The challenges of long-term narcotics use and abuse in the management of pain

By Timothy K. Michels, Esq., Chief Operations Officer, Chesapeake Employers’ Insurance Company – Maryland

prescription pills and bottles graphic

Timothy K. Michels, Esq., Chief Operations Officer, Chesapeake Employers’ Insurance Company  Every year more than 16,500 people in the U.S. die from prescription
  opioidrelated drug overdose, more than from heroin and cocaine
  combined.  The more than fourfold increase in opioid overdose
  deaths parallels the fourfold increase in sales of these drugs over
  the past decade, according to the U.S. Centers for Disease Control
  and Prevention (CDC).

  Nowhere is this problem of narcotics overuse more evident than in the field of workers’ compensation. “Opioids have been widely prescribed for and filled by injured workers.  About [depending upon the specific State] 55% - 85% of injured workers receive narcotics, despite medical recommendations to avoid routine prescription and to limit the use of opioids…,” as reported in the Workers Compensation Research Institute (WCRI) 2014 research on Longer-Term Use of Opioids, 2nd Edition.

Narcotics are a huge cost driver for workers’ compensation insurers.

The narcotic pain relievers oxycodone, hydrocodone, tramadol, Oxycontin, and Morphine Sulfate, are among the most frequently prescribed medications for chronic pain among injured workers today, according to Chesapeake Employers’ claims statistics.   Drug cost can exponentially increase with prescribing drugs like Opana and Exalgo that can cost more than a thousand dollars a prescription.  The 2013 Update: Workers Compensation Prescription Drug Study by the National Council on Compensation Insurance (NCCI) noted that narcotics account for nearly one-quarter of workers’ compensation drug costs.  And, more than forty-five percent of narcotic costs are for drugs with Oxycodone HCL as an active ingredient.  The 2014 WCRI report further indicated that for patients with occupational injuries, a higher use of opioids may also lead to addiction, increased disability or work loss.

The importance of effective claims management

In the absence of individual states’ statutes or national regulations governing medical costs in workers’ compensation cases, it often falls to insurers to monitor and police the system using industry best practices for claims management and patient care.

As Maryland’s largest writer of workers’ compensation insurance, Chesapeake Employers has taken a lead in controlling the rising costs of medical care in workers’ compensation claims. At 9%, our total pharmacy costs are well below the national average of NCCI’s estimate of 19%, despite the fact that Maryland is among the states with the highest prescription costs per medical claims. 

The practice of over-prescribing narcotics compelled us to form a multidisciplinary pain management team representing claims, medical services, and legal departments.  The primary goal is to mitigate long-term narcotic use and abuse in the management of pain. The team works closely with our Pharmacy Benefits Management (PBM) vendor as part of this comprehensive approach.

 Our team of nurses and medical directors review drug utilization of the injured workers with the prescribing physicians, while using evidence-based treatment guidelines for chronic pain management. The focus is on claimants’ use of long-term, high-dose narcotics; and narcotics prescribed beyond 90 days from injury.  The PBM monitors the program and reports at-risk opioid utilization for early intervention, in addition to potential fraud, waste and abuse.  

Since inception in 2010, Chesapeake Employers’ Pain Management Program has generated significant savings for the company and the Maryland businesses we insure.  Managing medical costs – and the escalating cost of prescription drugs in particular – requires a truly balanced approach between both cost and quality patient care.


Timothy K. Michels, Esq. is the Chief Operations Officer of Chesapeake Employers’ Insurance Company (, the largest writer of workers’ compensation insurance in Maryland. Celebrating its centennial year, the company has served as a continuous, guaranteed source for fairly priced workers’ compensation insurance. It also champions workplace safety for Maryland employers and employees. This information is advisory only and is not intended as a substitute for professional medical advice. Employers should seek the advice of a licensed physician or other healthcare professional if they have specific questions related to their employees’ health and wellness.


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