Over the past decade, the widespread use of Schedule II and Schedule III opioid analgesics to manage both acute and chronic pain has become a hotly debated issue as the volume of prescriptions for these drugs has grown despite a growing body of evidence linking their long-term use to adverse outcomes, including delayed recoveries, functional impairment, increased sensitivity to pain, addiction, overdoses, and death. This new CWCI study updates earlier analyses that examined utilization and reimbursement trends for Schedule II and Schedule III opioids in California workers’ compensation by reviewing data on prescription drugs dispensed to injured workers through June 2013.

The findings show that in the first half of 2013, Schedule II opioids, which include powerful narcotics such as oxycontin, fentanyl and morphine, have grown to 7.3 percent of California workers’ compensation prescriptions – nearly 6 times the proportion noted in 2002. Over the same period, payments for these drugs have increased from 4.7 percent to 19.6 percent of California workers’ compensation prescription dollars. The data also suggest that the use of Schedule II drugs in workers’ compensation may have stabilized near this record level, as over the most recent 3-1/2 years these drugs have accounted for between 6.5 and 7.3 percent of all prescriptions dispensed to injured workers, while over the most recent 4-1/2 years Schedule II drug payments have represented about 1 out of every 5 dollars paid for workers’ compensation prescriptions in California.

The findings also show that since 2002, less powerful Schedule III opioids – primarily Vicodin or other forms of hydrocodone compounded with a non-steroidal drugs such as acetaminophen -have accounted for a much more consistent share of workers’ compensation prescription drugs, generally representing around 20 percent of all prescriptions dispensed to injured workers and 10 to 11 percent of the overall drug spend. The only exception was a brief dip in both Schedule II and Schedule III prescriptions following the implementation of the 2002-2004 reforms and the adoption of the pharmacy fee schedule, which took effect in January 2004.

The analysis of the prescribing patterns for Schedule II opioid prescriptions reveals that a relatively small percentage of providers continue to account for the vast majority of these prescriptions in California workers’ compensation. In 2010, the top 10 percent of doctors who prescribed Schedule II opioids to California injured workers accounted for 79 percent of all workers’ compensation prescriptions for these drugs and 88 percent of the associated payments. The more recent data from 2012/13 show similar results, as the top 10 percent of the doctors who wrote these prescriptions accounted for 82 percent of the prescriptions and 86 percent of the payments. The prescribing patterns data also found that more than 8 out of 10 physicians who ranked among the top 3 percent of Schedule II opioid prescribers in 2012/13 were also in the top 3 percent in 2010. In addition, as in the earlier study, almost half of all Schedule II prescriptions dispensed to injured workers in the 2012/13 sample were for relatively minor injuries for which the use of these drugs is not supported by evidence-based medicine.

These findings suggest that the widespread publicity about the dangers associated with opioid medications, the public policy efforts to curb the utilization and cost of these drugs through the adoption of chronic pain medical treatment guidelines and the pharmacy fee schedule, and the attempts to tighten controls over the use of Schedule II and III drugs through utilization review have thus far had limited success in reducing system-wide use.