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Despite a growing awareness of the problems and long-term repercussions associated with opioid use, utilization of these drugs in California’s workers’ compensation system has expanded to the point where they now comprise the single largest category of medications prescribed to injured workers.

A number of CWCI studies have tracked this growth, the most recent being an analysis published in May 2014 that measured utilization and payment trends for Schedule II opioids such as oxycodone, morphine, and fentanyl, as well as less potent, but still potentially addictive Schedule III opioids (primarily hydrocodone combination drugs such as Vicodin, Norco and Lortab).

The results of the 2014 analysis showed that except for a brief dip following the enactment of SB 899 in 2004, use of Schedule II opioids had risen steadily, increasing nearly sixfold from 1.3 percent of all workers’ compensation prescriptions in 2002 to a record 7.3 percent in the first half of 2013. Furthermore, the study noted that although the growth rate for Schedule II opioids plateaued after 2010, use of these drugs remained at an all-time high and payments for these painkillers had increased from about 4 percent of all California workers’ compensation prescription dollars in 2005 to nearly 20 percent in the first half of 2013.

Use of less powerful Schedule III drugs fell to a post reform low in 2005 and remained fairly level thereafter. From 2005 through the first half of 2013, these drugs consistently accounted for about 20 percent of the prescriptions dispensed to injured workers and around 10 percent of the prescription dollars.

Now a new CWCI report updates and expands upon those earlier findings using data from more than 10.8 million workers’ compensation prescriptions that were dispensed to injured workers in California between January 2005 and December 2014. Aggregate payments for these prescriptions totaled $1.1 billion.

Several measures of opioid utilization that increased in the first several years of the study period have showed decline in recent years.

1) The number of opioid prescriptions per user increased from 3.38 in 2005 to a peak of 4.43 in 2009 and then declined to 4.10 in 2012.
2) The average number of morphine equivalents per opioid prescription increased from 473 in 2005 to a. peak of 550 in 2007 and then declined to 422 in 2012.
3) Morphine equivalents per opioid user increased from 1,599 in 2005 to a. peak of 2,355 in 2008 then decreased to 1,728 in 2012.
4) Opioids increased from 27.0 percent of all prescription drugs dispensed to California injured workers in 2005 to a peak of 31.8 percent in 2008 and then declined to 27.2 percent in 2014. Even with the recent decline, however, opioids have remained the number one prescription category in both use and payments since 2006.
5) In 2005, 15.9 percent of every dollar paid for an opioid was for a brand name drug; by 2009, the percentage had more than tripled to 49.4 percent. However, between 2009 and 2014, the proportion of brand name opioids declined to 41.0 percent as the use of the lower cost generic opioids increased relative to brand name opioids.

The CWCI concluded that “These recent trends are positive, so it will be important to monitor them and to explore what may be driving them as this information may be useful to those charged with shaping policies to govern the use of opioids in workers’ compensation.”