Addressing Pain Management & Opioid Use/Abuse

Building a Business Case: Background

How did we get here?

Several factors have contributed to the rise in the use of opioids over the past 20 years. In the 1990s, in response to reports of under treatment of chronic pain, health organizations began to advocate for more aggressive pain control. Long acting opioids were developed and approved by the Food & Drug Administration (FDA) for patients with persistent pain that requires stable around the clock dosing.

The unintended consequences of opioid misuse, abuse and related overdose rose dramatically in the early 2000s which spurred states to implement drug monitoring programs. Multiple organizations published guidelines for appropriate utilization. The FDA required that some opioids be removed from the market, reclassified or reformulated to be more difficult to manipulate and abuse.

Although prescriptions written for opioid medications have decreased since reaching their peak in 2010-12, they remain three times as high in 2015 as in 1999, and death rates from opioid-involved overdose have continued to increase driven by illicit fentanyl and heroin.

Data from the Centers for Disease Control (CDC) show prescribing of opioids has increased in three ways since the 1990s:

  • Opioid use for chronic non-cancer pain increased the number of opioid prescriptions written
  • The use of opioids to treat chronic pain conditions increased the average length of time for which opioids were prescribed
  • Average doses of opioids prescribed are higher for patients who are prescribed long-term opioids so the average doses per patient have also increased 6

Why should pain management be important to employers?

More than half of Americans live with chronic or recurrent pain – this is greater than those with cancer and stroke combined. In addition, about four in 10 Americans say pain interferes with their mood, sleep and the ability to do work or have enjoyment in their lives.1 Opioid analgesics are one of several types of drugs available to treat pain. Since the 1990s, doctors have used prescription opioids to manage pain resulting from an injury or after surgery, and for health conditions like cancer. However, in the last decade the use of opioids for treatment of chronic, non-cancer pain has increased dramatically. Click here for more information from the CDC about the opioid epidemic. View a map of opioid abuse and dependence state-by-state. When you click on a state, an infographic will be displayed that includes the top five procedure codes by utilization and aggregate cost, and diagnoses by age and gender.

This epidemic is taking both a human and financial toll on employers, employees and covered dependents. For example, a study done in 2016 involving one million lives revealed that nearly one out of three opioid prescriptions subsidized by U.S. employers is being abused, costing them approximately $10 billion a year from absenteeism and presenteeism alone.6 However, the National Safety Council (NSC) states that opioids are no more effective than non-opioid alternatives such as acetaminophen or ibuprofen to treat the most common workplace-related injuries including soft tissue and musculoskeletal issues.1

Despite these statistics, many employers have struggled to see the business case for addressing the management of pain. This is, in part, because the associated costs are distributed among multiple clinical conditions and measuring the total impact of pain on an organization requires reviewing data from diverse, internal and external sources.1