California’s Division of Workers’ Compensation has drafted new guidelines to curb use and misuse of opioids by workers’ compensation claimants.

The guidance is in response to a number of studies that have noted the ill-effects of increased opioid prescriptions on injured workers, including addiction, disaffection from the workforce, staying out longer on disability and increased claims costs.

The proposed guidelines were written to provide a roadmap for the best practices for using opioids to manage pain in work-related injuries.

It’s hoped that the proposed guidelines, when codified into regulations, will pare down the misuse of these drugs, which are essentially synthetic forms of opium. Anytime a worker is injured and they are having trouble dealing with the resulting pain, the likelihood is strong that they will be prescribed an opioid, which in turn can increase the cost of a claim fourfold, according to the National Council on Compensation Insurance.

The proposed guidelines recommend that:

  • Opioids should not be the first line of treatment for pain and should not in general be used for mild injuries. Other therapies, such as non-opioid medication, appropriate physical activity and complimentary/alternative modalities, should be used first.
  • Opioids should only be used for treatment of acute pain when the severity of the pain warrants that choice, and after determining that other non-opioid pain medications or other therapies will not provide adequate pain relief or are contraindicated for medical reasons.
  • They should only be prescribed at the lowest dose that provides pain relief, for a limited time, and with no refill, prior to re-assessment.
  • Opioids for acute pain treatment should be tapered to zero within two weeks whenever possible.
  • If opioids are prescribed, doctors should access the Controlled Substance Utilization Review and Evaluation System, a state drug-monitoring program that tracks prescriptions of addictive prescription drugs. If the system indicates the simultaneous use of other narcotic medication, or if the worker is getting the same prescriptions from other doctors, opioid use may be contraindicated.


In cases of patients with chronic pain, when the doctor is considering prescribing opioids, they should only prescribe them after a comprehensive evaluation is performed and alternative treatments are considered.
Screening identifies patients with high risk of addiction or serious adverse events, substance misuse, and psychosocial factors that may contribute to misuse.

  • Patients are informed about risks, benefits and alternatives for opioids, and a treatment agreement/informed consent is completed.
  • Patients undergo urine drug testing prior to initiating an opioid trial.
  • A trial is conducted prior to committing to chronic opioid treatment.
  • CURES is queried.
  • Carefully manage chronic-pain patients who have been prescribed an opioid.
  • Periodically and randomly conduct urine tests to check for misuse, abuse or diversion (giving the drugs to others or selling them).


The guidelines also spell out steps doctors should take if they suspect misuse, abuse, addiction or diversion of the drugs.

This is good news for employers, particularly if you end up having a worker out with an injury that is causing them moderate to severe pain.

Outside of these guidelines, some insurers have started instituting controls that work closely with treating physicians to intercede if addiction or misuse is suspected. As an employer, you too can get involved by calling the claims adjuster if you suspect the same.