State policy changes coincided with opioid prescription reductions, report shows

A new report from the Worker’s Compensation Research Institute finds policy changes in Wisconsin coincided with reductions in the number of opioid prescriptions in the state. 

The report analyzed the dispensing of opioids by workers’ compensation programs in 27 states, as well as prescribing patterns for pain medications and treatments. It focused on nonsurgical claims for injuries with more than a week of lost time.

Of the states included, Wisconsin was on the lower end for opioids per claim at the beginning of the study period in late 2011. Over the next four years, that amount went down 44 percent on average, and even larger decreases were seen in claims for which the most opioids were prescribed. 

Report authors connect the decreases seen in the study period to policy changes made in the state. 

For injuries occurring roughly between 2013 and 2014, Wisconsin had a 15 percent reduction in opioids per claim. Around the same time, the state’s Prescription Drug Monitoring Program came online, requiring care providers to report the amount of opioids they prescribe. 

In the latest study period, covering injuries between late 2015 and late 2016 and prescriptions filled through part of 2018, the average amount of opioids per claim decreased 26 percent from the beginning of that period. Report authors link that decrease to Wisconsin Act 266, which required that all prescribers in the state review patient records on the PDMP before prescribing opioids or other monitored prescription drugs.

In 2017, the state’s licensing board began requiring all state-licensed physicians to complete two hours of medical education on the Wisconsin Medical Examining Board’s opioid prescribing guidelines. It’s noted the PDMP was queried 5 million times in 2017, compared to 1.6 million times in 2016.

The potency of prescribed opioids varies widely, from stronger drugs such as oxycodone to weaker ones like tramadol. The report highlights “substantial variation” in the types of opioids prescribed to injured workers across the 27 states it covered. 

Although oxycodone is a relatively powerful option, report authors observed that more frequent oxycodone prescriptions “did not always imply an overutilization of opioids in the state.” 

Doctors in Wisconsin were more likely to prescribe the drug, with oxycodone making up 10 percent of pain medications in the state, compared to 6 percent for the median of the 27 states. Still, the average amount of opioids per claim in Wisconsin was 23 percent lower than the median. 

In most of the 27 states included in the report, the average amount of opioids dispensed per worker decreased over the four-year study period. The greatest decreases — between 50 and 52 percent — were seen in California, Connecticut and Kentucky. Wisconsin was grouped in with six other states that had average decreases of 42 percent to 48 percent. 

Data for the latest Interstate Variations in Dispensing of Opioids report came from more than 575,000 workers’ compensation claims with more than seven days of lost time, and more than 4.3 million associated prescriptions. Report authors tracked the workers’ medical treatment for an average of 24 months after the injury. 

The Worker’s Compensation Research Institute is a not-for-profit founded 35 years ago and based in Cambridge, Mass. It’s  supported by members including 185 companies, labor unions, government agencies and other groups, according to the group’s most recent annual report. That includes Mayo Clinic. Walmart, and The Walt Disney Company, as well as the Wisconsin Compensation Ratings Bureau and the Wisconsin Department of Workforce Development. 

See the full opioids report: