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By Margy de Movellan, Corporate Counsel, Kentucky Employers’ Mutual Insurance

Opioid use and abuse in workers’ compensation is a significant concern for carriers throughout the nation today and for the foreseeable future. The impact of opioids on workers’ compensation ranges from ability to achieve return-to-work status to problems with addiction and even death. Most states have standards by which physician prescribing is reviewed for reasonableness and necessity, but is this enough? 

Unfortunately, a medical peer review opinion that opioid treatment is not reasonable or necessary may often not be enough to compel the decision-maker to preclude the claimant from obtaining this type of treatment. Often, it becomes a battle of physicians, one who is actively treating the injured worker versus another who is reviewing and often criticizing this treatment on behalf of the carrier. If utilization review by peer physicians is not enough, how does a state effectively address the opioid epidemic? The answer exists in providing information and guidance at all levels: injured worker, treating physician, carrier, insurance regulators, administrative law judges and other decision-makers. 

Education about the costs opioid use and abuse have on society as a whole, coupled with the presentation of successful strategies implemented by other jurisdictions, will provide a template by which a state can create policy to address the opioid abuse epidemic. Setting forth specific guidelines by which the providers and decision-makers can compare the proposed treatment of chronic pain of an injured worker to a recommended course of treatment has proven effective.

Many states rely on the Official Disability Guidelines (ODG) and the American College of Occupational and Environmental Medicine (ACOEM) guidelines to assist in providing recommendations for care and setting forth a measuring stick for decision-makers to use in evaluating care. Other states have developed state-specific guidelines addressing chronic pain treatment and long-term opioid use. 

For the states that have not adopted specific guidelines or legislation targeting the issues of opioid use and abuse, it is imperative that a policy be established to broach the problem. Assembling a panel of stakeholders to assess the experiences of other jurisdictions and thoughtfully consider recommendations of professional groups is essential.

The International Association of Industrial Accident Boards and Commissions (IAIABC) is currently preparing a policy guide intended to provide assistance to the workers’ compensation community for management of the issue of opioid use and abuse. To be successful, the workers’ compensation regulatory effort must be coordinated with the medical community. This relationship can be difficult even with the best interest of the injured worker/patient in mind. 

Consideration of the immediate needs of acute pain patients versus chronic pain patients should be undertaken, including: implementing the use of pain management contracts, urine drug screens, state and/or national programs for monitoring of prescriptions, and pain management treatment plans. In an effort to provide a range of possible approaches for establishing opioid policies, IAIABC has compiled information from jurisdictions across the country, publications from professional organizations, and journals reporting results of recent studies relating to opioid use. This guide is certain to provide a much needed reference for states undertaking the challenge of opioid control.