Opioid Addiction: Issue spotting in workers’ compensation, addressing systemic abuse

When does workers’ compensation lead to addict’s compensation?
When does workers’ compensation lead to addict’s compensation?

Painkillers are a big problem in the workers’ compensation industry. Many Americans are addicted to opioids and there are too many opportunities to fuel the fire of abuse. Workers’ compensation and the healthcare system are significant in causing an increasing amount of opioids in society. From a school librarian with an ankle sprain and a prescription to the street dealers selling oxycodone to high school kids planning to sell them at parties, most people know at least someone with an opioid experience.

While most responsible patients properly manage their recovery, carefully following care instructions, others are not so diligent. In too many cases, the most unlikely people find themselves becoming dependent, then addicted to painkillers. Many people who just need another refill, repeatedly, look like any other healthy friend, neighbor or family member.

When does workers’ compensation lead to addict’s compensation?

Pharmaceutical companies like Purdue Pharma, Phizer and Janssen Pharmaceuticals produce and provide doctors, hospitals and pharmacies with oxycodone (OxyContin), morphine (Avinza) and fentanyl (Duragesic), respectively[i].   

Opioid addiction is an issue many health care administrators spot with increasing frequency. According to Joseph Paduda, principal of Health Strategies Associates, Inc., “There are more than 200,000 workers’ compensation claimants who have been on a high dose of opioids for more than six months. The vast majority of them are addicted.[ii]

For many, a workers’ compensation claim, hospital visit and opioid prescription is a first-time experience. However, others know exactly what they are getting; get hurt and score. Paduda says, “The data indicates that about 19 percent of claimants who are prescribed opioids, when they’re tested, there’s no evidence of the drug in their urine. That means those opioids prescribed to workers’ comp claimants are getting in the hands of people who are going to use them for illicit purposes.[iii]

Technology: Advances in healthcare processes make it easier to use the workers’ compensation system on a path to painkillers.

In days past, workers’ compensation claimants drove to their nearest workers’ compensation commission office to talk to staff about procedures, fill out paperwork and file a claim or obtain status information about their case. Today, the process is web-interactive and injured workers can learn all the information they need to file a claim online and update their case.

The data collection and information sharing systems used in the healthcare industry largely fell short in combating systemic abuse. In contrast, “a well-functioning workers’ compensation system allows insurance carries, state insurance funds, and self-insured entities to efficiently manage the core process of underwriting workers’ compensation policies and investigating and processing claims. Historically, these entities have faced a number of challenges in carrying out these functions, particularly in claims.[iv]

New and improving software platforms and systems sharing information among qualified users can make it easier to spot patterns of abuse and anomalies in patient claims. As the healthcare and workers’ compensation industries adopt new technologies there should be tighter controls on the production, sale and distribution of painkillers; proactive abuse prevention is important to cutting off the supply to those addicted to morphine, oxycodone and all the other opiate drugs.

The Chicago law firm of Michael V. Favia & Associates and its affiliated Illinois Professional Licensing Consultants, work to keep everyone informed about news and resources in healthcare and workers’ compensation.

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[i] FDA, Drug Safety Information By Drug Class, List of Extended-Release and long-Acting Opiod Products Required to Have an Opioid REMS.

[ii] Insurance Journal, Magazine Features, 10 Challenges Ahead for Workers’ Compensation, by Andrea Wells, May 5, 2014.

[iii] See HNii above

[iv] AASCIF.og, The Impact of Modern Technology on Workers’ Compensation Claims, by Sandy Leyva, Jan-Mar. 2006.