A construction worker is injured on the job. His back pain prevents him from returning to work. Because his employer provides excellent health insurance, the worker is quickly seen by a physician. So far, so good. But when the doctor continues to prescribe a narcotic painkiller, or opioid, the worker may actually be delayed in returning to his job. The insurer is likely to balk at the rising costs incurred by this worker and others like him who do not return to work for months, if ever.

According to a June 3 story in the New York Times, “Workplace insurers spend an estimated $1.4 billion annually on narcotic painkillers, or opioids. But they are also finding that the medications, if used too early in treatment, too frequently or for too long, can drive up associated disability payouts and medical expenses by delaying an employee’s return to work.”

The article went on to say, “Along with causing drowsiness and lethargy, high doses of opioids can lead to addiction, and they can have other serious side effects, including fatal overdoses.”

An executive with Accident Fund Holdings, who is quoted in the New York Times piece, said “the cost of a typical workplace injury — the sum of an employee’s medical expenses and lost wage payments — was about $13,000. But when a worker was prescribed a short-acting painkiller like Percocet, that cost tripled to $39,000 and tripled again to $117,000 when a stronger, longer-acting opioid like OxyContin was prescribed.”

Because ongoing use of opioids can lead to addiction, the medical community is paying attention to the prevention strategies offered by the Centers for Disease Control (CDC), including:

• Use prescription data combined with insurance restrictions to prevent "doctor shopping" and reduce inappropriate use of opioids.
• Improve legislation and enforcement of existing laws. Most states now have laws against doctor shopping, but they are not enforced uniformly.
• Improve medical practice in prescribing opioids. In a prospective, population-based study of injured workers with compensable low back pain, 38% of the workers received an opioid early in their care, most at the first doctor visit (14). Among the 6% who went on to receive opioids for chronic pain for 1 year, most did not report clinically meaningful improvement in pain and function, even though their opioid dose rose significantly over the year.