Workers’ Compensation Opioid Use: Trends, Problems, and Solutions Made Simple

Introduction

Opioids are strong painkillers often used for workplace injuries, but they can cause serious problems like addiction. In workers’ compensation, where people get hurt at work and need treatment, opioids have been a big issue. This article explains workers’ compensation opioid use in simple terms, using recent studies from the National Council on Compensation Insurance (NCCI) and the California Workers’ Compensation Institute (CWCI). We’ll look at how opioid use has changed, why some problems still exist, and what can be done to help workers and employers. Our goal is to make this easy to understand and share clear solutions.

What Is Opioid Use in Workers’ Compensation?

The Past

In the late 1990s and early 2000s, doctors prescribed opioids a lot for pain from workplace injuries like back pain or broken bones. By 2012, over half (55%) of workers’ compensation claims with prescriptions included opioids, according to the NCCI [1]. This happened because work injuries can be very painful, and there weren’t many rules about prescribing opioids back then.

But opioids can be dangerous. They can lead to addiction, make pain worse over time, or even cause death from overdoses. Starting around 2015, states and the government made rules to limit opioid use, and things have gotten better. Still, some issues remain, especially for people who use opioids for a long time.

What’s Happening Now

NCCI Study

The NCCI, a group that studies workers’ compensation, shared a report in 2024 by Raji H. Chadarevian. It looked at opioid use in 39 states and Washington, D.C., from 2012 to 2022 [1]. Here’s what they found:

• Fewer Opioid Prescriptions: In 2012, 55% of claims with prescriptions had opioids. By 2022, this dropped to 32%. That’s a big improvement!
• Lower Doses: The amount of opioids given per claim, measured in Morphine Milligram Equivalents (MME), went down a lot. The average is now about 50 MME per day, which is safer, according to the Centers for Disease Control and Prevention (CDC) [2].
• Good News: Fewer people are getting opioids, and the doses are smaller, showing the opioid problem is getting better.

But the study says some workers who use opioids for a long time still need attention [1].

CWCI Study

The CWCI, a group studying workers’ compensation in California, released a report in 2024, shared by WorkCompCentral.com [1]. It showed both good and bad news:

• Long-Term Users: Workers who use opioids for a long time (chronic users) got 9.1% more days of opioid medicine per person from 2017 to 2023. This happened because each prescription gave more days of medicine (up 10.8%), even though the number of prescriptions dropped a little (1.5%).
• 2020 Jump: In 2020, chronic users got 21.7% more days of opioid medicine. This might be because the COVID-19 pandemic made it hard to get other treatments, so doctors gave more opioids.
• Problem Area: While fewer workers use opioids overall, those who use them for a long time are a worry because they might get addicted.

The CWCI study shows that while workers’ compensation opioid use is going down, chronic users need more help [1].

Why Opioid Use Is a Problem

Health and Safety Risks

Using opioids in workers’ compensation can cause big problems:

• Addiction: Taking opioids for a long time can make people dependent or addicted. A 2005 study by Franklin et al. found that some workers died from opioid overdoses, even for minor injuries like back pain [3].
• More Pain: Long-term opioid use can make pain worse, a problem called hyperalgesia [2].
• Workplace Danger: Opioids can make people slow or confused, increasing the chance of accidents at work, especially in jobs like construction or driving [4].
• Longer Recovery: A Washington State study showed that workers who used opioids before their injury stayed out of work longer [5].
• Higher Death Risk: Workers in tough jobs like construction or farming have a higher chance of dying from drug-related causes. A West Virginia study found more deaths among workers with opioid-related claims [6].

Money Problems

Opioids cost a lot for employers and workers’ compensation systems:

• Higher Costs: Claims with opioids have bigger medical bills, longer time off work, and more payments for lost wages. The Workers Compensation Research Institute (WCRI) says work injuries are often worse, so opioids are used more than in regular healthcare [4].
• Other Costs: Employers lose money when workers can’t work, and insurance costs go up. Helping workers with addiction also costs money.

How to Fix the Problem

Rules and Policies

States and the government have made rules to reduce workers’ compensation opioid use:

• State Rules: Washington State made guidelines in the early 2000s that cut opioid use by 25.6% from 2004 to 2010 [5].
• Federal Rules: In 2019, the U.S. Department of Labor’s Office of Workers’ Compensation Programs (OWCP) limited opioid prescriptions to 7 days at first and 28 days total without special approval. This cut opioid use by 34% and high-dose prescriptions by 71% for federal workers [7].
• Tracking Prescriptions: Many states use Prescription Drug Monitoring Programs (PDMPs) to watch opioid prescriptions and stop people from getting too many [2].

Other Ways to Manage Pain

The CDC says there are safer ways to treat pain without opioids [2]. These include:

• Physical Therapy: Exercises help with injuries like back pain or sprains.
• Counseling (CBT): Cognitive Behavioral Therapy helps people handle pain by changing how they think about it.
• Other Treatments: Things like acupuncture, yoga, or meditation can reduce pain.
• Safer Medicines: Drugs like ibuprofen or acetaminophen work for mild pain without addiction risks.

What Employers Can Do

Employers can help reduce workers’ compensation opioid use by:

• Working with Doctors: Encourage doctors to use safer treatments instead of opioids.
• Workplace Rules: Create drug-free workplace programs and offer help for workers with addiction.
• Acting Early: Spot workers who might rely on opioids early and suggest other treatments.
• Helping Workers Return: Programs to get workers back to work quickly can reduce the need for opioids.

Helping Long-Term Users

The CWCI study shows chronic opioid users need special help [1]:

• Reducing Use Slowly: Tapering programs slowly lower opioid use with other pain treatments.
• Mental Health Help: Counseling can address stress or other issues that make pain worse.
• Using Data: Looking at claims data can find chronic users early and offer better care.

Examples from Different Places

Washington State

Washington State has done a great job reducing workers’ compensation opioid use. Their guidelines from the early 2000s cut opioid use by 25.6% from 2004 to 2010 [5]. They focus on early help and safer treatments, which also lowers deaths and long absences from work.

California

California’s workers’ compensation system shows progress, but chronic users are a problem, especially after a big jump in 2020 [1]. The state uses PDMPs and limits on prescriptions, but more work is needed for long-term users because California has many workers.

Federal Programs

The OWCP’s 2019 rules show how federal programs can help. By limiting opioid prescriptions, they cut use by 34% [7]. This is a good example for states and employers.

What’s Next?

To keep improving workers’ compensation opioid use, we need to:

• Use Data: Studies from NCCI, CWCI, and WCRI can show where to focus efforts.
• Combine Treatments: Use medical, mental health, and workplace solutions together.
• Use Technology: Tools like telehealth or wearable devices can help manage pain and track opioid use.
• Teach Everyone: Workers, employers, and doctors need to know the risks of opioids and safer options.

Conclusion

Workers’ compensation opioid use has gone down a lot from 2012 to 2022, thanks to better rules and safer treatments. Studies from NCCI and CWCI show fewer workers get opioids, and doses are smaller. But chronic users, especially in California, still face risks of addiction. By using safer treatments, helping workers early, and making smart rules, we can keep improving. Employers, doctors, and policymakers must work together to keep workers safe and healthy. For more details, check out Cut Comp Costs.

References

1. Moore, J. J. (2024). Workers Comp Opioid Use – Great News, Some Concerning. Cut Comp Costs. https://cutcompcosts.com/2024/10/workers-comp-opioid-use-great-news-some-concerning.html/
2. Centers for Disease Control and Prevention. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
3. Franklin, G. M., et al. (2005). Early Opioid Prescription and Subsequent Disability Among Workers with Back Injuries. Spine, 30(8), 926–933.
4. Workers Compensation Research Institute. (2020). Interstate Variations in Use of Opioids. https://www.wcrinet.org/
5. Franklin, G. M., et al. (2012). Opioid Use for Chronic Low Back Pain: A Prospective, Population-Based Study Among Injured Workers in Washington State. Clinical Journal of Pain, 28(9), 763–769.
6. West Virginia University. (2018). Opioid-Related Mortality in Workers’ Compensation Claims. https://www.wvu.edu/
7. U.S. Department of Labor. (2019). OWCP Opioid Prescribing Guidelines. https://www.dol.gov/