opioids in workers’ compensation opioids in wc...geographic variation in opioid prescribing 32...
TRANSCRIPT
2018 Annual Meeting
& Educational Conference
Opioids In Workers’ Compensation:
Research From WCRI
John W. Ruser, Ph.D.
NCSI 2018 Annual Meeting
June 12, 2018
AGENDA • Introduce WCRI
• Opioid dispensing to injured workers
• How does opioid prescribing vary across geographic areas?
• How has it changed over time and why?
• What measures are stakeholders taking to control opioid
prescribing?
• Impact of opioid prescriptions on duration of temporary
disability
2
ABOUT WCRI • Independent, not-for-profit research organization founded in
1983
• Diverse membership and funding support
• Including larger self-insured and insured employers
• Research focuses on WC benefit delivery systems
• Not pricing
• Resource for public officials & stakeholders
3
WCRI APPROACH • Mission
“Be a catalyst for improving WC systems by providing the public
with high-quality, credible information on important public policy
issues.”
• Don’t make policy recommendations nor take positions on
issues
• Provide just the facts by means of peer-reviewed studies
4
OPIOID DISPENSING TO INJURED WORKERS:
COMPARISONS ACROSS 26 STATES
FINDINGS BASED ON
SEVERAL WCRI STUDIES • Interstate Variations in Use of Opioids, 4th Edition
• Longer-Term Dispensing of Opioids, 4th Edition
• Impact Of Kentucky Opioid Reforms
6
DATA FOR INTERSTATE
COMPARISONS • Injuries from 2010 to 2013 with Rx observed over an average
24-month period postinjury
• Nonsurgical claims with more than 7 days of lost time with Rx
paid under workers’ compensation
• Large samples from 26 states
• Sample represents 36–69 percent of claims across study states
7
MAJOR FINDINGS • Frequency and amount of opioids per claim decreased in most
states over the study period
• Reflect measures taken by many stakeholders
• More than 2 out of 3 injured workers with pain medications
received opioids in majority of states
• Amount of opioids per claim continued to be higher in LA, PA;
also higher in NY despite large decrease
• Opioids were frequently dispensed together with other sedating
drugs
• Few injured workers with longer-term opioids received
guideline recommended services
8
DECLINES IN OPIOID PRESCRIBING
CDC: OPIOID PRESCRIBING
DECREASED IN SEVERAL COUNTIES
FROM 2010 TO 2015
10
Source: Guy et al. (2017). Vital Signs: Changes In Opioid Prescribing In The United States, 2006–2015
Increased
Stable
Decreased
Insufficient Data
Change In Morphine Milligram Equivalents Prescribed Per Capita (2010–2015)
-16
2
-18
-16
-14
-12
-10
-8
-6
-4
-2
0
2
4
KY
*
NY
*
MD
*
NV
*
TN
*
LA
*
NJ*
VA
*
IN*
FL
*
AR
*
PA
*
NC
*
CT
*
CA
*
KS
MA
WI
GA
IL MI
TX
MN
IA SC
MO
FEWER INJURED WORKERS WITH PAIN
MEDICATIONS RECEIVED OPIOIDS IN
LATEST STUDY PERIOD
11
2013/15: Nonsurgical Claims With > 7 Days Of Lost Time, Injuries Occurring From October 1, 2012, To September 30, 2013, Prescriptions Filled Through March 31, 2015; Similar Notation Used For 2010/12 Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
% P
oin
t C
ha
ng
e In
% C
laim
s W
ith
Pa
in M
ed
ica
tio
ns
Th
at
Ha
d O
pio
ids
, 2
01
0/1
2 T
o 2
01
3/1
5
* Statistically Significant At 10% Level
SIGNIFICANT REDUCTIONS IN
AMOUNT OF OPIOIDS PER CLAIM
SEEN IN MOST STATES
12
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
-1,500
-1,000
-500
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
MO IA WI
IN
NJ*
AR
MN
*
KS
* IL
FL
*
TN
*
VA
NV
*
CT
*
MI*
GA
*
TX
*
NC
*
SC
CA
*
KY
*
MA
*
MD
*
PA
*
NY
*
LA
Average MEA per Claim, 2010/2012 Difference between 2010/2012 and 2013/2015 Claims
-9% -6%
4% 2%
-21% -16% -26% -27%
-9%
-22% -24%
-4%
-29% -26% -37%
-24% -22% -15% -15% -28%
-34%
-23%
-37%
-11%
-35%
-6%
Ave
rag
e M
orp
hin
e E
qu
iva
len
t A
mo
un
t (M
EA
) P
er
Cla
im W
ith
Op
ioid
s, 2
01
0/1
2 T
o 2
01
3/1
5
* Statistically Significant At 10% Level
% PAIN RX FOR NON-OPIOID ANALGESICS INCREASED IN MOST STATES
13
-15%
-10%
-5%
0%
5%
10%
15%
NY KY CA FL CT VA MN TX PA OK GA NJ TN ARMDMA IA IN KS NC MI LA MO WI IL SC
Ch
an
ge I
n %
Pain
Med
icati
on
R
x:
2010/1
2 T
o 2
013/1
5
Hydrocodone-acetaminophen Non-opioid pain medications
FEDERAL AND STATE POLICIES
ADDRESSING OPIOIDS PRESCRIBING
AND DISPENSING • Federal
• CDC Guideline for Prescribing Opioids for Chronic Pain
• Up-scheduling of Hydrocodone Combination Products
• State
• Prescription drug monitoring programs (PDMP)
• Drug formularies
• Limits on prescribing and dispensing of opioids
• Treatment guidelines addressing opioids
• Other policies addressing opioid prescribing
14
SEVERAL REFORMS COINCIDED WITH
REDUCTIONS IN OPIOIDS FILLED OVER
THE STUDY PERIOD
15
CME: Continuing Medical Education; ppt: Percentage Points
KY NY MD MI TN MA TX
Change In % Claims With
Pain Meds. That Had
Opioids
-16 ppt -9 ppt -6 ppt 0 ppt -5 ppt -1 ppt 0 ppt
Change In Average Amount
Of Opioids Per Claim -34% -35% -37% -37% -24% -23% -22%
PDMP Use
Chronic Opioid Guidelines
Drug Formulary
Quantity Limits
Provider Education CME
Pain Clinic Regulations
• Mandatory use of PDMP (KASPER) use (July 2012)
• Mandatory prescribing, dispensing, and reporting standards
(September 2012)
• Regulation of pain clinics
KASPER: Kentucky All Schedule Prescription Electronic Reporting
IMPACT OF KY REFORMS
SCOPE OF KY HOUSE BILL (HB) 1
16
Source: Kentucky House Bill 1 Impact Evaluation (2015)
IMMEDIATE INCREASE IN KASPER
QUERIES BY PRESCRIBERS AFTER
MANDATE
17
Prescriber Use Mandate Went Into Effect
0%
10%
20%
30%
40%
50%
60%
70%
2011 2013
% C
laim
s W
ith
Pain
Med
icati
on
s
Th
at
Receiv
ed
Op
ioid
s
KY OPIOID REFORMS IMMEDIATELY
DECREASED OPIOIDS DISPENSED TO
KY INJURED WORKERS
18
Claims With Injuries Occurring In Calendar Years 2011 (pre-reform) And 2013 (post-reform), Opioid Rx Filled For One Year Following The Date Of Injury. Kentucky HB 1 Went Into Effect On July 2012. Case-Mix Adjusted Measures Are Reported. Source: Impact Of Kentucky Opioid Reforms (2017)
MO, 1%
IN, -3%
IL, 0%
KY, -10%
MEA: Morphine Equivalent Amount
AVERAGE AMOUNT OF OPIOIDS
RECEIVED BY KENTUCKY WORKERS
DECREASED POST-HB 1
19
0
200
400
600
800
1,000
1,200
1,400
1,600
2011 2013
Avera
ge M
EA
Per
Cla
im W
ith
O
pio
ids (
mg
)
KY, -16%
IL, -9%
IN, -7%
MO, -9%
STATE POLICIES ADDRESSING
OPIOIDS PRESCRIBING AND
DISPENSING Prescription drug monitoring programs (PDMP)
• Drug formularies
• Limits on prescribing and dispensing of opioids
• Treatment guidelines addressing opioids
• Other policies addressing opioid prescribing
20
20 STATES ADOPTED COMPREHENSIVE
PDMP PRESCRIBER USE MANDATES AS
OF 12/2016
21
Source: NAMSDL And Sherry L. Green & Associates, LLC. Key State Requirements For Mandatory Use Of PDMPs By Prescribers (http://www.namsdl.org/library/6757CFE2-E9D2-2C3E-3EED217690E6ABA3)
CA
NC OK AZ TN
IN
GA MS
CT
DE
PA
States With Limited PDMP Prescriber Use Mandates
States With Comprehensive PDMP Prescriber Use Mandates
NV
NM
CO
ND MN
WA
AR
LA
VA KY
OH
NY
RI
WV
VT
NJ
AK
ME
MD
NH
SC
UT
WI
States Without Prescriber Use Mandates
MA
MORE PDMP QUERIES BY
PRESCRIBERS CORRELATED WITH
DECEASES IN OPIOID DISPENSING
22
a Source For X-Axis: The Pew Charitable Trusts (2016). Prescription Drug Monitoring Programs: Evidence-Based Practices To Optimize Prescriber Use
b Source For Y-Axis: Interstate Variations In Use Of Opioids, 4th Edition (2017)
WI
MD
CT
TX
CA
IL
MA
IA
KS
MN
SC
VA FL
NJ
AR
LA
NC IN
MI
TN
NY
KY
-18
-16
-14
-12
-10
-8
-6
-4
-2
0
2
4
0 50 100 150 200 250
% O
f C
laim
s W
ith
Pa
in M
ed
ica
tio
ns
T
ha
t H
ad
Op
ioid
s,
Ch
an
ge
Fro
m
20
10
/12
To
20
13
/15
b
Queries Per DEA-Registered Prescriber In 2014a
STATE POLICIES ADDRESSING
OPIOIDS PRESCRIBING AND
DISPENSING • Prescription drug monitoring programs (PDMP)
Drug formularies
• Limits on prescribing and dispensing of opioids
• Treatment guidelines addressing opioids
• Other policies addressing opioid prescribing
23
16 STATES IMPLEMENTED OR PASSED
LEGISLATION TO IMPLEMENT A DRUG
FORMULARY
24
Formulary or preferred
drug list in place
Legislation passed
to implement a
formulary
CA
OK AZ TN
DE
NV
TX
MT ND
WA
AR
OH
NY WY
KY
IN
• Ohio’s Bureau of Workers’ Compensation reported that their
formulary resulted in
25% decrease in opioid Rx
• 74% decrease in muscle relaxant Rx
• TDI Study on Impact of Texas Closed Formulary
• Formulary resulted in decrease in non-formulary (‘N’) drugs
Non-formulary opioids decreased 60%, all opioids decreased 10%
• ‘N’ opioids largely long-acting
Sources: Fiscal Year 2014 Report. 2015. Ohio Bureau of Workers’ Compensation; Impact Of TX
Pharmacy Closed Formulary: A Preliminary Report Based On 12-Month Injuries With 24-Month Services
& Legacy Status. 2015. TX Department Of Insurance, Workers’ Compensation Research & Evaluation
Group.
EXAMPLES OF IMPACT
OF DRUG FORMULARY
25
STATE POLICIES ADDRESSING
OPIOIDS PRESCRIBING AND
DISPENSING • Prescription drug monitoring programs (PDMP)
• Drug formularies
Limits on prescribing and dispensing of opioids
• Treatment guidelines addressing opioids
• Other policies addressing opioid prescribing
26
STATE POLICIES LIMITING
PRESCRIBING AND DISPENSING OF
OPIOIDS • FL: banned physician dispensing of CII, CIII opioids (Jul. 2011)
• KY: physician dispensing of opioids limited to 48-hour supply
(Sep. 2012)
• TN: restricts dispensing of opioids and benzodiazepines to a
30-day supply (Oct. 2013)
• MA: landmark legislation limiting first fills to 7-day supply with
exceptions for chronic pain and cancer patients (Mar. 2016)
• Several other states adopted similar first fill limits (AZ, CT, IN,
ME, NH, NJ, NY, PA, RI, VT)
27
STATE POLICIES ADDRESSING
OPIOIDS PRESCRIBING AND
DISPENSING • Prescription drug monitoring programs (PDMP)
• Drug formularies
• Limits on prescribing and dispensing of opioids
Treatment guidelines addressing opioids
• Other policies addressing opioid prescribing
28
• Workers’ compensation jurisdictions with treatment guidelines
for chronic pain, include CA, CO, CT, LA, MA, MN, NY, OK, and
WA
• Evidence-based guidelines also developed at the national level
• ODG
• ACOEM
• CDC chronic pain guidelines
• FSMB model policy guidelines
INCREASING NUMBER OF STATES
ADOPTED TREATMENT GUIDELINES
FOR CHRONIC PAIN
29
Random urine drug testing
Psychological and psychiatric evaluations and treatment
Active physical therapy
• Maximum daily dose exceed with caution
• Check state prescription drug monitoring program (PDMP)
database
• Co-prescribing of other drugs
• Interdisciplinary and multidisciplinary care
• Alternative care
TREATMENT GUIDELINES FOR
MANAGEMENT OF LONG-TERM
OPIOID USE FOR CHRONIC PAIN
30
GAP OBSERVED BETWEEN
PRACTICE AND TREATMENT
GUIDELINE RECOMMENDATIONS
Nonsurgical Claims With > 7 Days Of Lost Time That Were Identified As Receiving Opioids On A Longer-Term Basis, Injury Year 2012, Prescriptions Filled Through March 2014, Average 24 Months Of Experience; Source: Longer-Term Dispensing Of Opioids, 4th Edition (2017)
Median Of States
Studied
Range
Among States
Studied
% Of Claims With Opioids That Had Opioids On A Longer-Term Basis
6% 3%–18%
Of These, % That Received Recommended Services
Drug Testing 40% 22%–59%
Psychological Evaluation 7% 3%–30%
Psychological Treatment 3% 1%–12%
Active Physical Therapy 87% 73%–91%
31 31
GEOGRAPHIC VARIATION IN OPIOID
PRESCRIBING
32
CDC: OPIOIDS PRESCRIBED VARIED
SUBSTANTIALLY ACROSS THE
COUNTRY
33
Source: Guy et al. (2017). Vital Signs: Changes In Opioid Prescribing In The United States, 2006–2015
Morphine Milligram Equivalents Prescribed Per Capita (2015)
AT LEAST 2 IN 3 INJURED WORKERS
WITH PAIN MEDICATIONS RECEIVED
OPIOIDS IN MOST STATES
34
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
NJ IL MD KY CT MI NY CA PA FL TN MO IN GA MA IA VA KS TX NV WI NC MN SC LA AR
% O
f C
laim
s W
ith
Pain
M
ed
icati
on
s T
hat
Had
Op
ioid
s,
20
13
/15
1 Opioid Prescription 2 Or More Opioid Prescriptions
52%
85%
OPIOID DRUGS COMMONLY PRESCRIBED
TO INJURED WORKERS, PAID UNDER
WORKERS’ COMPENSATION
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
% Of Pain Medication Rx That Were For …
Federal Schedule
Median State
26-State Range
Hydrocodone-APAP (Vicodin®) II* 29% 9%–45%
Tramadol (Ultram®) IV 15% 9%–25%
Oxycodone (Percocet®, OxyContin®) II 9% 1%–30%
All Other Opioids (Morphine, Fentanyl, Buprenorphine, etc.)
II & III 3% 2%–6%
Non-Opioid Pain Medications – 42% 32%–57%
35
* The Drug Enforcement Agency rescheduled hydrocodone-combination products from Schedule III to
Schedule II, effective October 2014.
35
AMOUNT OF OPIOIDS PER CLAIM
CONTINUES TO BE HIGHER IN LA,
FOLLOWED BY PA AND NY
36
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
0
1,000
2,000
3,000
4,000
MO IA NJ KS MN WI TN MI IN NV FL AR CT IL KY GA MD VA TX CA NC SC MA NY PA LA
Ave
rag
e M
orp
hin
e E
qu
iva
len
t A
mo
un
t
Pe
r C
laim
Wit
h O
pio
ids
, 2
01
3/1
5
SMALL PROPORTION OF
CLAIMS HAVE LARGE
AMOUNT OF OPIOIDS
37
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
16,863 LA
10,950 NY
12,450 PA
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
p0 p5 p10 p15 p20 p25 p30 p35 p40 p45 p50 p55 p60 p65 p70 p75 p80 p85 p90 p95
ME
A P
er
Cla
im W
ith
Op
ioid
s,
20
13
/15
HIGHER AMOUNT COULD BE DRIVEN
BY LONGER DURATION OR
STRONGER DOSES MEA per claim = Number of Rx *
Quantity *
Strength *
Morphine conversion factor (CF)
Rx Fill Date Drug
Name
Morphine
CF
Narcotic
Strength
Qty. MEA
01/01/2012 Vicodin® 1 5mg 40 200
01/10/2012 Percocet® 1.5 10mg 60 900
1100
38 38
LARGER VARIATIONS IN DURATION OF OPIOIDS,
SMALLER VARIATIONS IN AVERAGE DAILY DOSE
OF OPIOIDS
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
39
Based On Claims With Opioids That Had Days Supply Populated For All Opioid Rx
Median Of States Studied
Range
Among States
Studied
Average Duration Of Opioids Dispensed (days)
44 25–104
Average Morphine Equivalent Daily Dose (MED) Of Opioids (milligrams)
36 32–42
39
METRICS OF HIGHER RISK
OPIOID DISPENSING • Dispensing of opioids on a chronic basis
• Dispensing of opioids at doses exceeding guideline
recommended maximum daily doses
• Concomitant dispensing of opioids with other sedating drugs
40
7–29% OF WORKERS WITH OPIOIDS HAD
CHRONIC OPIOID USE; SOME WORKERS
HAD HIGH-DOSE CHRONIC OPIOID USE
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
41
Based On Claims With Opioids That Had Days Of Supply Populated For All Opioid Rx
Median Of States
Studied
Range
Among States
Studied
Receiving 60 days or more of opioids in any 90-day period
13% 7%–29%
More than 50 MED of opioids for 60 days
or more in any 90-day period 1.7% 0.6%–4.0%
More than 90 MED of opioids for 60 days
or more in any 90-day period 0.5% 0.2%–1.2%
41
RECEIPT OF OPIOIDS WITH OTHER
SEDATING DRUGS IS ASSOCIATED WITH
HIGHER RISK OF OVERDOSE DEATHS • CDC guideline cautions prescribers about the dangers of prescribing
opioids with central nervous system depressants
• A 2017 WA study found higher risk of opioid overdose deaths when
WA Medicaid enrollees received opioids with other sedatives
• Example:
42
Source: Garg, Fulton-Kehoe, & Franklin (2017): Patterns Of Opioid Use And Risk Of Opioid Overdose Death Among Medicaid Patients
Risk Of Opioid-Related Death Among WA Medicaid
Enrollees With ≥ 1 Opioid Rx Who Concomitantly
Received
Adjusted Hazard Ratio (95% confidence interval)
None 1.0 (base)
Benzodiazepines Only 7.5 (5.5–10.0)
Benzodiazepines And Skeletal Muscle Relaxants 12.6
(8.9–17.9)
Skeletal Muscle Relaxants Only 2.8
(1.8–4.2)
5%
0%
1%
2%
3%
4%
5%
6%
AR IA WI MA CT TN MDMOMN NJ MI NC KS IN NV NY VA KY SC FL TX GA IL CA PA LA
OPIOIDS ARE FREQUENTLY
DISPENSED TOGETHER WITH OTHER
SEDATING DRUGS IN MOST STATES
43
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
0%
9%
0%
2%
4%
6%
8%
10%
TX KS FL TN MO GA AR CA KY IA NJ NY IN IL MD MN NC PA NV VA MI SC CT LA WI MA
28%
48%
0%
10%
20%
30%
40%
50%
60%
NJ MO WI MA IA NY MI IN MN IL KS TN PA CT AR VA KY SC TX NC NV MD CA GA FL LA
30%
51%
0%
10%
20%
30%
40%
50%
60%
NJ MO WI IA NY KS TN IN MI MA IL AR KY VA CT TX PA MN SC NC MD CA NV GA FL LA
% Of Claims With Opioid That Concomitantly Received…
Benzodiazepines (Valium®, Xanax®) Muscle Relaxants (Flexeril®, Soma®)
Sedatives (Ambien®) Any Sedating Drug
MA: HIGHER RATE OF CONCOMITANT
DISPENSING OF SEDATING DRUGS AMONG
MA WORKERS WITH CHRONIC OPIOID USE
44
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
Among MA
Claims
With
Opioids
Among MA
Claims With
Chronic
Opioids
% That Received Opioid Simultaneously With …
Benzodiazepines (Valium®, Xanax®) 9% 23%
Muscle Relaxants (Flexeril®, Soma®) 31% 55%
Sedatives (Ambien®) 1% 3%
Any Sedating Drug 36% 65%
IL: WORKERS WITH PHYSICIAN- AND
PHARMACY-DISPENSED OPIOIDS HAD HIGHER
RATE OF OPIOIDS & MUSCLE RELAXANTS
45
Source: Interstate Variations In Use Of Opioids, 4th Edition (2017)
% Of IL Claims With
Opioids, By
Dispensing Point
% Of IL Claims With Opioids
That Concomitantly
Received Muscle Relaxants,
By Dispensing Point
Pharmacy-Dispensed
Opioids Only 61% 29%
Physician-Dispensed
Opioids Only 28% 34%
Both Physician- And
Pharmacy-Dispensed
Opioids
10% 52%
Similar patterns were seen in other states with frequent physician
dispensing of opioids and muscle relaxants: CA, CT, FL, GA, MD, and
PA
RECAP OF MAJOR FINDINGS • Frequency and amount of opioids per claim decreased in most
states over the study period
• More than 2 out of 3 injured workers with pain medications
received opioids in majority of states
• Amount of opioids per claim continued to be higher in LA, PA;
also higher in NY despite large decrease
• Opioids were frequently dispensed together with other sedating
drugs
• Few injured workers with longer-term opioids received
guideline recommended services
46
THE IMPACT OF OPIOID PRESCRIPTIONS ON
DURATION OF TEMPORARY DISABILITY
MOTIVATION • Impact of opioids on injured workers is not well understood
• Does it improve ability to return to work or does it delay return to
work?
• Does it have therapeutic value?
• Is there a different impact of short-term versus longer-term
prescribing?
48
STUDY GOAL IS TO EXAMINE
CAUSAL EFFECT OF OPIOID USE • Prior studies, as they admit, did not establish a causal impact
of opioids on injured workers
• Estimating effect of opioid use is challenging since cases with
opioids are different from cases without
• Unobserved injury severity
• Unobserved personal characteristics
• Study uses statistical approaches that address concerns about
differences in unobserved injury severity and worker
characteristics
49
THIS STUDY EXAMINES CAUSAL
IMPACT OF OPIOID PRESCRIPTIONS
ON TD DURATION • What is the effect of opioid use on duration of temporary
disability benefits?
• What is the effect of longer-term opioid prescribing on duration
of temporary disability benefits?
50
DATA • Workers with primarily low back pain cases in 2009–2013
• Cases with more than seven days of lost time
• Measures at 24 months’ after an injury
• 28 states
51
MAJOR FINDINGS • Longer-term opioids lead to substantially longer duration of
temporary disability
• Controlling for injury severity
• Shorter-term opioid use has little or no effect on duration of
disability
• Local prescribing patterns matter: Workers receive more
prescriptions for opioids in areas where prescribing is more
prevalent
52
LONGER-TERM
OPIOIDS DEFINITION • Claim has opioid prescriptions in the first 3 months postinjury
and 3+ opioid prescriptions in 7 through 12 months postinjury
53
IMPACT OF LONGER
DURATION OPIOIDS
54
*** Statistically Significant At 1% Level. Regression Controls Include Worker, Injury, And Employer Characteristics, And State Dummies. Longer-Term Prescribing Defined As Having Prescriptions Within The First Three Months After An Injury And Three Or More Visits To Fill Opioid Prescriptions Between The 7th And 12th Months After An Injury.
Estimates For Duration Of Temporary Disability Benefits
Change In Duration Of TD Due To Opioid Use
Longer-Term Opioid Prescribing 251%***
Compared To No Opioids, TD Duration More Than Triples When
Opioids Prescribed On Longer-Term Basis
LITTLE IMPACT OF “ANY OPIOIDS”
USE ON DURATION OF DISABILITY
55
Estimates For Duration Of Temporary Disability Benefits
Change In Duration Of TD Due To Opioid Use
Any opioids within 24 months after an injury 5%
LOCAL PRESCRIBING PATTERNS
ARE STRONG PREDICTORS OF
OPIOID USE • Opioid prescribing rate varies across areas within states; of
claims with low back injuries in our sample, % with opioids:
• 62% in Philadelphia
• 71% in Harrisburg
56
Based On OLS Estimates For Any Opioids Specifications. All Estimates Shown Are Statistically
Significant At 1% Level. Regression Controls Include Worker, Injury, And Employer Characteristics,
And State Dummies.
Change In Individual Opioid Prescriptions Due To 10 ppt Increase In
Local Prescribing
Any Opioid Use
10 ppt increase in rate of “any opioids” within local area 3.4 ppt
THANK YOU! • For comments/questions about the findings:
John Ruser
[email protected] (617) 661-9274 • The research I discussed today is available for purchase on our
website at www.wcrinet.org
• For information about membership, visit
https://www.wcrinet.org/membership
• We invite you to follow us on social media
57