A new ruling from Texas adds to the list of states that have found payers liable for a range of opioid-related side effects ranging from addiction to death. In this particular case, the payer was found liable for death benefits in light of the injured worker's death caused by hydrocodone overdose. This adds to recent rulings in several other jurisdictions (e.g., Pennsylvania, Texas, North Carolina – these are the ones I've seen; I believe there are others) in which payers have found themselves on the hook for death benefits due to drug overdose.

Prediction: This is just the beginning. Why? Because we know too much. And our unwillingness (or inability), as an industry, to apply what we know is going to cause a lot of financial pain over the next several years.

We really do know too much. We have sound, evidence-based clinical guidelines. We have peer-reviewed studies (many of which are incorporated into the guidelines) that suggest the limited benefits (and significant harm) that result from chronic opioid therapy. We have thought leaders, in both the clinical and business realms, offering a constant drumbeat of warnings that solutions are needed. We have industry conferences devoted entirely to this issue. We have a growing body of regulatory mechanisms intended to help control opioid misuse (e.g., Texas closed formulary rules, new Tennessee utilization-review rules, Washington's guidelines, etc.) We have public health agencies, including the Centers for Disease Control, calling the issue of prescription drug abuse an "epidemic" and a "public health crisis."

I hear various excuses for why payer organizations aren't attacking the problem with greater force.

"Look," they say, "this is really complicated... these people are addicted." Or "we don't have sufficient clinical resources"... or "we're pretty sure plaintiff's counsel is going to come at us pretty hard"... or "we're working on it"... or "our pharmacy benefit manager has a handle on it."

Enough. There's going to be noise. Deal with it. We're on the right side of this fight. By taking aggressive action, we have the opportunity to improve overall patient health while simultaneously saving money. This is exactly what our health care system needs.

Let's get to work.

Michael Gavin is president of Prium, a medical cost-containment firm for the workers' compensation industry. This column was reprinted with his permission from the firm's Evidence Based blog.