Addressing the Opioid Epidemic

Opioid tablets and money

The Opioid epidemic has been described by United States Surgeon General, Vivek H. Murthy, M.D., M.B.A., as an “urgent health crisis facing America.” This crisis knows no boundaries, affecting people from all walks of life, all economic circumstances, and ages from teens to the elderly. It is in the headlines when reporting the overdose deaths of celebrities. It is in the social media posts by parents sharing the tragic deaths of their children in order to raise awareness of the crisis. Education of the general public with additional focus at the physician/patient level is critical in preventing addiction to prescription opioids, and we provide this information for your reference.

Statistics reported by the U.S. Centers for Disease Control and Prevention (CDC) are staggering. The amount of opioids prescribed and sold in the U.S. has quadrupled since 1999, but the overall amount of pain reported by Americans hasn’t changed. More than 40 people die every day from overdoses involving prescription opioids. Since 1999, there have been over 165,000 deaths from overdose related to prescription opioids. As many as 1 in 4 patients receiving long-term opioid therapy (in primary care settings) struggle with opioid addiction. In 2013, healthcare providers wrote 249 million prescriptions for opioid pain medication – enough prescriptions for every adult American to have a bottle of pills.

What are these pills? The term “opioids” is used to describe opiate drugs containing the naturally occurring alkaloids found in the opium poppy plant, including morphine, codeine, thebaine, papaverine, heroin and opium. Opioids are semi-synthetic drugs derived from active opiates such as oxycodone, hydrocodone, hydromorphone, and all drugs synthesized from them. These include OxyContin, Vicodin, Demerol, oxycodone, fentanyl (Actiq), methadone, Percodan, and Percocet.

The CDC Guideline For Prescribing Opioids For Chronic Pain (CDC Guidelines) states “Prescription opioids can help manage some types of pain in the short term. However, we don’t have enough information about the benefits of opioids long term, and we know that there are serious risks of opioid use disorder and overdose – particularly with high dosages and long-term use.” (Chronic pain is described as pain lasting longer than 3 months or past the time of normal tissue healing).

Side effects of opioid use include tolerance – meaning more is needed to obtain the same level of pain relief, physical dependence – meaning you have symptoms of withdrawal when the medication is stopped, increased sensitivity to pain, constipation, bowel obstruction, nausea, vomiting, dry mouth, sleepiness, dizziness, confusion, depression, itching, sweating, low levels of testosterone that can result in lower sex drive, energy and strength, and liver and kidney damage/failure.

In workers’ compensation claims, opioids are generally prescribed for catastrophic injury with chronic pain, an injury involving surgical treatment which requires immediate pain control, and general pain control. Long term use of prescription opioids may become more costly not only because of the premium costs of the opioids themselves, but also for the additional costs of medications to treat the conditions resulting from opioid side effects. The additional drugs used to treat the numerous opioid side effects may add the risk of poly-pharmacy. The side effects may compound each other creating the need for additional drugs to deal with the additional side effects.

States are addressing the problem with legislative and regulatory solutions such as licensing and regulating pain management clinics, or creating a prescription drug monitoring program. Texas was one of the first states to implement a closed formulary on prescription drugs in the workers’ compensation system. The Washington State Department of Labor & Industries instituted guidelines for prescribing opioids to treat pain in injured workers.

Wisconsin has a program involving agency partnerships for a comprehensive approach. DOSE OF REALITY is a program of the Wisconsin Department of Justice, in conjunction with the Wisconsin Department of Health Services and partners across the state, working to prevent prescription painkiller abuse in Wisconsin. DOSE OF REALITY reports that 80% of workers’ compensation claims in Wisconsin involve pain medications including opioids.

The CDC Guidelines include 12 recommendations including goal setting and discussing risks and benefits with the patient, and opioid selection, dosage, duration, follow up, and strategies to assess risk and address harms. The CDC also has a checklist for primary care providers when prescribing opioids for chronic pain.

Assuring that the CDC Guidelines get maximum exposure, the U.S. Surgeon General enclosed them in his August 2016 letter to 2.3 million American doctors – the first time in history that a surgeon general has sent a letter directly to American physicians. He asks doctors to pledge their commitment to combat the crisis by educating themselves, screening patients for opioid use disorder and providing them with evidence-based treatment, and treating addiction as a chronic illness and not a moral failing.

For more information on how to incorporate the CDC Guidelines in your Workers’ Compensation claim management program, contact an Old Republic Risk Management Account Executive at (262) 797-3400.


Claim Department

The Old Republic Risk Management Claim Department provides oversight of the claims handled by the third-party administrators (TPAs) selected by our Insureds. Claim Specialists liaise with the TPA Adjusters and Insureds to provide guidance on the management of serious claims. The Claim Department is based out of our corporate office in Brookfield, WI.