The pain of deprescribing opioids in personal insurance

The Pain of Deprescribing Opioids

Long-term opioid use is a major issue in workers’ compensation, and once it starts it is far harder to reverse than it is to initiate. What often begins as short-term pain relief in the acute phase of an injury can quietly evolve into long-term dependence, delayed recovery, and complex claims management problems.

Research shows that around 1 in 5 injured workers who take time off work are prescribed opioids within the first three months of their claim. The real problem is what happens after that. Data suggests that three out of four people who are still using opioids at 12 weeks remain on them at 52 weeks. At that point the medication is no longer helping recovery. It is often contributing to poorer outcomes.

Long-term opioid use is associated with a wide range of complications including overdose risk, hospitalisation, falls, hormonal disruption, sleep disturbances, and the development of secondary medical conditions. These complications often lead to additional medical investigations, specialist referrals, legal reviews and extended wage replacement. For insurers, that can translate into tens of thousands of dollars in additional claim costs.

The complexity usually builds slowly. Workers can end up taking 20, 30 or even 40 medications due to fragmented care, multiple prescribers, and prescribing cascades where medications are added to treat the side effects of other drugs. High-risk combinations such as opioids, pregabalin, benzodiazepines, sleep medications and alcohol create significant safety risks that may not be obvious when prescriptions are viewed individually.

Some insurers have started identifying high-risk claims by analysing medication spending and prescribing patterns. However, cost alone does not explain the issue. When pharmacists conduct independent medication reviews, they often uncover complex medication profiles with multiple prescribers, drug interactions and no clear plan to reduce medications.

Pharmacist-led reviews allow for structured deprescribing plans, developed collaboratively with treating doctors. Rather than simply telling a doctor to stop opioids, strategies may include consolidating multiple opioids into one medication, rotating to a safer option, addressing the highest-risk medications first, and gradually tapering doses in a way that is safe for the patient.

Real-world outcomes can be dramatic. In one case, a worker who was taking multiple opioids, sedating antidepressants, pregabalin and sleep medication while also consuming alcohol was gradually stabilised through a structured medication plan. Over twelve months, the medication list was reduced to a single anti-inflammatory, alcohol use stopped, and the individual returned to meaningful daily activities.

One of the biggest advantages pharmacists bring is visibility. With access to prescription monitoring systems and full dispensing histories, pharmacists can see the complete medication picture across prescribers and pharmacies. This level of oversight is often greater than what any individual treating doctor can see.

New technologies such as AllMeds.ai are being developed to support this process. These systems analyse medication lists or pharmacy data to automatically flag high-risk prescribing patterns and help case managers identify which claims require independent review.

The key message is simple. Early oversight matters. When medication risks are identified early, there is time to intervene before prescribing patterns become entrenched. Independent review, structured deprescribing and collaboration with doctors can significantly improve outcomes for injured workers and reduce long-term scheme costs.

The goal is not simply to remove opioids. The goal is to restore health, improve function and prevent claims from deteriorating because of poorly managed medications.

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