Opioid use in California’s workers’ compensation system has decreased more rapidly than in the state’s general population, according to a new analysis by the California Workers’ Compensation Institute (CWCI) based on data from the California Department of Justice’s CURES database from 2017 to 2023. The study tracked key opioid usage metrics, including the number of patients prescribed opioids, average daily morphine equivalent dose (MED), and the duration of opioid use among workers’ comp patients. These factors are closely tied to addiction risks and harmful side effects, such as overdose and overdose-related deaths.
Between 2017 and 2023, nearly 22.3 million Californians were prescribed opioids, with workers’ comp patients accounting for only 1.1% of the total. During this period, opioid prescriptions for the general population dropped by 34%, while workers’ comp patients saw a steeper 62% decline, from 91,620 in 2017 to 34,744 in 2023.
The study revealed that opioid use among workers’ comp patients declined at a faster rate than for the general population across all usage categories. Acute workers’ comp opioid users (less than 30 days) decreased by 9.2% annually, compared to a 4.9% drop among all acute patients in the state. Subacute workers’ comp users (30-89 days) declined by 12.6% per year, versus a 9.8% decrease for the broader population. Chronic workers’ comp opioid users (90+ days) also experienced a sharper decline, falling by 10.6% annually compared to 6.3% for all chronic opioid patients.
The average daily MED for workers’ comp patients also saw notable reductions during the study period, dropping 26% for chronic patients, 23.6% for acute patients, and 17.6% for subacute patients. The percentage of acute workers’ comp patients exceeding the recommended 50 MED per day fell by 9.9 points, while those staying within the 20-50 MED range increased by 13.3 points.
A significant change occurred after California implemented new Pain Management and Opioid Treatment Guidelines into the Medical Treatment Utilization Schedule (MTUS) and introduced the MTUS Formulary in 2018. This led to a sharp decrease in the percentage of acute workers’ comp patients receiving opioid prescriptions exceeding the recommended 5-day supply. Overall, the share of chronic workers’ comp patients receiving prescriptions over 50 MED dropped from 27.1% in 2017 to 21.3% in 2023.
Additionally, a decreasing percentage of chronic workers’ comp opioid patients received prescriptions from multiple payer systems, declining from 72.1% in 2017 to 68.7% in 2023. The study found no indication that reductions in opioid prescriptions within workers’ comp led to increased use through other systems. In fact, overlapping opioid prescriptions between workers’ comp and other payer systems dropped from 8.0% in 2017 to 3.7% in 2023.
The sharp decline in opioid use within California’s workers’ comp system is attributed to several reforms over the past two decades. These include mandates requiring adherence to evidence-based treatment standards, the addition of Chronic Pain and Opioid Guidelines to the MTUS, and stricter requirements for monitoring opioid prescriptions through the CURES database. Collectively, these reforms have proven effective in reducing opioid dependency and improving patient safety in California’s workers’ compensation system.
