Do your workers have a problem with prescription painkillers? Odds are that some of them do—and that the number is increasing. Use of opioid painkillers like OxyContin®, Vicodin®, and Percoset® has increased throughout the United States since the 1990s, when new formulations made the drugs practical to use for long-term, chronic pain. The drugs are effective at fighting pain, but their side effects include addiction and deadly overdoses.

According to the National Safety Council's (NSC) Injury Facts 2015, accidental poisonings are now the leading cause of accidental death in the general population, and prescription painkillers account for most of those fatalities. And now there are some new twists in the tale of opioid painkillers in the workplace: Employers may be contributing to the problem when these drugs are paid for by workers' compensation.

Two new reports have identified cost and safety issues created by prescription painkiller use in connection with workers' comp claims. The NSC's Prescription Pain Medications: A Fatal Cure for Injured Workers was published in July 2015; the California Workers' Compensation Institute (CWCI) published The Utilization and Cost of Drug Testing in the California Workers' Compensation System in October 2015.

These reports suggest that opioid painkillers may cost insurers and employers large sums of money. Keep reading to find out how prescription painkillers may be affecting your workers' compensation costs.

Opioids in the workplace

Most employers are aware that opioid painkiller abuse can create many of the same hazards in the workplace as illegal drug abuse. Even if they're not abusing these drugs, workers who are under their influence may be:

• Drowsy or sedated


• Confused


• Excessively energetic


• Subject to excessive mood swing

These altered states can impair workers' attention and judgment and increase their risk of accidents.

Practice Tip

California's Prescription Drug Monitoring Program (http://bit.ly/1RVdOWl) can help you identify drug abuse.

Paying for painkillers

Unfortunately, workers' use of opioid painkillers may also cost you a lot of money in other ways. Here's how:

When you're paying for them. When a worker is injured on the job and suffers from chronic pain as a result, his or her physician may prescribe opioids. Opioid painkiller use to treat work-related injuries is at near-record levels right now and has been since 2008, according to the recent CWCI report.

A May 2014 CWCI report titled Part 1: Schedule II & Schedule III Opioids: Prescription and Payment Trends in California Workers' Compensation found that between 2002 and 2013, controlled substance prescription painkillers cost workers' compensation insurers more than $141 million and accounted for nearly one-quarter of all prescriptions covered by workers' compensation.

When you're paying to test for them. As opioid painkiller use increases, so do employers' efforts to monitor workers for painkiller use and impairment. The CWCI report found that between 2007 and 2014, employers' use of urine drug testing methods to identify painkiller use and abuse increased nearly sixfold as a percentage of all California workers' compensation laboratory services, from 10.2 percent to 59.1 percent.

The cost of those tests increased, too, with reimbursements for urine drug testing increasing from 23.1 percent of total lab payments to 77.0 percent. In 2011, workers' comp insurance paid $27.4 million for drug testing—not surprising, when the cost of a urine drug test can range from $250 to $1,400 per test.

When workers are injured by them. As noted above, accidental poisonings are now the leading cause of accidental death in the United States, and prescription painkillers cause most of those deaths.

The NSC report details multiple cases in which workers injured on the job later died from opioid-related drug overdoses. Because those drugs had been prescribed and paid for as part of a workers' comp claim, the worker's death was ruled a compensable claim under workers' compensation. Workers' comp insurers have also been ordered to pay for rehabilitation for workers who became addicted to these drugs.

So you could not only be paying for the drugs and the testing but also when the worker becomes addicted, overdoses, and dies.

Controlling your risk

How can you reduce the risks and costs associated with opioid painkiller use? The NSC recommends that employers and insurers:

• Follow guidelines. Make sure your insurer and providers follow the American College of Occupational and Environmental Medicine guidelines for opioid prescribing.


• Avoid methadone. Although it works well to treat substance abuse disorders, methadone is far more dangerous when used to treat chronic pain. Workers' comp formularies should not list it as a primary choice for drug treatment.


• Watch out for dangerous interactions. When opioid painkillers are taken together with antidepressant medications, workers are at greatly increased risk of overdose. In addition, depressed workers are more prone to addictive behaviors.


• Use a pharmacy benefit manager. Pharmacy benefit managers can identify potentially hazardous drug interactions and suspicious prescribing patterns.


• Educate workers. Workers—especially injured workers—should be aware of the risks of prescription medications.