opioid use, with a 19% drop in opioid dependence in 2017. Since 2011, opioid dependent populations fell 59%, and today the BWC estimates that 3,315 individuals are still opioid dependent. Furthermore, these efforts have resulted in drug costs falling $47 million since 2011, with $24 million of that in opioid spending.
Ohio's formulary was implemented in 2011, containing a list of drugs that the BWC will cover when prescribed for allowed conditions in an approved claim. The P&T Committee maintains the formulary list and regularly reviews and updates it. The committee includes the BWC's pharmacy program director and five to thirteen other members who must be licensed physicians or pharmacists representing the diverse groups of providers that service injured workers.
The opioid prescribing rules, implemented in 2016, established that the BWC would not reimburse opioid prescriptions that did not fall in line with best medical practices as defined by the Ohio state medical board. Among many stipulations, the rules require:
- Development of an individualized treatment plan justified by clinical rationale
- Establishment of a risk assessment through the use of a clinically validated tool
- Documented response to treatment as demonstrated by clinically meaningful improvement in pain and function in the injured worker
- Evidence of informed consent
- Appropriate additional consultations for comorbidities and for patients with extremely high morphine equivalent doses (MEDs)
- Policies for discontinuing opioid use