Summary
A new research report published today, on National Opioid and Substance Awareness Day, by the Employee Benefit Research Institute (EBRI) finds that states’ efforts to increase drug testing of chronic pain patients undergoing long-term opioid therapy have been successful at increasing testing rates. In general, increased testing is important to prevent opioid abuse and help pain patients and their physicians safely manage their conditions.
As of 2023, 24 states have passed laws that require physicians to perform urine drug testing of chronic pain patients undergoing opioid therapy. Despite the potential health and financial benefits of testing for employees and employers, there is no prior study to date regarding compliance with these state policies or second-order effects.
The new report, “State Drug Testing Laws for Opioid Therapy: Implications for Employment-Based Health Plans,” uses claims data to quantify the impact of the state laws on testing rates of opioid therapy patients and document selection into treatment effects. This research provides key insights for plan sponsors and employers considering cost-effective health benefits designs to support employees with chronic pain.
“The cumulative findings indicate that the state laws have increased testing rates, and the groups with the largest increases in testing rates are those who are most likely to require opioid therapy to treat their chronic pain, showing that urine drug tests are an important diagnostic tool for doctors seeking to responsibly treat employees most in need,” said Eden Volkov, research associate, Health Benefits Research, EBRI.
Key findings in the research report include:
• Pain diagnosis rates among group plan enrollees have been relatively flat over time. Eighteen percent of enrollees were diagnosed with chronic pain in 2013, while 16% were in 2021
• Prescribing opioids for 3-plus months to chronic pain patients has been less common over time, falling from 10-12% prescribed opioids in 2013 to 1-3% in 2021.
• State drug testing laws have no impact on opioid prescribing rates.
• State drug testing laws increase testing rates among chronic pain patients prescribed opioids by 4.7 percentage points (11%).
• Effects are largest for enrollees most affected by chronic pain and in need of long-term opioid therapy, such as workers over 45 years old and those working in physically demanding jobs like construction and durable goods manufacturing.
• Mandatory testing makes healthier patients more likely to receive a pain diagnosis but has negligible effects on those who ultimately undergo opioid treatment once diagnosed.
This research report was authored by Eden Volkov, Ph.D., research associate, EBRI, Aaron M. Gamino, Ph.D., Middle Tennessee State University and Paul Fronstin, Ph.D., director, Health Benefits Research, EBRI.
“Our research findings are novel in that it is the first documented evidence of state-level policies’ efficacy in increasing testing of chronic pain patients. This evidence of the first-order effects of the state-level urine drug testing can be used to further research into the health and employment effects of urine drug testing. This report also shows drug testing doesn’t encourage overprescribing to younger and more vulnerable patients, an important risk to consider. Taken together, these results are promising and indicate that urine drug testing can be an important and powerful tool for allowing employees with pain diagnoses to receive appropriate care while remaining safe,” said Volkov.
National Opioid and Substance Awareness Day, observed on September 21, 2023, is meant to raise awareness of overdoses, reduce the stigma of drug-related deaths and acknowledge the grief felt by families and friends.
To view the complete research report, “State Drug Testing Laws for Opioid Therapy: Implications for Employment-Based Health Plans, visit www.ebri.org/opioid-testing.
The Employee Benefit Research Institute is a non-profit, independent and unbiased resource organization that provides the most authoritative and objective information about critical issues relating employee benefit programs in the United States. For more information, visit www.ebri.org.