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Do you have a strong opioid program for your injured employees?

June 10, 2016

Overuse of drugs, coupled with workers’ compensation claims, may lead to increased medical costs.

Associate Medical Director

Dr. Joe Semkiu joined Zurich in December, 2007. As Zurich's United States' Medical Director, his... About this expert

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Per the Centers for Disease Control and Prevention (CDC), 78 Americans die every day from an opioid overdose. In 2014, more people died from drug overdoses than in any year on record, with the majority of those deaths (more than six out of ten) involving an opioid.

Do you have a strong opioid program for your injured employees?

Drugs prescribed to address pain related to worker injuries can include narcotics – chemical substances often associated with physical dependence and psychological addiction. Prescription narcotics, in some instances, may escalate toward negative medical consequences, such as addiction, illicit drug use or non-medical use. Drug over-utilization coupled with workers’ compensation claims may lead to increased medical costs, higher risk of surgery, prolonged opioid use, increased days away from work and accidental opioid overdose.

As discussed in my recent article, "Opioid Abuse: The Undetected Risk in Your Organization" (co-authored with Eric Lambert) for FMI Quarterly, a recent Mayo Clinic study found one in four patients prescribed an opioid painkiller for the first time progressed to long-term prescriptions.

A strong opioid pharmacy program, focusing on patient safety and addressing escalating claims costs, is an important part of patient care. It assists claims professionals in identifying red flags related to opioid use and provides the proper medical oversight when red flags are present. These programs usually include nurse case managers and peer review involvement to help identify prescribing patterns or behaviors that lead to negative medical consequences. After a review of medical outcomes for claims referred into Zurich’s program, we have seen a reduction in cases involving multiple prescribers, multiple pharmacies and injured workers receiving a higher dose of narcotics than necessary.

Because of the potential risks, the standards of care for physicians who prescribe narcotics in the management of chronic pain include both drug screening and drug agreements.


Drug screening

Employment-related drug testing falls into four categories: post offer, random, post-accident and “for cause.” It is the random drug screening that is the standard of care when narcotics have been prescribed. The purposes of a random urine drug test in this circumstance include:

  • Verifying the person is taking the medications as prescribed — not diverting or selling the drugs
  • Ruling out the presence of illicit, illegal drugs

Drug testing only identifies the presence of substances; however drug screen panels (other than those mandated by state and federal agencies) can be customized for drugs used.


Drug agreement

Signed by the patient prescribed narcotics and the prescribing physician, a drug agreement outlines the responsibilities of the patient being prescribed drugs. These responsibilities include submission to random, unannounced drug testing to verify compliance with prescribed pain regimens and verification that there are no illicit or illegal drugs being taken. Consequences for failure to comply with the drug agreement can include discontinuance of the pain medication and termination from the physician’s practice.

The information in this publication was compiled from sources believed to be reliable for informational purposes only. All information herein should serve as a guideline, which you can use to create your own policies and procedures. Any and all information contained herein is not intended to constitute advice (particularly not legal advice). Accordingly, persons requiring advice should consult with independent advisers when developing programs and policies. We do not guarantee the accuracy of this information or any results and further assume no liability in connection with the publication and sample policies and procedures, including any information, methods or safety suggestions contained herein. We undertake no obligation to publicly update or revise any of this information, whether to reflect new information, future developments, events or circumstances or otherwise. The subject matter of this publication is not tied to any specific insurance product nor will adopting these policies and procedures ensure coverage under any insurance policy. Risk engineering services are provided by The Zurich Services Corporation.

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