America is experiencing an epidemic that does not discriminate by age, gender, race or income. It is impacting every community and has become a serious public health concern. Opioids, a class of prescription medications that are all derived from the same plant as heroin, are a particularly powerful and dangerous prescription painkiller, and one that has become especially prominent as a treatment for injured workers. In fact, according to the National Institute of Drug Abuse, the number of opioid prescriptions written has nearly tripled in the past three decades, and the trend shows no signs of slowing down.
In certain circumstances, opioids are a powerful tool that can ease a patient’s pain or aid in a speedy recovery from a traumatic injury. However, the risks associated with opioids — addiction, escalation to other drugs, and overdose — mean that employers need to remain vigilant about this pervasive, and potentially lethal, risk.
Dependence and addiction
Patients who are prescribed opioids are often susceptible to dependence and addiction. Because the prolonged use of opioids results in a higher tolerance, the body’s endogenous opioids (which are opioids, like endorphins, that occur naturally in the body) become insufficient to stave off the physical symptoms of withdrawal. Doctors are aware of and even expect many patients to develop a physical dependence if prescribed opioids for a prolonged period of time. Fortunately, doctors can account for this and create interventions that allow patients to break their dependence, usually by gradually lowering the dosage.
Unfortunately, physical dependence is often a precursor to addiction. Addiction occurs when a patient develops uncontrollable cravings for a drug and engages in risky or self-destructive behavior in order to acquire it. It’s worth noting that not all people who develop an addiction have a physical dependency on the drug, just as not all those who have a dependence on the drug will necessarily become addicted.
One especially disturbing trend has been the rapid increase of both heroin use and heroin overdose. These increases coincide with the increased prevalence of opioid use and overdose in the United States. Though it is a disturbing trend, the correlation isn’t altogether surprising. Prescription opioids are chemically very similar to heroin, which is a naturally occurring drug derived from the opium poppy.
Two factors — the chemical similarity between heroin and prescription opioids, and the increased availability of more potent forms of heroin flooding the country in recent years — have created an environment in which people see and use opioids and heroin interchangeably. When opioid users transition to heroin, either as a supplement to or as a cheap replacement for opioids, they then assume all of the risks associated with unregulated, illegal drugs. Unknown levels of purity can make it hard to ascertain the amount of heroin the body can tolerate, and additives used to “cut” the drug might themselves be lethal.
Overdose is an especially complicated risk when it comes to opioids. Most overdoses are usually the result of a patient taking a combination of drugs that can depress the central nervous system and depress breathing, resulting in suffocation. Case law has been varied, depending on both the state and circumstances of overdose. In some cases though, employers may be required to pay workers’ compensation benefits to the survivors of workers who have overdosed on opioids prescribed to treat a job-related injury.
But, even in cases where other drugs aren’t in play, patients can and still overdose. One of the side effects of opioid use is impaired judgment and confusion. It’s not uncommon for a patient to take a dose and find him- or herself taking an additional dose, having forgotten about the one earlier.
3 ways to curb opioid abuse
Fortunately, there are measures that employers can take to decrease the abuse of opioids among employees. Some are preventive, while others are designed to identify and combat opioid abuse in employees. Taken together, they represent a robust, comprehensive strategy for keeping employees safe and free from substance abuse.
Educate workers: The best way to combat drug use is to stop it before it starts, and the best way to prevent opioid abuse is through education. The good news is that a number of surveys show that patients are becoming more invested in their healthcare treatment plans and are looking for more information. Use that as an opportunity to educate your workers on the dangers of opioid use.
Speak with healthcare providers: If your company partners with a clinic, make sure to talk to doctors about the danger of over prescribing opioids. (See our article to learn more about establishing a clinic relationship.) Sometimes, when dealing with severe acute pain or chronic pain for which other interventions have failed, opioids might be an appropriate treatment. Often, though, doctors may prescribe opioids to patients who might do just as well, or better, with other, less dangerous pain relievers. Make sure the doctors that you work with are aware of all treatment options and are diligent about preventing opioid abuse.
Gather thorough patient histories: Certain risk factors — like depression, high blood pressure or obesity — radically increase the likelihood of dangerous side effects from opioid use. Gathering patient histories can alert doctors to these risk factors and allow them to alter treatment plans so that patients with a high risk are closely monitored for those ill effects.
Can this epidemic impact your company?
The answer is yes. Your healthcare and business costs are determined by the health of your population and how they manage their health and well-being. Aggregate financial and utilization data provides a high level overview of the cost, but it does not allow you to drill down looking for the specific drivers for the cost, or answer these questions:
What is the risk associated with my employee population for experiencing chronic pain? What is our prevalence for neck pain or back pain or osteoarthritis?
What are the opioid prescribing patterns?
Are there increased emergency department visits or inpatient admission due to non-medical opioid use?
Are there other chronic conditions that could play a role?
Are they receiving care for their addiction? Addiction is a chronic condition similar to high blood pressure or diabetes; however access to care sometimes is limited.
It's important to understand that opioid addiction is preventable and treatable. Look for the key drivers of the risk in your population and begin to address those risks. Our health management team, utilizing our robust clinical data analytic tool, can help you identify your hidden healthcare costs and partner with you to develop a multi-year strategy plan that will meet the needs of your company and your team. If you are interested in learning more about Health Management Solutions, please contact us.