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      1. AMTRUST OPIOID PRESCRIPTION RISK REPORT

        Improving chronic pain outcomes by reducing opioid prescriptions

        Chronic pain affects more than 100 million Americans and millions more worldwide.

        The opioid crisis continues to plague America, as drug overdose deaths have steadily increased since the late 1990s.

        blue pill

        6x Higher

        In 2017, the number of overdose deaths involving opioids was 6 times higher than in 1999.

        blue capsule

        130 a day

        On average, 130 Americans die every day from an opioid overdose.

        red pill

        700,000

        From 1999 to 2017, more than 700,000 people have died from a drug overdose.

        white pill

        68%

        Around 68 percent of the more than 70,200 drug overdose deaths in 2017 involved an opioid.

        AmTrust partners with Optum Workers’ Comp and Auto No-Fault and reduces opioid prescriptions for workers’ comp claims

        The opioid crisis continues to plague America, with recent data suggesting a person is more likely to die from an accidental opioid overdose than a car crash. AmTrust has partnered with Optum Workers' Comp and Auto No-Fault, a pharmacy care management company, to implement processes that reduce overall opioid prescriptions to our insured’s injured employees.

        This initiative, started in mid-2018, delivered immediate impact in reducing the volume and duration of prescriptions issued to the insured’s injured employees. AmTrust saw a drastic reduction in the percentage of prescription claims with opioids, dropping from almost 60 percent to just under 25 percent in Q4 year over year and a reduction of more than half in the average days’ supply per claimant. In this report, we’ll take a closer look at:

        • The rise of the opioid epidemic
        • The effects of the opioid epidemic on the workers’ compensation space
        • The proactive approach AmTrust has taken by partnering with Optum
        • Why AmTrust’s partnership with Optum makes us different from other work comp carriers
        • Safer, alternative treatments to opioids

        AmTrust has seen a drastic reduction in the percentage of claims with opioids since the inception of the program

        AmTrust Opioid Perscription Risk Report

        Epidemic Growth & Evolution

        The rise of the opioid epidemic

        According to the CDC, the rise in opioid overdose deaths took place in three distinct waves. In the 1990s, opioid prescriptions increased. In 2010, there was a rise in overdose deaths involving heroin. By 2013, there were an increased number of deaths from synthetic opioids like fentanyl.

        Wave 1 - 1990s

        Opioids are prescribed in increasing numbers

        Wave 2 - 2010

        Rise in overdose deaths involving heroin

        Wave 3 - 2013

        Increased number of deaths from synthetic opioids like fentanyl

        The Dangers

        The ongoing epidemic

        Injuries

        The National Safety Council (NSC) reports that the Washington State Department of Labor and Industries found that receiving more than a one-week supply of opioids or two or more opioid prescriptions soon after an injury doubles a worker's risk of disability at one-year post injury, compared with workers who do not receive opioids.

        NCS Report
        Few Studies

        Very few studies have been conducted that provide evidence to support the long-term benefits of opioid use for chronic pain. See Agency for Healthcare Research and Quality.

        Agency Study
        Lost Time

        A Workers Compensation Research Institute (WCRI) study of workers with low-back injuries shows those who receive longer-term prescriptions for opioid painkillers take significantly longer to return to work than those who are not prescribed opioids.

        WCRI Study
        Scripts

        The National Council on Compensation Insurance (NCCI) data shows that injured workers who were prescribed at least one prescription in 2016 received three times as many opioid prescriptions as the U.S. opioid prescribing rate.

        NCCI Data

        The impact on workers’ comp claims

        The connection between workers' comp claims and opioids

        "The opioid epidemic has those in the workers' comp space concerned," said Matt Zender, Senior Vice President overseeing the workers' comp product at AmTrust.

        The greater prevalence of payments for opioids in workers’ comp claims is a direct result of the types of injuries, which are often debilitating and lead to chronic pain. Opioids like fentanyl, oxycodone and morphine have long been the go-to medications for managing pain from traumatic injuries and major surgeries to provide both short- and long-term relief from the injuries sustained as part of a workplace accident.

        A proactive approach

        This hands-on clinical approach is driven by evidence-based and nationally recognized treatment guidelines, including CDC (Centers for Disease Control) and ODG (Official Disability Guidelines).

        Compensation Claims

        With the Optum partnership, when a prescription is flagged for prior authorization it is now sent to nurses for review, preventing nearly

        13,000 prescriptions that could have been unnecessary or unsafe.

        Our Stance

        Driving optimal claim outcomes

        “AmTrust has always taken measures to monitor opioid usage in the past, but this is truly a proactive step that sets us apart,” said Dr. Burke. “The fact that these requests are all viewed by a licensed nurse is what makes us different. We value the impact that medications can have on a claim outcome, and that’s why as soon as a prescription is requested, we present it to a medical professional - a nurse with a pharmaceutical focus. We’re different that way.”

        A growing concern

        The opioid epidemic continues to be a growing concern for employers of all sizes throughout the country. A survey from the National Safety Council (NSC) reports more than 70 percent of employers state that opioids affect their workplace.

        Alternative treatments

        Safer, alternative treatments to opioids

        The CDC provides guidelines for prescribing opioids for chronic pain, however, in many cases there may be a better, safer way to manage pain, as doctors and hospitals across the U.S. shift away from prescribing opioids when not medically necessary to other treatments.

        MASSAGE THERAPY

        YOGA

        NON-OPIOID MEDICATIONS

        INTERVENTIONAL TREATMENTS

        PHYSICAL THERAPY & EXERCISE

        COGNITIVE BEHAVIORAL THERAPY (CBT)

        The Future

        At the University of Pennsylvania’s Perelman School of Medicine, Assistant Professor Dr. Greg Corder's group uses a multidisciplinary approach that combines advanced neuroscience tools to visualize brain activities encoding pain information, and then control the activity of those brain cells with light-sensitive proteins. It’s their hope that this research will identify new molecular targets for novel pain therapies that can significantly improve the quality of life for chronic pain patients.

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