If you had told me fifteen years ago that opioid prescribing would eventually become one of the defining healthcare issues of a generation, I would have believed you.
If you had told me that we would spend more than a decade collecting mountains of data, implementing formularies, changing prescribing guidelines, introducing prescription monitoring programs, restricting access, educating physicians, and dramatically reducing opioid utilization, I would have believed that too.
I would have believed you because, starting in 2003, I built services, spoke and wrote, and lobbied regulators and legislators against the over-prescribing of opioids and the medication cocktails used alongside them to manage symptoms and risk. That is the origin story of my RxProfessor moniker.
What I would not have predicted is that many people would still misunderstand the lesson.
The opioid story was never really about opioids. It was about what the overuse of opioids revealed.
I have stated on many occasions that workers’ compensation was one of the earliest warning systems for what would later become a national crisis. Long before opioid overdoses became front-page news, claims professionals, nurse case managers, pharmacists, and physicians were seeing the consequences play out in real time. Injured workers who should have recovered within weeks were remaining disabled for months. Functional improvement was being replaced by medication dependence. Side effects were creating new problems. Families were struggling. Claims were deteriorating. Monthly and reserve costs were escalating.
Our industry recognized the issue early because we had the most at risk. Workers’ comp often carries the cost of medical care for years, sometimes decades, beyond the end of a policy year.
At the time, much of the industry’s attention focused on the medication itself. Its brand or generic name became an active part of our lexicon.
Over the past decade, however, the data has been telling a very different story. Opioid prescribing has declined dramatically across healthcare and within workers’ compensation. According to 2024 research by NIOSH, work comp claims involving opioid prescriptions declined from approximately 55% of prescription claims in 2012 to roughly 32% in 2022. That is a remarkable shift in a relatively short period of time.
More broadly, national opioid prescribing rates have fallen substantially from their peak years, and opioid dispensing rates continue to decline across the country. You can read more about it at the CDC’s “Opioid Dispensing Rate Map” published in February 2026.
By many measures, those statistical trends are a success story. But success stories can be dangerous when they create the illusion that the underlying problem has been solved.
The lesson was never simply “prescribe fewer opioids.” The lesson was “understand pain differently.”
One of the most important things the opioid crisis exposed was how often healthcare, and work comp specifically, confused symptom management with recovery. When an injured worker reported pain, the system frequently responded with a prescription, using the highly subjective Visual Analog Scale of 1 to 10 as an objective measurement. The goal was understandable. We wanted to relieve suffering, improve comfort, and help people regain function.
The problem was that pain is rarely that simple. Pain is physical, psychological, and social. Pain is influenced by expectations, fear, catastrophizing, stress, relationships, financial pressures, sleep quality, activity levels, the dynamics of the claims process itself, uncertainty about return-to-work, and countless other factors. Yet for years, many systems behaved as though pain could be solved primarily through pharmacology. Almost everyone chose the easiest path … a prescription.
In fact, treatment required a more holistic – biopsychosocial – approach. While that model was initially developed in 1977, it was a completely new concept to most of our industry when I first started advocating for it in 2011. Unfortunately, most people looked at me as though I was Medusa and wanted nothing to do with “opening pandora’s box of psych” as part of a work comp claim.
Eventually, we learned that reducing pain does not necessarily improve function and improving function does not always eliminate pain. Neither one automatically leads to recovery. That realization fundamentally changed how many of us think about claims management. That shift, from treating symptoms to treating the whole person, is the foundation of how we think about recovery today.
The most effective claims professionals no longer ask, “How do we reduce pain?” Instead, they ask, “How do we improve recovery?”
Those are very different questions.
The opioid data also taught us something equally important about unintended consequences. In healthcare, every intervention has the potential to create a cascade. A medication prescribed to address one problem creates side effects that require another medication. Activity levels decrease. Sleep becomes disrupted. Anxiety increases. Functional capacity declines. At some point, we are treating the consequences of treatment rather than the condition that initiated the process (also known as iatrogenesis). As an example, the 2016 Super Bowl advertisement that introduced OIC (opioid induced constipation) as a new medical acronym was a wakeup call for many. Especially when they realized the commercial was on behalf of a medication that would address OIC and not the reduction of the opioids that were inducing constipation.
I’ve written previously about the concept of a medical cascade. The opioid crisis provided one of the clearest examples our industry has ever witnessed of that concept.
The good news is that many stakeholders responded. Formularies were implemented. Guidelines evolved. Prescription monitoring improved. Educational efforts to both prescribers and patients expanded. Clinical oversight increased. As a result, prescribing patterns changed dramatically.
The other good news is that our thinking changed as well. We … eventually … embraced the bigger opportunity. We learned that:
- Injured workers are more than diagnoses
- Communication influences outcomes
- Expectations matter
- Function is often a better measure of progress than pain scores
- Behavioral health cannot be separated from physical health
- Early intervention matters
And perhaps most importantly, we learned that recovery requires a whole-person perspective.
Those lessons remain just as relevant today as they were during the height of the opioid crisis. In fact, they may be even more important.
Today, our industry faces new challenges. Behavioral health claims, presumptive or not, are increasing. Medical complexity continues to grow. An aging workplace brings more physical and psychological comorbidities. New treatment options continue to emerge like cannabis, psychedelics, and virtual reality. Meanwhile, acupuncture, once considered alternative, is gaining acceptance among a growing number of payers, including work comp.
Different issues. Same underlying lesson.
The answer is rarely found in a single treatment, a single medication, a single technology, or a single intervention. Recovery is much more complicated than that.
When you review a claim today, are you more interested in the pill count or what the pill count represents? What is driving the prescription? What barriers to recovery exist? What conversations are occurring? What expectations have been established? Is the worker becoming more functional? Are they empowered and engaged?
Those questions tell us far more than a pharmacy report ever could.
The opioid crisis taught our industry many valuable lessons, but perhaps the most important one is this: data is only useful if it changes how we think as we uncover the root cause(s). We can celebrate declining prescribing rates, reduced opioid utilization, and improvements in clinical oversight. Those achievements matter and should be recognized.
But the real value of the past decade lies in what it revealed about recovery itself.
The goal was never to win a war against opioids. The goal was always to help injured workers reclaim their lives.
If the last decade taught us anything, it is that recovery cannot be measured by the number of pills prescribed, denied, or discontinued. Instead, it is measured by whether the person behind the prescription is moving forward.
And that is a lesson worth carrying into whatever challenge comes next.
