California State Fund Says It Reduced Opioid Prescriptions by 60%

California’s State Compensation Insurance Fund is reporting a significant reduction in the number of opioid prescriptions for injured workers through a program launched four years ago.

State Fund’s opioid-reduction strategy, which included early prevention in new cases and reduction of chronic opioid usage in existing cases, reduced opioid prescriptions 60 percent since 2014, according to the organization.

Results also show the number of patients taking high doses of opioids over the past four years fell from 1,458 to 186, and a 74 percent reduction in expenditures on opioids prescribed to injured workers covered by State Fund.

The strategy included elements like a peer-to-peer physician review program, education for injured workers and treating physicians and a “functional restoration program” for injured workers taking high levels of opioids.

“I got here at State Fund in 2013,” Dr. Dinesh Govindarao, State Fund’s chief medical officer, told Insurance Journal. “We knew that we had to address the opioid crisis that was going on, not only in the worker’s comp arena, but it’s a national phenomenon.”

He said the peer-to-peer education of prescribing physicians was instrumental in the success of State Fund’s opioid-reduction program.

“Back in 2013, we started a peer-to-peer physician review pilot where some of our folks that were high prescribers, we decided to have them talk to another physician who was an expert in the field, to help them with really doing a record review, medication review, and trying to develop some type of a treatment plan to work with them and also look at various options to help them with their chronic pain patients,” Govindarao said.

State Fund’s announcement follows findings from the California Workers’ Compensation Institute in March that opioids now account for less than a quarter of all workers’ comp prescriptions in the state, down from nearly a third a decade ago.

Other drugs, such as anti-inflammatories and anticonvulsants, often used as alternative painkillers, now represent a much larger share, the CWCI report shows.

Govindarao acknowledged the trend of an opioid prescription reduction in workers’ comp, and said he believes the experience at State Fund is a combination of their reduction efforts, as well as physicians and others getting the message that opioids aren’t always best to treat injured workers.

“A lot of it is due to a lot of our strategies that we put together,” he said. “So, I would say a lot has been as a result of that, but there’s also a lot of awareness now, you know that we read about in the news every day about opioids. And I think physicians are a lot more aware and a lot more cautious on prescribing opioids. So I think some of that just getting the word out and the awareness out has also I think had an impact too in changing providers’ behavior as well.”

He said State Fund’s work isn’t done, and that the carrier will continue to focus on reducing opioids by:

• Expanding its chronic pain program to reach even more injured workers;
• Adopting Division of Workers’ Compensation guidelines limiting initial opioid prescriptions to four days;
• Updating its online physician training modules for treating acute and chronic pain.

“I think the big thing is that we still have a lot of work to do,” he said. “The work isn’t done yet.”