The prevalence of longer-term dispensing of opioids has droppedconsiderably in a number of states that have implemented policiesand initiatives to combat the opioid epidemic, according to a newstudy by the Workers Compensation Research Institute.

The Cambridge, Mass.-based nonprofit tracked the prevalence oflonger-term dispensing of opioids in 26 states during two studyperiods — from 2010 to 2012 and then again from 2013 to 2015 — andfound that the prevalence of longer-term opioid dispensingdecreased in most study states. WCRI found even more noticeabledrops for several states in the 2016 edition of the study, likelydue to numerous legislative and regulatory changes within thesestates aimed at addressing issues related to opioid prescribing andchronic opioid management, both within and outside workers’compensation.

Key policies include a mandatory check of prescription historyin the state prescription drug monitoring program database at thepoint of prescribing and dispensing opioids; treatment guidelinesfor prescribing opioids and managing chronic opioid therapy; drugformularies; mandatory provider education focusing on appropriateopioid prescription and pain management; and state laws regulatingpain clinics and dispensing of opioids by physicians.

“More recently, a number of states passed comprehensivelegislation to address opioid overuse prevention and intervention,”writes the study’s author, Dongchun Wang. “Efforts were also madein several states to encourage inter-agency collaborations andcollaborations among state agencies and stakeholders to addressopioid issues in a coordinated way. Research on opioid policies andtheir impact has also been conducted to support evidence-basedpolicymaking.”

However, longer-term dispensing of opioids was more prevalent inLouisiana and several other states in the study period of 2013through 2015, according to the study. Moreover, WCRI continued tofind that fewer-than-expected injured workers who received opioidson a longer-term basis had certain services recommended bytreatment guidelines for chronic opioid management.

“Long-term opioid therapy for chronic non-cancer pain is acontroversial topic, and there is little evidence about theeffectiveness of such treatment on functional recovery or return towork,” Wang writes. “Unnecessary opioid prescriptions may lead toopioid addiction, overdose, and diversion, which is a top prioritypublic health topic in the United States. The public concern isalso shared by the workers’ compensation community.”

Key findings from the study include:

• The frequency of claims that received opioids on a longer-termbasis decreased more than 4 percentage points in Kentucky and NewYork. The same measure decreased 2 to 3 percentage points inseveral other states (Kansas, Massachusetts, Michigan, Minnesota,and Tennessee). Noticeable decreases in the longer-term dispensingof opioids were also seen in several other states, includingCalifornia, Florida, and Texas, with reductions of 1 to 2percentage points.

• Among claims with injuries in 2013 that were observed over atwo-year time period ending March 2015, longer-term dispensing ofopioids was most prevalent in Louisiana: 1 in 6 injured workerswith opioid prescriptions were identified as receiving longer-termopioids. Compared with most study states, the number was alsohigher in California, Georgia, North Carolina, Pennsylvania, SouthCarolina, and Texas. By contrast, about 1 in 25 injured workerswith opioid prescriptions received them on a longer-term basis inIndiana, Kansas, Missouri, Nevada, New Jersey, andWisconsin.

• The study continued to find that fewer-than-expected injuredworkers who received opioids on a longer-term basis had certainservices (i.e., drug testing, psychological evaluation andtreatment, etc.) recommended by treatment guidelines for chronicopioid management. For example, in 19 out of 26 states, less than10 percent of injured workers with longer-term opioids receivedpsychological evaluations.

• This study uses data comprising over 400,000 nonsurgicalworkers’ compensation claims with more than seven days of losttime, and over 2 million prescriptions are associated with theseclaims from 26 states. These claims had injuries in 2010 and 2013and received on average up to 24 months of medical treatment. Thesample of claims in the study represents 36 percent t- 69 percentof workers’ compensation claims in each state.

• The 26 states in the study are Arkansas, California,Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas,Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota,Missouri, Nevada, New Jersey, New York, North Carolina,Pennsylvania, South Carolina, Tennessee, Texas, Virginia, andWisconsin.