In Case You’re Still Not Convinced, a WCRI Study Documents That Prescription Drug Monitoring Programs Are a Valuable Tool in the Opioid Crisis

Over the last decade, the opioid epidemic within workers’ comp has spurred industry professionals to start cracking down on overprescribing and preventing addiction within injured employee populations.

Since then, a number of strategies have been deployed in the battle against opioid use. From alternative pain treatments to new regulations, these efforts have met with some success. A 2020 Workers Compensation Research Institute (WCRI) study found that the median opioid spend decreased from 20% in 2016 to 9% in 2019 in the 28 states studied.

Recently, WCRI conducted a study looking into the effectiveness of one of the most popular tools in the fight against workers’ comp opioid use: prescription drug monitoring programs (PDMPs).

The study, “Effects of Opioid-Related Policies on Opioid Utilization, Nature of Medical Care, and Duration of Disability,” examined how policies that limited opioid access affected utilization and how they contributed to alternative forms of management of pain.

Last month, the study’s authors conducted a webinar where they broke down the results and discussed what they mean for the workers’ comp industry.

Study author Dr. Bogdan Savych walked attendees through the significant results of two of the four policies addressed within the scope of the study — prescription drug monitoring programs (PDMPs) and limits on initial prescriptions  —  which have been successful in numerous states as compared to other states that did not implement the same policies.

“If you know a little bit about opioids, you know that opioid use [in workers’ comp claims] decreased substantially over the last decade,” Savych said, referring to two graphs showing aggregate trends revealing precipitous declines in morphine milligram equivalent [MME] doses since 2010.

“If you look at claims at 12 months maturity, the average amount of opioids prescribed decreased by 74%. This reflects two main components: a decrease in how many workers had prescriptions and a decrease in the amount of opioids prescribed when workers were getting prescriptions.”

Tighter Controls on Access to Opioids

The data in the study delineate the difference between claims with at least seven days of lost time, versus all claims. The lost time claims were where the most changes were observed — about one in every two workers, versus one in about every three.

“There were many efforts by providers and by payers, to address excessive opioid prescribing in workers’ compensation. And policymakers also intervened, limiting potentially excessive prescribing of opioids,” Savych said.

“These state-level policies are the primary focus of our analysis. Some of these policy interventions were directly related to care provided to injured workers — pain treatment guidelines, drug formularies. While other policies like must-access PDMPs or limits on initial opioid prescriptions were not specific to the workers’ compensation system, they affected all care provided in the state.”

At least half the country has enacted laws constraining the outpatient use of opioids for acute pain. Most laws limiting opioids for acute pain were enacted since 2017, and there is wide variation in the characteristics of state opioid restrictions.

Must-access policies legally require providers to access a state-level database with a patient’s prescription history before prescribing controlled substances in some cases.

These policies, as Savych explained in the webinar, worked in tandem with federal action to affect the results of the study, although federal policy was out of the scope of the analysis.

So it’s important to ask — if these policies were enacted outside of the workers’ compensation system, do they have a real effect on injured workers and the workers’ comp industry?

Savych was unequivocal: “The answer is yes,” he said.

Tighter controls on the number of prescriptions written has meant that injured workers are turning to other tools to manage their pain. Savych and his partners also examined this area in their study.

He explained that there is evidence that substitute care for opioids was provided. These treatments included non-opioid pain medications, exposure to physical therapy, and interventional pain management.

A poll during the webinar revealed that 60% of attendees thought PDMPs were a major factor.

Though PDMP policies date to the 1930s, Savych noted that these tools were once optional and a previous WCRI study revealed very little effect on prescribing, if any effect at all, because they provided very little incentive to change entrenched behavior.

The must-access PDMP policies analyzed by WCRI in this report led to significant decreases in states that implemented the policies, as compared to control states in the analysis. In states that already had high levels of opioid prescribing like Delaware, Louisiana, and New York, these efforts were especially effective.

Beyond PDMP: The Effects of Limits on Prescribing

The other policy examined by the webinar was limits on initial opioid prescriptions. As the study shows, limits were somewhat effective in reducing overall morphine equivalent doses, but not by the significant levels seen with the must-access PDMP policies.

Prescriptions above the limit were common after the limits on initial prescriptions were introduced at the state level.

“Think about it,”  Savych said. “If the limit is set at 14 days and there were no prescriptions above 14 days, the policy would have no effect.” Savych brought up the data for attendees, which highlighted the difference between one year before the limits were implemented and one year after.

“What you see is that in states with the lowest limit — three days’ supply — quite a few prescriptions were affected by this.” Kentucky, Florida and Wisconsin thus showed larger variations, since they had the three-day limits.

Regarding the overall results, two major findings are important:

• Must-access PDMPs resulted in about a 12 percent decline in morphine milligram equivalent doses prescribed.
• Limits on initial opioid prescriptions resulted in about a three percent decline by the same measure.

Importantly, the policies had almost no effect on dangerous use indicators, such as 90 days or more of opioids prescribed or a daily dose of opioids over 120 milligrams.

In terms of the study objectives, to determine whether these policies had an effect, Savych says it’s complicated.

“We saw a decrease in the amount of opioids prescribed, but it’s all driven by a lower amount of opioids among those who had opioids [already], and there was little change in whether workers were able to get opioid prescriptions,” he said.

Savych believes this evidence is potentially in line with policy goals — no excess opioids, while keeping pain patients who need them able to receive them from their treating physicians.

You can view the webinar slides here. &