The WCIRB has released its Study of Chronic Opioid Use and Weaning in California Workers’ Compensation. This Study uses data from the WCIRB databases of medical transaction records and unit statistical reports to help understand the cost implications of chronic opioid use and the process of weaning injured workers off of opioids in California workers’ compensation.

Until 2012, opioid use in California workers’ compensation, as in many other systems, was growing. Since 2012, claims with opioid prescriptions in the California workers’ compensation system have dropped sharply but opioid prescriptions still reflect a significant portion of all pharmaceutical costs.

About 22% of the claims with accidents in 2013 and 2014 with at least one paid medical service had an opioid prescription, with those claims accounting for about 60% of the total medical payments of all 2013 and 2014 claims within two years of the date of injury.

The recent decline in opioid use is attributable to both fewer newer claims for which opioids were prescribed and a reduction in opioid use on claims in which there was “chronic” opioid use. There is limited information available on workers’ compensation claimants who “weaned” off of opioids.

Approximately 60% of the chronic opioid claims involved permanent disability compared to 11% of all claims. Conversely, only 3% of the chronic opioid claims were medical only claims compared to 65% of all claims.

The median time from achieving chronic opioid status to wean off of opioids completely was 8 months. The median time from accident date to when the worker was weaned off completely was 19 months.

Claims involving chronic opioid use are considerably more expensive than the typical workers’ compensation claim. The average medical payments per claim for physician services over the 24-month period after the accident date for claims involving chronic opioid use was more than nine times the average of all claims.

During the first 6 months after weaning started, weaned claim opioid payments dropped 48% and total drug payments decreased by 42% compared to the payments during the 6 months before weaning. The percentage of payments per claim for non-opioid pain medications (i.e., NSAIDs) reduced significantly less than the decreases of both total drug payments and the opioid payments for the weaned claims during the 6 months after weaning began.

Injured workers who did not wean off of opioids were significantly more likely to have a major surgery than those who weaned off. However, injured workers who weaned off of opioids were more likely to have a major surgery within 30 days of the injury date.