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Milbank Quarterly

Opioid-Review Programs Work

By Moby Salahuddin

Workers’ compensation programs that seek to rein in opioid prescribing have not generally resulted in unmanaged pain or reduced function in patients, or led to resistance from patients or providers, or damaged patient–provider relationships, or harmed clinical autonomy, according to research published in the September 2024 issue of The Milbank Quarterly.

Despite fears articulated by pharmaceutical companies and patient advocates, opioid review programs have been well-received by patients and providers and led to more cautious prescribing than in the past. Also, both patients and providers reported collaborative pain-management relationships and satisfactory pain control for patients.

Researchers looked at opioid review programs - a form of quality improvement based on utilization review – implemented by workers’ compensation agencies in Washington and Ohio. “The consequences of opioid regulations have been generally positive: providers report more limited prescribing and a focus on multimodal pain control; patients report satisfactory pain control and recovery alongside collaborative relationships with providers,” the researchers report.

“Although interacting with workers’ compensation agencies involves difficulties typical of interacting with other insurers, opioid controls seem to have generally positive effects and are generally perceived favorably,” they conclude. .

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The recently published research confirms other broad-based findings that show a decline in opioid prescribing in workers’ compensation. The National Institute for Occupational Safety and Health Safety notes that in 2022, 32% of workers’ compensation claims with prescriptions had at least one prescription for opioids, compared to 2012 when 55% of such claims included opioids

In the study reported in The Milbank Quarterly, researchers looked at programs adopted by Ohio and Washington specifically designed to reduce unsafe prescribing. These programs include systematic methods to review opioid-prescribing practices, along with advising prescribers on the best practices for use of opioids and comprehensive pain-management. The review programs end coverage of opioid prescriptions that exceed safe limits or that do not achieve functional goals.

In the study reported in The Milbank Quarterly, researchers looked at programs adopted by Ohio and Washington specifically designed to reduce unsafe prescribing. These programs include systematic methods to review opioid-prescribing practices, along with advising prescribers on the best practices for use of opioids and comprehensive pain-management. The review programs end coverage of opioid prescriptions that exceed safe limits or that do not achieve functional goals.

In WA, the Department of Labor and Industries requires prior authorization for any opioid prescribed more than six weeks after a worker’s injury and denies coverage of prescriptions for which the prescriber has not documented best prescribing practices and clinically meaningful improvement of the patient’s pain and function.. In OH, the Bureau of Workers’ Compensation has the authority to retrospectively review claims of a worker receiving an opioid prescription for more than six weeks after the injury. If this review reveals that best practices for prescribing are not being documented, the prescriber receives a series of up to three letters asking them to come into compliance; if they do not, the bureau can stop covering the prescription. 

Although overt resistance to prescribing regulations was rare, it was quite common for patients and providers to object to other practices and procedures of their state’s WC agencies. Patients’ most common complaints dealt with long approval and appeal process wait times, and delays caused by bureaucratic regulations. In addition, many patients said they were frustrated by sparse communications or lack of transparency from these agencies.