Strong responses to the opioid epidemic have led to decreased opioid use over the past five years. However, has the decline been consistent across industries? Studies have shown that certain industry groups have been more prone to opioid use and abuse1 than others. Further, NCCI data2,3 shows that the treatment of injured workers in certain industry groups is significantly more likely to include opioids. For example, in the contracting industry, the quantity of opioids prescribed to injured workers is more than double the average number prescribed to those in all other industry groups.4
This article explores the difference in opioid use between industry groups by looking at data-driven trends underlying opioid prescribing patterns in workers compensation—with a special focus on the contracting industry.
Claims statistics in this report are per active claim for Service Year 2017, unless stated otherwise. An active claim is a claim receiving at least one medical service during the referenced year.
A common measure of opioid usage is the morphine milligram equivalent (MME5), which converts doses of opioids to an equivalent daily dose of morphine. This provides an apples-to-apples comparison across the various strengths and forms of opioids prescribed. For example, in terms of MME, three 10 mg pills of Vicodin® is equivalent to one 20 mg pill of Oxycodone.
There are several components of opioid usage: (i) the share of claims receiving an opioid prescription, (ii) the number of prescriptions these claims receive, and (iii) the strength/number of pills for these prescriptions (measured in MME per prescription). Comparatively higher values for each of these components have been observed in the contracting industry group.
First, the share of claims receiving an opioid is greater for the contracting industry group (20%) when compared with all other industry groups combined (14%). This means that, on average, one out of every five contracting claims involves at least one opioid prescription. In addition, these contracting industry group claimants, on average, receive both 20% more opioid prescriptions and opioid prescriptions that are 20% stronger (in terms of MME).
Overall, NCCI data shows that the quantity of opioids per claim in the contracting industry group is more than double the average for all other industry groups combined (Chart 1).
OPIOID CLAIM CHARACTERISTICS
Monitoring the quantity of opioids prescribed over time helps to identify trends in prescribing patterns. However, there are other claim characteristics that help to explain different facets of opioid usage, such as why more opioids may be prescribed.
One factor contributing to the higher opioid usage in the contracting industry group is the greater likelihood for serious injuries to occur. Higher medical costs are typically associated with more serious injuries—claims that may be more likely to require pain management efforts, including the potential use of opioids. For accidents occurring in 2017, the average medical cost per claim, including prescription costs, in the contracting industry group was approximately 2.3 times greater than that for all other industry groups combined (Chart 2).
Another measure of claim seriousness is the type of injury. Not only are permanent total (PT) claims typically more serious and costly relative to many other claim types (e.g., permanent partial and temporary total), the contracting industry has a disproportionate share of PT claims. While contracting industry group employment is associated with 10% of all workers compensation claims, this industry group gives rise to 27% of PT claims.
As may be expected, PT claims are also associated with relatively higher MME totals when compared with other claim types. NCCI data indicates that in 2017, a single PT injury received, on average, 12,250 MMEs—more than 20 times higher than the average MME total for all claim types combined. To further put that into perspective, 12,250 MMEs on a PT claim is equivalent to an annual consumption of 410 pills of 20 mg Oxycodone—versus an average consumption of 20 pills of 20 mg Oxycodone for all other claim types combined.
Opioid usage has experienced decreases in recent years, including among the contracting industry. Despite large decreases, the contracting industry group remains higher relative to the other groups. Between 2012 and 2017, overall, per-claim opioid usage fell by 49% in the contracting industry group (Chart 3).
As a more specific example, consider the roofing classification (Class Code 5551), in which nearly two-thirds of claimants receiving a prescription in 2012 were prescribed an opioid. This declined to just over one-half of claimants in 2017.
Decreased opioid usage in the contracting industry group can be primarily explained by a combination of two factors: (i) fewer claimants receiving an opioid prescription, and (ii) a reduced number of opioid prescriptions for those who do receive them. While there was also a reduction in MME per opioid prescription, this was less impactful (Chart 4).
As shown in Chart 4, the largest driver of the decrease in opioid usage is a decrease in the share of claims receiving an opioid. This is due, in part, to increased physician awareness, an enhanced understanding of pain and pain management, and the impact of enacted legislation aimed at addressing opioid prescribing patterns.7
The contracting industry group has relatively higher opioid usage when compared with the other industry groups—in part, caused by the occurrence of more severe claims. However, opioid usage has declined across all industry groups during the time period studied. The reduction in opioid usage could potentially result in decreased drug costs for the workers compensation system—to the extent opioids are not replaced with other drugs or are replaced with less costly drugs. This raises several questions, including what alternative pain management techniques are currently being used, will new drugs appear on the market, or will there be a continued increase in alternate methods for treating pain?
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