Reducing opioid use requires multipronged approach

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SAN ANTONIO — The head of risk management for a company whose 454,000 workers are tasked with delivering 2.5 million packages around the world each day, said solving the opioid crisis will take a multitude of strategies.

“There’s no silver bullet,” Michael Fenlon, Atlanta-based senior director for corporate risk management for United Parcel Service Inc., told attendees at the Risk & Insurance Management Society Inc.’s annual conference in San Antonio on Tuesday. “It’s a bunch of little things.”

Mr. Fenlon was joined by John Ruser, president and CEO of the Cambridge, Massachusetts-based Workers Compensation Research Institute, in a session on solving one of workers compensation’s biggest conundrums: how to help injured workers manage their pain without overprescribing or unnecessarily prescribing strong pain medications.

Mr. Ruser said numerous strategies put in place nationwide and in individual states are working in concert to lower unnecessary opioid prescribing in workers comp — echoing the common sentiment in comp circles and what Mr. Fenlon has noticed in his own workforce.

The solution involves everyone from the injured worker to the legislation in their respective states, to the claims managers and providers, they said.

UPS has several protocols in place for injured workers who have opioid prescriptions. Strategies include case managers for individual workers, “opioid letters” to both the worker and his or her prescriber that explain the drugs’ dangers, and “red-flag” notifications that tell a claims manager what a worker was prescribed and how much, said Mr. Fenlon.

For UPS, the strategies are seeing results, he said. In 2013, 31% of lost time UPS patients received an opioid as part of treatment, making up 26% of the drug spend in the company’s workers comp costs. Today, with tighter programs in place at UPS, 21% of injured workers receive a prescription for opioids, representing 22% of total drug spend, he said.

Overall between 2013 and 2017, UPS has seen a 30% decrease in lost time claims receiving opioid prescriptions, Mr. Fenlon said.

Wider efforts to cut opioid use are working, too, said Mr. Ruser.

Overall, states that have implemented prescription drug monitoring programs have seen a noticeable drop in the amount of opioid prescriptions, said Mr. Ruser, highlighting WCRI data from states with programs in place.

For example, H.B. 1 in Kentucky went into effect in 2012, calling for all physicians to access and provide input on who is prescribed opioids for a state database.

“The immediate effect (was) 400,000 queries in the first month, July 2012,” Mr. Ruser said, adding that the number of prescriptions dropped immediately.

His researchers looked at states without PDMPs to see whether their prescribing behavior changed year over year. In the states without programs, “the line was pretty flat,” he said.

Other data shows that prescribers subjected to state formularies as another strategy in reducing opioids in comp have resorted to much safer nonsteroidal anti-inflammatory drugs, Mr. Ruser said.

Unfortunately, most strategies focus on the beginning of a claim, said Mr. Fenlon, who added this caution: “If you’ve missed it on the front end and you are fighting it on the back end, it isn’t always successful and can be expensive.”

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