Opioid abuse is taking a huge toll in the U.S.…regardless of age, geography or any other measure.  Since 1999, the number of overdose deaths from opioids has nearly quadrupled, according to the American Society of Addiction Medicine, and the opioid crisis is front-page news everywhere.  It was during this same time that an increase in prescription opioid prescribing practices also increased according to Managed Healthcare Executive.

Here are seven steps insurers can take to help cut down on opioid abuse:

  1. Ensure case managers follow patients throughout treatment and their use of any opioids.
  2. Develop red flags — such as specific diagnoses, procedures, injuries and lost time thresholds and polypharmacy indicators — that could point to the need or use of chronic pain medications. These alarms should signal the need for early assignment of the file to case managers or to in-house medical reviewers.
  3. Insist on periodic, random drug screenings for the work environment and while under a drug protocol or contract which look for drug compounds not found in a five-panel test — benzodiazepines and opioid pain medications — as recommended by the National Safety Council.
  4. Look out for warning signs, including doctors who prescribe a high number of opioids and patients who use several pharmacies or seek regular increases to the dosage.  Look to prescription drug monitoring programs (PDMPs).
  5. When appropriate, make sure patients sign AND that providers enforce narcotic agreements.
  6. Cover alternative pain treatments, pain rehabilitation programs and psychology/cognitive behavioral techniques as well as monitor new treatment developments which may be more cost effective than traditional opioids in the long run.
  7. Embrace a multi-faceted and tiered approach to both chronic pain management and opioid abuse programs.

A little background

While some insurers are taking necessary steps to make improvements and awareness is growing, many traditionally consider opioids simply as an effective and inexpensive way to treat pain.  The problem often arises when acute pain management with opioids gradually morphs into a challenging medical case of chronic pain and potential opioid abuse.  The RXInformer found that prescription opioid abuse can lengthen the life of a claim.  Claims are 30 percent less likely to close within three months if a patient starts taking an opioid within the first four weeks, according to the clinical journal’s report.


There is no one answer.  Our opioid problems are complicated, touching multiple, interwoven aspects of our culture and society and the insurance, medical, work and legal sectors.

Despite the challenges and complications, it’s important that the insurance industry recognize the ongoing and growing addiction to prescribed pain management meds and consider greater…

  • Internal data analytics and mining
  • Consumer and prescriber education and monitoring and
  • Investigation and authorization of approved alternative therapies

In addition, it’s important that insurers foster an ever greater dialogue among the industry’s stakeholders and, if possible, assert more influence over potential “over” prescribers.


NOTE:  This is the first of several posts from MKC Medical Management on the issue of opioid abuse.  Over the next several weeks, we plan to post our thoughts about what employers, physicians and patients can do about the crisis.  Your comments are always welcome.