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Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Although difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local governments for judicial, emergency, and social services. This manuscript's objective is to provide payers with strategies to control these costs, while supporting safe use of prescription opioid medications for patients with chronic pain.A Tufts Health Care Institute Program on Opioid Risk Management meeting was convened in June 2010 with private and public payer representatives, public health and law enforcement officials, pain specialists, and other stakeholders to present research and develop recommendations on solutions that payers might implement to combat this problem.While protecting access to prescription opioids for patients with pain, private and public payers can implement strategies to mitigate financial risks associated with opioid abuse, using internal strategies such as formulary controls, claims data surveillance, and claims matching; and external policies and procedures that support and educate physicians on reducing opioid risks among patients with chronic pain.Reimbursement policies, incentives, and health technology systems that encourage physicians to use universal precautions, to consult prescription monitoring program (PMP) data, and to implement Screening, Brief Intervention, and Referral to Treatment protocols have a high potential to reduce insurer risks while addressing a serious public health problem.

Recent policy discussions of the distribution of earnings in the United States have emphasized the effect of formal education and other skill training programs. While the theoretical justification for this approach arises out of human capital analyses, the human capital analyses, as well as the more recent dual labor market analyses also emphasize that on-the-job training is a critical determinant of the income distribution [11; 8]. While a vital determinant of differentials in on-the-job training is the differences that exist between alternative job structures, there has been little analysis of the effect of the characteristics of particular jobs which individuals hold. Rather global measures of onthe-job training (such as years of experience in the labor force) typically are used to analyze the effect of labor market experience on the acquisition of marketable skills [11]. Yet, different "job experiences" obviously result in different types and amounts of on-the-job experience. This article is an attempt to clarify the nature of these differential effects of alternative job experiences by focusing on the effects of career origin on the acquisition of on-the-job training. Earnings differentials generated by on-the-job training in given occupational categories are generated. A central hypothesis is that failure to standardize for career origin incorrectly attributes earnings differentials to differences in formal education, rather than differences in on-the-job training. At least some of the problems in eval