The director of the Labor Department’s Office of Workers’ Compensation Programs says that efforts to mitigate dependence on addictive pain medication are paying off.
Imagine living with pain as the result of a work injury. Soon after your injury, your doctor prescribed an opioid to relieve the pain, and maybe it had some benefit. So your doctor gave you another prescription, and the next month, another. Months later, your pain is still there, you’re still taking opioids, and you are still unable to work. But now it’s not just the pain and the inability to work that has affected your life, you’re also tired, depressed and have an upset stomach. Most significantly, you are unknowingly addicted to opioids. What happened?
Chronic opioid therapy, or long-term opioid therapy, generally represents the daily or near-daily use of opioids for at least 90 days, and often much longer. As the amount of early opioid use increases, the risk for long-term use rises. More than just a few days of opioid use can lead to addiction and each day of unnecessary opioid use increases the likelihood of physical dependence without added benefit. So much so that if you take opioids for just 10 days, you have a 1 in 5 chance of being on opioids a year later. The duration of opioid use is also linked to misuse. In a large study of surgical claims, the total duration of opioid use was the strongest predictor of misuse, with each refill and additional week of opioid use associated with a 44% increase in the rate of misuse.
Since 2015, many workers’ compensation programs have prioritized efforts to mitigate opioid use and have seen large decreases in opioid utilization, including the U.S. Department of Labor’s Office of Workers’ Compensation Programs, which administers disability programs for federal employees.
In 2017, OWCP implemented a four-point strategic plan to: institute more effective controls at the pharmacy; tailor treatment more appropriately to individuals’ needs; issue more meaningful communication about opioids; and aggressively detect and eliminate fraud. As a result, OWCP has seen a 49% reduction in overall opioid use, and a 30% reduction in new opioid prescriptions among injured federal workers’ since 2017. Additionally, since January 2017, OWCP has seen an astounding 91% reduction in injured workers’ utilizing at least 60 or more days of opioids within their first 90 days. This is often a marker of early chronic opioid use.
In June of 2017, OWCP began requiring prior authorization for opioids at the 60 day mark to prevent chronic opioid use from spiraling out of control. More recently, OWCP has instituted a policy where injured workers that are newly prescribed opioids will be limited to an initial 7-day supply with the ability to receive a maximum of four sequential 7-day supply prescriptions (an initial and three subsequent prescriptions) for a total of 28 days, before prior authorization is required.
Sadly, long-term opioid therapy for injured workers’ has been common practice for years and, depending on where you live, it may still be occurring, despite limited evidence of benefit for chronic, non-cancer related pain. Many people on long-term opioid therapy also feel stuck, dependent on and potentially addicted to their treatment while developing ever increasing tolerance. OWCP’s own analysis found that many injured federal workers have been taking opioids for years, and as a result, OWCP has been working to assist these potentially at-risk claimants. These efforts have yielded small but important initial steps in the fight against chronic opioid use with OWCP seeing a 16% overall reduction in chronic opioid use among this population since 2017.
What’s encouraging is that prescribing habits and policies are continuing to change on a national scale with the help from the SUPPORT for Patients and Communities Act, which President Trump signed into law in 2018, and information from the Centers for Medicare and Medicaid Services and the Food and Drug Administration. Research in recent years has also accelerated the change. Using agents other than opioids has been found to be as good or even better than opioid therapy. For example, one study showed that in patients with chronic back, hip, or knee pain, opioids were no better than acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) in improving pain-related function. Other research has shown that reducing opioids with the chance to eventually stop them may improve pain, function, and quality of life.
Overall, OWCP has started to see measurable progress in efforts to reduce opioid dependency. We are encouraged by the initial outcomes as we work to improve the lives of injured federal workers impacted by opioid use.
Julia Hearthway is the director of the Labor Department’s Office of Workers’ Compensation Programs.