Addressing Opioid Addiction in a Workers’ Compensation Program

The ongoing opioid crisis is raising difficult questions for employers and their workers’ compensation providers. Drug use by employees has long been a serious risk management issue for employers. For many employers, adopting strict policies against employee drug and alcohol use is an important step in maintaining a safe work environment. But when an employee gets injured on the job and becomes addicted to opioid pain medications over the course of treatment, does the employer and its workers’ comp provider have an obligation to cover treatment?

The answer is not entirely clear. For an injury or illness to be eligible for workers’ compensation benefits, it must have arisen out of and occurred during the course of employment. This standard gives conventional employers a fairly clear idea of where their risks lie. Controlling for foreseeable workplace hazards, like equipment safety practices or workstation ergonomics, can be a straightforward matter of analysis and training. But how can an employer control the evolution of an employee’s recovery from an injury, especially when the treatment itself creates new problems?

Prescription opioid analgesics are a common treatment provided to patients who are dealing with serious pain. According to studies like this one, about a quarter of patients who are prescribed opioid medications will misuse them, and about a tenth develop a physical addiction. In time a regular user can develop tolerance, requiring more and more of the drug to achieve familiar levels of stimulation. The cascading effect on a person’s life can be dramatic, leading to chronic, daily use, and for some, criminal behavior and use of illegal drugs, like heroin.

Opioid dependency, abuse, and addiction in an employee can create long-term problems for an employer. The cost of prescriptions to the insurance carrier is often only a small part of the overall cost. An abuser who returns to work, even on light duty, presents an increased risk of further injury. Depending on the nature of the employee’s dependency, the workers’ comp program may need to cover an addiction recovery program. And in extreme cases, an employee risks death from an overdose.

For the employer, managing these risks requires a multi-part process. Among the steps an employer might take, these may be the most important:

  • Stay in touch with employees who are receiving workers’ comp benefits, especially if they have suffered an injury that requires pain management.
  • Verify that the workers’ comp program’s pharmacy claims are managed by a prescription benefit manager with policies in place for limiting the potential for opioid abuse, including pre-approval requirements and procedures for identifying and responding to abuse.
  • Seek out programs that offer coverage for alternatives to pharmacological pain management.
  • To the extent it is practical and legal, consider adopting a drug screening program.

Gunnin Insurance specializes in serving the risk management needs of clients in the temporary staffing industry. Our experienced team of professionals helps clients analyze their current policies and practices and develop plans for achieving a more cost-effective, sustainable program. Give us a call today to learn more.

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