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The report highlights the most promising policies, strategies, and practices for opioid prescription management between 2014 and 2019. The environmental scan covered approaches applied in workers’ compensation programs and other health care settings, such as health insurance programs and health care systems.

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Research Questions

• What are existing policies, strategies and interventions implemented among the 50 state workers’ compensation programs to address prescription opioid misuse and overuse? What are the promising approaches, issues and challenges associated with implementation?
• What are strategic or programmatic interventions that may be relevant to the FECA population? Why are they promising?
• What are opportunities for generating new evidence on workers’ compensation programs and the prescription opioid crisis?

Key Takeaways

• Multi-pronged approaches involving more stakeholders and prescribing factors may be more effective than narrow ones. State-level policies that target prescribers, pharmacists, health insurers, and patients may produce better results than policies targeting only one group.
• Data and technology that can track and manage opioid prescribing can have advantages and may improve policy implementation.
• Some states and health care systems combined multiple intervention strategies. The scan found the multifaceted approach effective in modifying opioid prescribing practices within health care systems.
• Policies combining prescriber education with tracking and reinforcing can be effective. For example, prescriber education was commonly paired with peer-based feedback and reinforcement.
• Policies imposing dispensing limits can substantially reduce opioid prescriptions.
• Healthcare and insurance systems that adopt or enforce updated opioid prescribing guidelines by federal and state authorities and by professional medical associations can reduce opioid prescribing rates, doses, and duration.

Research Gaps

• A greater uniformity of outcome measures across studies would provide more opportunities for meta-analytic methods to synthesize findings and to compare effects between different types of policy interventions… using more rigorous evaluation methods would enable researchers to better account for secular trends in opioid prescriptions and other policy changes that confound many of the results in the studies we reviewed... Studies that track other important outcomes (such as measures of employment, well-being, and mortality) and for longer follow-up periods would greatly improve our understanding of the true benefits (and sometimes unintended consequences) of various approaches. (page 67)

Citation

Ben-Shalom, Y., McIntyre, M., Pu, J., Shenk, M., Zhu, W., Shaw, W. (2020). Mathematica. Workers’ Compensation and the Opioid Epidemic: State of the Field in Opioid Prescription Management. Chief Evaluation Office, U.S. Department of Labor.

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The Department of Labor’s (DOL) Chief Evaluation Office (CEO) sponsors independent evaluations and research, primarily conducted by external, third-party contractors in accordance with the Department of Labor Evaluation Policy and CEO’s research development process.