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September 2024 (Volume 102)
Quarterly Article
Tasleem J. Padamsee
Courtni Montgomery
Stefan Kienzle
Jeremy B. Straughn
Andrea Elmore
Deborah L. Fulton-Kehoe
Beryl Schulman
Thomas M. Wickizer
Gary M. Franklin
Sep 14, 2026
Jul 29, 2026
June 2026
Back to The Milbank Quarterly
Policy Points:
Context: Unsafe prescribing practices have been among the central causes of improper reception of opioids, unsafe use, and overdose in the United States. Workers’ compensation agencies in Washington and Ohio have implemented opioid review programs (ORPs)—a form of quality improvement based on utilization review—to curb unsafe prescribing. Evidence suggests that such regulations indeed reduce unsafe prescribing, but pharmaceutical companies and patient advocates have raised concerns about negative impacts that could also result. This study explores whether three core sets of problems have actually come to pass: (1) unmanaged pain or reduced function among patients, (2) anger or resistance to ORPs from patients or providers, and (3) damage to patient–provider relationships or clinical autonomy.
Methods: In-depth semistructured interviews were conducted with 48 patients (21 from Washington, 27 from Ohio) and 32 providers (18 from Washington, 14 from Ohio) who were purposively sampled to represent a range of injury and practice types. Thematic coding was conducted with codebooks developed using both inductive and deductive approaches.
Findings: The consequences of opioid regulations have been generally positive: providers report more limited prescribing and a focus on multimodal pain control; patients report satisfactory pain control and recovery alongside collaborative relationships with providers. Participants attribute these patterns to a broad environment of opioid caution; they do not generally perceive workers’ compensation policies as distinctly impactful. Both patients and providers comment frequently on the difficult aspects of interacting with workers’ compensation agencies; effects of these range from simple inconvenience to delays in care, unmanaged pain, and reduced potential for physical recovery.
Conclusions: In general, the three types of feared negative impacts have not come to pass for either patients or providers. Although interacting with workers’ compensation agencies involves difficulties typical of interacting with other insurers, opioid controls seem to have generally positive effects and are generally perceived of favorably.