The Workers’ Compensation Insurance Rating Bureau (WCIRB) recently released the report Study of Chronic Opioid Use and Weaning in California Workers’ Compensation, which analyzes characteristics of injured workers who were chronic opioid users and weaned off opioids.
The study focused on 1,030 chronic opioid users with dates of injury from 2013-2014. For the purposes of this study, chronic opioid users were classified as those who reached opioid dosing levels of 50 morphine milligram equivalents (MME) or more per day for a minimum of three months.
On average, claims with chronic opioid use were nine times as expensive than the average of all claims, with higher volumes of service transactions and higher costs. Furthermore, 60% of chronic opioid claims involved permanent disability, compared to 11% of all claims, and over 80% of transactions associated with chronic opioid users had primary diagnoses of soft tissue injury.
Of these claims, 47% of patients were successfully weaned off opioids completely, taking an average of eight months after achieving chronic opioid use status before ceasing opioid use entirely, with an average of 19 months between injury date and opioid cessation Those who did not wean completely off opioids still achieved a reduction in opioid dosage by an average of 52%.
An interesting finding was that those who did not wean off opioids completely had on average 23 more days between their injury date and their first opioid prescription when compared to those who successfully weaned off opioids completely. Furthermore, those who did not wean off opioids completely had an extra 12 days between their first and second opioid prescription.
No clear patterns of non-drug treatments (e.g., Physical Medicine) for weaning patients off opioids were evident, although the weaning process typically involved a gradual decrease in opioid prescribing combined with a mix of alternative non-drug treatments and non-opioid drugs. Additionally, those who successfully weaned off opioids were more likely to have suffered fractures, while those who did not completely wean off opioids were more likely to have unspecified injuries.
The WCIRB believes these findings, and overall decreases in opioid use, to be tied to increased public awareness, the increased usage of the state’s prescription drug monitoring program (PDMP), and workers’ compensation reforms, which have led to fewer new claims for which opioids are prescribed.