Opioid Use in California Workers’ Comp Continues to Go Down, Report Shows

A California Workers’ Compensation Institute analysis opioid prescription data between 2017 and 2023 from the California Department of Justice’s Controlled Substance Utilization Review and Evaluation System builds on prior CWCI studies by tracking multiple opioid utilization metrics.

The study examines the percentage change in the number of opioid patients over the study period, changes in the average strength of the daily dose of morphine equivalents (the “morphine equivalent dose” or MED) and the average duration of opioid use for workers’ comp opioid patients.

According to the CWCI, duration of use and MED level are highly correlated with addiction and harmful side effects of opioids, including overdose and overdose-related death.

The study also identifies the proportion of patients whose opioid use exceeded guideline recommendations and how these proportions changed over time.

According to the study, nearly 22.3 million Californians were prescribed opioids between 2017 and 2023, with workers’ comp patients accounting for 1.1% of the total. The number of Californians who were prescribed opioids each year fell 34% from 6.8 million in 2017 to 4.5 million in 2023, while the number of workers’ comp patients prescribed opioids fell 62% from 91,620 in 2017 to 34,744 in 2023.

Other findings in the study include:

• Over the study period the average daily morphine equivalent dose for workers’ comp patients declined across the board, falling 26% for chronic patients, 23.6% for acute patients, and 17.6% for subacute patients.
• The proportion of new acute workers’ comp patients receiving opioid prescriptions that exceeded the recommended five-day supply decreased by 8.2 percentage points during the study period, with two-thirds of that decrease occurring in 2018, immediately after the state incorporated Pain Management and Opioid Treatment Guidelines into the Medical Treatment Utilization Schedule and implemented the MTUS Formulary.
• Among chronic workers’ comp patients, the share of total days’ supply with an MED over 50 dropped from 27.1% in 2017 to 21.3% in 2023.
• A declining share of workers’ comp opioid patients had prescriptions in which their days’ supply of opioids from other payers overlapped with their workers’ comp prescriptions.
• While opioid use nationwide has declined across different health care systems, the steep decline in California workers’ comp, which the CWCI study shows exceeded the decline noted for the general population, reflects the success of reforms enacted over the past two decades.

CWCI published its study, “Opioid Prescribing for Injured Workers Covered by California Workers’ Compensation System and Other Payers: 2017 – 2023,” which is available on the CWCI website.