1. High Times: The Opioid Crisis
Statistics, Trends, SIGNS, EFFECTS and WC Methods for Combating the Problem
Patrick Cronin, CPCU, AIC, AIM, AAI, ARM, CWCP
District/Claims Manager – CorVel HealthCare Corporation

2. Statistics
Prescription abuse is the fastest growing drug issue in America
In terms of controlling the cost of indemnity claims, prescription opioids are the number one problem
Nationally, 55% to 86% of all claimants are receiving opioids for chronic pain relief
Evidence based medicine only supports its long term use in very specific cases, most of which involve end- stage cancer treatment

3. Statistics
Overdose deaths (involving opioids) have increased 300% since 1999
2015 – 12.3 overdose deaths in Mississippi per 100,000 people (369)
The misuse of prescription pain-killers was responsible for 475,000 ER visits in 2009
Currently, the opioid epidemic kills almost 100 Americans each day (more than motor vehicle accidents)

4. Current State of Affairs
A 2015 survey (51,200 participants) reported 92 million Americans (37.8%) used prescriptions in 2014
In September, Senator Claire MacAskill (MO) released her findings that one Rx company (Insys),”repeatedly employed aggressive and likely illegal techniques to boost prescriptions.”
Researchers estimate that the annual economic cost of the U.S. opioid epidemic may be as high as $80 billion per year (excluding the economic value of a lost life).

5. Current State of Affairs
The attorneys general of 41 U.S. states are banding together to investigate the makers and distributors of powerful opioid pain killers
Numerous states, including Louisiana, Arizona, Massachusetts and Washington have sued opioid manufacturers for fraudulent marketing schemes and additional state medical costs.
Opioid abuse may account for as much as 20% of the decline in the American men’s participation in the labor force

6. Signs of Potential Opioid Abuse
Increased general anxiety and or anxiety attacks
Euphoria
Improved self-esteem
Irritability
Utilization of opioids for longer or at a greater amount than intended

7. Signs of Potential Opioid Abuse
Unsuccessful attempts to decrease dosages
Abandonment of important activities
Increased sensitivity to sensory stimuli
Increased heart rate
High blood pressure
Physical agitation

8. Effects of Opioid Abuse
Fatigue
Constipation
Breathlessness
A sense of elation
Nausea
Confusion
Chest pain
Death
Difficulty breathing

9. Rx Impact on WC Expenditures
1990 – Rx accounted for approximately 2% of medical expenditures
2001 – Impact increased by 400% (from 1990)
Today – WC Rx accounts for approximately 19% of total medical expenditures

10. Rx Impact on WC Expenditures
Opioids account for approximately 25% of the current Rx spend
Opioids account for approximately 35% (or greater) of Rx spend in claims open for three (3) or more years
Based on projected Rx utilization (specifically opioids), the cost of MSA calculations are increasing exponentially

11. Rx Impact on WC Expenditures (continued)
Less than proactive pharmacy management increases indemnity payments and impairment ratings
The treatment of comorbidities (when coupled to opioid abuse) results in 20-30% of workers’ compensation’s ultimate developed cost

12. Rx Impact on WC Expenditures (continued)
Bottom line – the ship has sailed on Rx’s relatively minor impact on workers’ compensation claim costs
In general, employers are unaware of the sizable impact of Rx on their workers’ compensation costs
Injured workers prescribed even one (1) opioid had total claim costs 4-5 times greater than claimants with similar claims who didn’t get opioids

13. Adverse Affects of Opioid Abuse
Increased frequency of emergency room visits from overdose
Death
Addition treatment
Comorbidities

14. Adverse Affects of Opioid Abuse
Abuse and misuse of prescription drugs
Estimates show that approximately 35% of patients receiving long-term opioid treatment protocols may be addicted
Since opioids reduce a patient’s pain by 30%-40%, it is common for opioids to be combined with other, non-opioid analgesics

15. Potential Tools in the Battle
Aggressive Claims Management
Generic Equivalents
First Fill approval for minor pain meds and anti-inflammatories
Make sure MD is conducting routine drug testing

16. Potential Tools in the Battle
Employer/Carrier/TPA Communication
Let TPA/Carrier know if employee’s activity level changes
Communicate any suspicious behavior to TPA/Carrier
Respond to TPA requests for information

17. Potential Tools in the Battle
Return to Work Program
Think “Outside the Box”
Facilitates faster recovery
Fewer doctor visits
Less likely to engage an attorney

18. MS WC Commission Opioid Prescription Guidelines
Documentation of efficacy and need for continuation of Rx protocols
Random drug screens required at least two (2) times per year
Psychological evaluation recommended when more than three (3) months of opioid prescribing is recommended

19. MS WC Commission Opioid Prescription Guidelines
Treatment for Addiction – Required for up to one (1) year
EME (Employer’s Medical Evaluation) for treating physicians’ failure to curtail adverse prescribing patterns
Administrative Law Judge intervention to curtail/prevent over-use and overly aggressive prescribing patterns

20. State Intervention - Mississippi
Per John Dowdy (Director of MBN), Mississippi is on the verge of a super pandemic, as relates to opioid abuse
Many addicts are switching to heroin at $10 per pack, as a prescription opioid runs $65-$85 per pill
Fentanyl, which is 50 times stronger than heroin (sold in time release patches – originally for pain associated with cancer related treatment) – Fentanyl is made in China, so the source may be at risk for tampering and combining with other drugs

21. State Intervention - Mississippi
2016 drug overdose deaths in Mississippi (suspects the number is much higher)
Per Marshall Fisher (Commissioner of MDPS), there are more prescriptions for opioids than people in Mississippi

22. State Intervention - Mississippi
So many opioids are prescribed in Mississippi that every man, woman and child could take a pill a day and not run out for 67 days
Governor Bryant has formed the Opioid and Heroin Task Force with $3.58M in initial funding

23. In Summary Be on the look-out for the signs of potential opioid abuse
Discuss any concerns with your doctor, HR advisor and TPA
This crisis has taken on a sense of urgency at the Local, State and Federal Levels
The impact on workers’ compensation costs is being addressed

24. In Summary
Anticipate massive amounts of litigation against the pharmaceutical industry
Know the risks of taking opioids and avoid the pitfalls
Know that it impacts practically every demographic and socio-economic member of American society