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Wilson and Bennett: Could AI Have Prevented the Opioid Crisis in Workers' Comp?

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The U.S. has been experiencing an opioid crisis since the mid-1990s, and opioids have had a significant effect on public health and the nation’s economic and social outcomes.

Heather Wilson

Heather Wilson

Beginning in the late 1990s, health care providers began prescribing opioids at greater rates. By 2006, opioid prescriptions were written at 72.4 per 100 people in the U.S. That is roughly six times the rate in 1992. More than 500,000 opioid-involved deaths have occurred since 2000, and the U.S. has the world’s highest number of opioid-involved deaths per capita.

Although federal funding to address the opioid crisis has increased in recent years, opioid overdose mortality has also increased. Deaths from opioid-involved overdoses were among the leading causes of death in 2020.

The use and misuse of opioids can result in serious health effects: People with certain harmful behaviors that result from opioid misuse — such as an increase in the amount and frequency of opioid use or failure to fulfill primary responsibilities at work, home or school — have opioid use disorder (OUD), which can affect an individual’s participation in the labor force and the ability to care for children. Treatment for OUD is used far less than behavioral health professionals recommend.

Chris Bennett

Chris Bennett

The crisis encompasses several key issues:

  • Overprescription. The surge in prescriptions of opioids for pain management.
  • Addiction. A high rate of users developing dependencies on opioids.
  • Overdoses. A significant rise in fatal and non-fatal overdoses.
  • Economic burden. Substantial direct and indirect costs to economies and healthcare systems.

The opioid crisis disrupted the workers’ compensation industry landscape by introducing a complex layer of new medical, ethical, legal and socio-economic challenges. Addressing these required a nuanced, multifaceted approach that safeguarded workers’ well-being while navigating the precarious terrain of opioid management, ensuring regulatory compliance and maintaining ethical integrity.

The opioid crisis peaked in 2012 when the prescription rate reached 81.3 prescriptions per 100 people. By 2020, the prescription rate had declined by almost half. And while the worst of the crisis is behind us, opioids are still being prescribed at three times the rate they were in 1992.

To rein in the crisis, workers’ compensation industry stakeholders explored diverse avenues, including alternative pain management therapies and stringent monitoring of prescription practices. Advances in technology have opened new avenues to explore and mitigate opioid risk.

What if artificial intelligence (AI) had been more widely available during the crisis? How could it have augmented these strategies to make them more effective sooner? Could AI have mitigated the impact of the opioid crisis on the industry and, more crucially, safeguarded the health and livelihoods of workers across various sectors?

The opioid crisis has created many challenges and concerns for insurance carriers related to injury management, recovery and claims. Many workers, following injury-related pain management treatments, are prescribed opioids. There are many valid reasons for opioids or strong painkillers to be used to minimize the pain that comes from catastrophic injury or surgery. In some instances, prolonged use or misuse leads to dependency or addiction, which complicates the workers’ path to recovery and reintegration into the workplace.

Various cases reveal a pattern where workers, after being prescribed opioids to manage pain post-injury, traverse the path of dependency. Often, a short-term prescription intended to manage acute pain can evolve into chronic use due to factors like inadequate monitoring, the absence of alternative pain management strategies and the inherently addictive nature of opioids.

The industry faced escalating financial strain as the nexus between opioid prescriptions and workers’ compensation claims strengthened. The intertwined challenges of managing opioid prescriptions, subsequent addictions, elongated recovery timelines and increased claim costs created a hefty financial burden for insurance carriers and their policyholders. Further, the cost is not merely monetary but also permeates the resource allocation and management aspects, necessitating more extensive care management and monitoring protocols.

The opioid crisis injected complexity into the health and rehabilitation journey of workers. Addiction or dependence on opioids can delay recovery, hinder effective rehabilitation and diminish the overall quality of life. Furthermore, the psychosocial impact, stigmatization and mental health toll of dealing with addiction introduce additional barriers to a worker’s rehabilitation and return to productive employment.

The legal landscape intertwining opioids and workers’ compensation is fraught with disputes and complexities. Cases where workers have succumbed to overdose, engaged in illicit drug-seeking behavior or experienced deteriorated life quality due to opioid addiction have found their way into courts, demanding legal scrutiny over prescription practices, monitoring and overall management within the compensation framework. Legal disputes may involve questions around liability, appropriateness of care and due diligence in prescribing and managing opioid-based treatment plans. In many cases, carriers are held accountable for insured workers’ negative actions.

The ethical discourse revolves around dual responsibilities: ensuring effective pain management and mitigating the risk of opioid misuse or addiction. Employers and insurance carriers encounter ethical dilemmas related to:

  • Prescription practices. Balancing effective pain management while avoiding contributing to potential opioid misuse.
  • Responsibility. Deciphering the extent of the employer’s or insurer’s responsibility in managing the repercussions of opioid prescriptions.
  • Worker support. Establishing how to adequately support workers navigating opioid dependency in a compassionate and economically viable manner.
  • Prevention and education. Implementing preventive measures and educational initiatives to enlighten workers about the risks associated with opioid use.

In this context, insurance carriers needed to act in the early 2000s to mitigate the crisis’ impact on their business. Suppose workers’ compensation carriers had more widely adopted artificial intelligence during the early stages of the crisis. How might it have been used to mitigate the extent of it and, in effect, save lives?

While it’s speculative to say AI could have “solved” the opioid crisis in the workers’ compensation industry, it could have significantly mitigated the impact. Through intelligent data analysis, predictive analytics, personalized interventions and more robust support systems, AI offers a multipronged approach to managing opioid prescriptions more effectively, thereby reducing the risk of dependency and its associated challenges. And while the worst of the opioid crisis is behind us, opioids still play an increased role in treating injured workers. It behooves insurance carriers to deploy artificial intelligence to help mitigate its effects today.

Heather H. Wilson is chief executive officer of CLARA Analytics. Chris Bennett is the head of strategy for the Origami Risk core solutions division. This blog post is reprinted with permission from InsuranceThoughtLeadership.com.

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