House Committee on Education & the Workforce discusses opioids and federal employees

“These are difficult discussions, and frustrating for all of us,” said Rep. Mark DeSaulnier (D-Calif.) in his opening remarks during the House Committee on Education and the Workforce’s hearing on “The Opioid Epidemic: Implications for the Federal Employees’ Compensation Act.”

The opioid crisis that currently exists in the U.S. has been fermenting since the 1990s. Doctors increasingly dispensed opioids from 112 million prescriptions in 1992 to a peak of 282 million in 2012, CNN reports.

As federal, state and local authorities continue to search for a solution, many organizations are providing invaluable insights to help combat the crisis. The Workers Compensation Research Insitute (WCRI), a not-for-profit research organization based in Cambridge, Mass., is an example of just that.

Its most recent study, “Interstate Variations in Use of Opioids, 4th Edition,” examines the variations and trends in the use of opioids and prescribing patterns of pain medications across 26 workers’ compensation jurisdictions using data from October 2009 through March 2015. The report also serves as a tool to monitor the results of the ongoing policy changes that have been directed at opioid prescribing and dispensing.

Related: Workers’ comp and pain management experts discuss alternatives to opioids

States play a role, but geography might not

The extent of variation in the average amount of opioids received by injured workers narrowed across the states over the most recent three-year study period. In 2013/2015, there was a three-fold variation across the 25 states other than Louisiana, whereas the variation was four-fold across the state 25 states in 2010/2012.

Despite this, geography is not believed to be a factor in the crisis. During today’s hearing, when asked by Rep. Virginia Foxx (R-N.C), whether a variation between rural and urban areas played a role in injured workers receiving an opioid prescription, WCRI’s executive vice president and counsel Ramona Tanabe testified that, “We have not done any studies on rural versus urban geographic differences of the frequency of opioid utilization. Neither did we see any patterns of high opioid utilization versus low opioid utilization across the United States.”

Related: How to increase injured employee engagement in the workers’ comp system

Daze off

In Louisiana, workers received opioids for 104 days, on average, compared with 44 days in the 17-state median. The figure was also higher in New York, South Carolina and Texas (55-63 days).

A sizeable proportion of claims in Louisiana and New York received high-dose opioids for at least 60 days during the study period. The frequency of injured workers receiving chronic and high-dose opioids during the same 90-day period was also higher in these two states.

Rep. DeSaulnier asked the panel why other states like Washington — which was one of the first states to have guidelines for chronic opioid management, along with Colorado — have been able to effectuate change while we’re “still having this discussion why we’re losing millions of dollars and people are absorbing unbelievable suffering.”

“There are many lessons to be learned from states and they’ve taken them incrementally. One of the recent phenomena is reimbursement for recovery and rehabilitation programs. Many states offer that now, and offer guidelines that include information on weaning opioids, as well,” said Tanabe. She added that many states “have put tools in place to monitor different issues that come up with opioids and FECA [Federal Employees' Compensation Act] has taken steps towards limiting the opioids first fill. For most of the states that put a limit on the opioids, they amount to seven days or less for an opioid fill.”

Related: Using virtual reality to manage chronic pain

Major findings worth noting

• Between 2010/2012 and 2013/2015, noticeable decreases in opioid utilization among nonsurgical claims with more than seven days of lost time in the majority of study states were observed.
• The percentage of injured workers receiving opioids for pain relief decreased in half of the study states. Larger reductions were seen in Kentucky (16%) and New York (9%), two states that implemented major reforms over the study period.
• The average amount of opioids received by injured workers decreased in the majority of the study states over the three-year period from 2010/2012 to 2013/2015.

“Today we have the added factor of trying to not only improve the quality of people’s lives but in some cases save their lives. So this was a very important hearing from those standpoints,” concluded Rep. Bradley Byrne (R-Ala.) ” A lot of people don’t realize the importance of the oversight function of Congress, and I think the hearing we’ve had today shows just how important that oversight function is.”

Related: Workers’ comp and pain management experts discuss alternatives to opioids