Workers’ Compensation and the Opioid Epidemic: State of the Field in Opioid Prescription Management
- Overall, most studies reported positive effects on reducing opioid prescribing rates, dosages, and refill rates and improving physicians’ attitudes and practices, and these patterns held even when researchers made strenuous efforts to rule out competing explanations for these effects. Positive effects of policy change have generally exceeded secular trends in reduced opioid prescribing rates or shown a sudden shift after a policy is implemented.
- New opioid policy changes in the past six years have shown a measurable influence on opioid prescribing practices. The size of the effect varies depending on the chosen outcome measure, follow-up period, and setting, but the reported changes in outcomes were nontrivial. Because of a lack of comparable outcomes across studies, we could not quantitatively synthesize and compare effect sizes between policy categories, but no one policy appeared to far exceed the benefits of other strategies. For policymakers, choices between specific policy actions may relate more to context, level of regulatory influence or authority, ease of administration, and the ability to enforce or reinforce the policies.
- Multi-pronged approaches that reach a larger number of stakeholders and address numerous prescribing factors simultaneously may be more effective than narrow approaches that target very specific stakeholders and prescribing factors. For example, state-level policies that involve prescribers, pharmacists, health insurers, and patients may result in larger cumulative effects than narrower policies that only target one of those groups.
- Many effective policies combined education and training with methods for tracking and reinforcing the desired prescribing methods. For example, prescriber education and training methods were commonly paired with peer-based feedback and reinforcement.
U.S. Department of Labor's (DOL's) Chief Evaluation Office, in partnership with DOL’s Office of Worker’s Compensation Programs, contracted with Mathematica and the University of Connecticut Health Center to help build knowledge about opioid prescription management strategies. As part of this effort, the project team conducted an environmental scan to identify existing policies, strategies, and practices for opioid prescription management and evidence on their effectiveness. The environmental scan covered approaches implemented in workers’ compensation and other health care settings, such as health insurance programs and health care systems.
The scan included identifying which approaches are the most promising for further consideration by relevant stakeholders, how and where they were implemented, and the strength of the evidence about their effectiveness. It includes 134 studies of initiatives and strategies across a variety of intervention categories, settings, and research designs published from 2014 to 2019. The many studies published in recent years reflect the growing interest in the United Statesamong policymakers and researchers to evaluate the effects of new policy-level programs designed to improve opioid prescribing practices and reduce opioid misuse and overdose deaths.