Work Comp and Illicit Drug Use: What Do You Think?

A new study from Ameritox indicates that work comp claimants are less likely than other payer groups to engage in illicit drug use. 

Ameritox looked at 2 million samples for 1.5 million chronic pain patients over a 2 year span from July of 2010 to June of 2012.  They found that rates of illicit drug use by payer class varied as follows:
- Medicaid (17.1%)
- Self-pay (14.8%)
- Commercial insurance (9.7%)
- Medicare (8.9%)
- Work comp (8.6%)

This finding likely runs contrary to assumptions I've heard many claims executives make about the chronic pain cases on adjusters' desks. 

So, while there are a range of potential explanations, I'll offer two possible perspectives and ask readers to weigh in.

A) Injured workers, generally speaking, have a goal to return to work and dealing with chronic pain through medication therapy is something injured workers, because they are "workers", do responsibly.  We know this isn't true for 8.6% of them, but those are bad apples and shouldn't spoil our view of the bunch.

B) Injured workers in chronic pain enjoy a higher rate of iatrogenic (physician-caused) tolerance, dependence, and addiction.  Work comp claimants don't need illicit drugs because they're getting all the narcotics they need from their physicians.  The existence of an indemnity benefit (which doesn't exist in the other payer classes) drives patient-directed care and higher levels of narcotics use without the need to seek out illicit drugs. 

What say you?  A or B?
I'll post the (informal) results in a few days. 

Michael
On Twitter @PRIUM1