CWCI Study Tracks the Changing Mix of Workers’ Comp Drugs as Opioid Use Declines

OAKLAND, Calif.–(BUSINESS WIRE)–#CWCI–Opioids remain the most common type of prescription drug used to treat
California injured workers with lost-time injuries, but sustained
efforts to curb their use are paying off as new data show that in the
past decade they fell from about a third of indemnity claim
prescriptions to less than a quarter, while there was a concurrent
increase in anti-inflammatories and anticonvulsants which are often used
as opioid alternatives.

A new study by researchers at the California Workers’ Compensation
Institute (CWCI), based on data from 12.5 million prescriptions
dispensed to California injured workers from 2007 to June 2017, measures
changes in the prescription and payment distributions among major
therapeutic drug groups used in indemnity claims, then takes an in-depth
look at the trends in the volume, cost, potency and types of opioids
used. The authors found that although opioids remained the top drug
group prescribed to workers with lost-time injuries, over the span of
the study their share of indemnity claim prescriptions declined from a
record 32.1% in 2008 and 2009 to 23.2% in 2017, while their share of the
prescription payments fell from 30.5% to 18.6%. As in prior research,
the new data show the decline in opioid use accelerated in 2012, which
tracks with tighter scrutiny by utilization review and independent
medical review programs; restrictions by payors, pharmacy benefit
managers, and medical provider networks; and increased physician and
public awareness of opioid risks.

The 2017 data show that while opioid use has dwindled, both
anti-inflammatories and anticonvulsants now account for increased shares
of indemnity claim prescriptions, while dermatological drugs had the
biggest increase in payments, more than doubling from 6.9% of the 2008
drug spend to 16.1% of the 2017 payments, largely due to the growing
prevalence of high-cost dermatological creams. As for the opioids, the
study found they have become less prevalent in the early stages
lost-time claims, which bodes well for the future as historically the
percentage of claims involving opioids shows little change beyond one
year post injury. The study also shows that the total number of morphine
equivalents (MMEs) dispensed per opioid user at different levels of
claim development has declined sharply since accident year 2012, though
looking at the development data on claims from each accident year show
that when opioids have been used to treat chronic pain, the average
strength per opioid prescription has continued to increase over time,
often doubling between 3 months and 60 months post injury, underscoring
the importance of weaning injured workers off of these drugs. In
addition to the prevalence, payment and potency trends, the study also
examines brand vs. generic opioid drug trends, as well as changes in the
prescription and payment distributions for the most common opioids,
based on drug ingredient.

CWCI has published its study in a Research Update report, “California
Workers’ Comp Prescription Drug Distributions & Opioid Trends.” CWCI
members and subscribers can access the report at
and others can purchase it at the Store.


California Workers’ Compensation Institute
Bob Young, 510-251-9470