Lockdowns, social distancing, and interruptions to “normal” healthcare during the COVID-19 pandemic have taken their toll on another deadly pandemic in the United States – the opioid crisis.
It has been widely reported that during the pandemic, when many were under stay-at-home orders to prevent the spread of COVID-19, there was an uptick in fatal opioid overdoses. There are many potential reasons behind this, including an increase in social anxiety and stress related to the coronavirus, disruptions to healthcare, support services and medical treatment for people with opioid use disorder, and delays and/or shortages in the drug supply chain.
The misuse of and addiction to opioids – including prescription pain relievers, heroin, and synthetic opioids like fentanyl – has been a developing issue in the US since the 1990s and reached crisis levels by 2017. At the height of the crisis in 2019, roughly 21-29% of patients prescribed opioids for chronic pain misused them, and from 8-12% of people using an opioid for chronic pain developed an opioid use disorder, according to the National Institute on Drug Abuse.
In the past couple of years – aside from the COVID-related blip – there has been a decline in the use of opioids to treat chronic pain, and a correlating drop in opioid addition and fatalities. This has been a strategic priority for workers’ compensation insurers nationwide, whose efforts to get injured employees back to work during the crisis were impeded by the debilitating impacts of long-term opioid use and/or addiction.
“Opioids and other pain-masking medications are inexpensive on the front-end, but they end up costing more and negatively impacting the quality of an injured employee’s life as the timeline extends,” explained Dr. Melissa Burke, vice president, head of Managed Care and Clinical for AmTrust Financial Services. “It’s so important for insurers to put more effort in upfront and practice early intervention following a workers’ compensation claim.
“At AmTrust, we have a predictive nurse assignment model that will identify claims that have the likelihood to require stronger medical management. We make sure that our nurses are assigned to those cases early on, and they’re talking to the injured employee to get a true understanding of: What’s driving their pain? What do they need? What are their struggles? What are the challenges that they perceive with returning to work?
“We’re able to really address those concerns and work to prevent the development of chronic pain by managing the injured workers’ medical care and working with their providers to ensure they’re getting treatments that are actually addressing what’s causing the discomfort, the pain, the ongoing symptoms, as opposed to utilizing opioids or medical marijuana, or any other substance to mask that pain. We’re truly trying to address it so they can get back to work and get back to life as soon as medically appropriate.”
Managing and treating chronic pain requires a personalized approach, according to Burke. Some injured workers will require mental health services such as cognitive behavioral therapy to deal with their pain, while others may need acupuncture, aqua therapy, or another pain management service. The challenge that insurers have is to convince insureds to get on board with personalized treatment plans instead of turning to seemingly less expensive opioid or pain-masking medication.
“It is often more expensive to get the right treatment and the right non-opioid medication to address chronic pain,” Burke told Insurance Business, “but it should be seen as investing upfront in a claim to ensure that it doesn’t go down that chronic pain route eventually. Opioids are far less expensive today, but tomorrow, that claim could turn into one that you can’t close because the injured worker has chronic pain and they’re using excessive medications that go beyond utilizing other pain management treatments, surgeries and so forth. It’s really important to have that early intervention upfront and not just utilize what’s inexpensive today.”
Burke said the industry has made good progress in limiting the use of opioids for chronic pain management. She added that even through COVID, when opioid usage increased because people were unable to access alternative treatment, AmTrust “maintained strong oversight” of its managed care program and therefore “did not see an increase in the use of opioids among [its] injured worker population”.