Opioid-involved drug overdoses topped 100,000 in 2022, according to the Centers for Disease Control and Prevention (CDC).

And another 10 million people misused prescription opioids in 2019, reports the U.S. Department of Health and Human Services .

Opioid painkiller misuse has become widespread, affecting every facet of life – and that includes the workplace. It not only threatens the general well-being of employees, but it can also create on-the-job safety risks and inhibit recovery and return-to-work.

Opioids do have their place when properly prescribed and used, but their misuse can have devastating effects on your employees.

Here are some basics for employers on opioids and opioid misuse:

What are opioids?

Opioids are narcotic painkillers that work by preventing pain signals from reaching the brain. They are synthetic drugs that resemble the effects of natural opium, derived from the opium poppy. OxyContin and Percocet are a couple of the popular brand-name opioids, but there are many more. Taking them may produce a euphoric effect, or “high.”

Why are they prescribed?

Opioids are generally recommended for short-term pain relief due to injury, surgery, disease or cancer treatment, or as a palliative measure for the terminally ill, but doctors also prescribe them to address chronic pain.

However, due to increasing opioid prescriptions for chronic pain, and a related increase in overdose deaths, the CDC issued guidelines for prescribing opioids. The guidelines are intended for primary care clinicians and other clinicians providing pain care for outpatients 18 years or older with:

• Acute pain (duration less than 1 month)
• Subacute pain (duration of 1-3 months)
• Chronic pain (duration of more than 3 months)

Are they necessary and effective?

Studies show that long-term use of high doses of opioids usually isn’t the best treatment for chronic pain, unless the patient is terminal.

In fact, nonopioid therapies are at least as effective as opioids for many common types of acute pain, according to the CDC.

“Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient,” reads a portion of the guidance from the organization.

Using the drugs long term can actually increase a patient’s sensitivity to pain, requiring higher doses for the same level of pain relief. This escalating dosage pattern can contribute to opioid addiction. Also, opioids are not among the most effective – or longest lasting – options available for relief from acute dental pain, an examination of the results from more than 460 published studies has found.

In addition to the risk of tolerance and addiction, according to a CDC factsheet , other side effects of taking opioids can include: constipation, nausea, vomiting, dry mouth, sleepiness, dizziness, confusion, depression, lower testosterone (resulting in lower sex drive, energy and strength), itching and sweating.

What about other treatment options?

A 20-year analysis of health care treatment released in early 2024 revealed a significant rise in use of complementary health approaches, such as yoga and meditation, especially for pain management.

The analysis , conducted by the National Institutes of Health’s National Center for Complementary and Integrative Health and published in the Journal of the American Medical Association, found that the percentage of individuals who reported using at least one of seven alternative approaches to care increased from 19.2 percent in 2002 to 36.7 percent in 2022.

For pain management, the use of alternative therapies increased from 42.3 percent in 2002 to 49.2 percent in 2022.

Researchers utilized data from the 2002, 2012 and 2022 National Health Interview Survey to evaluate changes in the use of seven complementary health approaches, including yoga, meditation, massage therapy, chiropractic care, acupuncture, naturopathy and guided imagery/progressive muscle relaxation.

How likely is it that one of my employees will suffer from opioid addiction?

In 2022, there were 39.5 prescriptions written for every 100 people in the U.S., although some counties had rates above 51 per 100 people, according to CDC prescribing rate maps . That 39.5 figure is down from 46.8 in 2019.

Opioid abuse has become so pervasive that any employer should be conscious of the possibility that an employee could be affected. The U.S. Health and Human Services Department declared the opioid crisis a public health emergency in 2017.

About 3 million people in the U.S. have had or currently suffer from what the National Library of Medicine calls opioid use disorder (OUD) as of July 2023. The group says the increase in OUD can partially be attributed to the overprescribing of opioid medications.

As an employer, how does this issue affect me?

The most important aspect of the opioid addiction epidemic is its potential to significantly impact the well-being of your employees, whether they themselves are misusing the drugs, or they’re dealing with the stress of a loved one’s addiction. Any drug addiction can have numerous negative effects like harming family relationships, threatening financial stability and even causing death.

Employee opioid use can also affect workplace safety. Employees taking opioids (even if not addicted) could pose a safety risk to themselves and other employees, depending on the kind of work they do.

• The behavior of someone on opioids can be similar to that of someone who has been drinking
• Jobs that involve working from heights, being on construction sites and driving are among those that cannot be safely performed while on opioids

An employer might choose to have a policy preventing employees from performing these kinds of tasks while taking drugs, like opioids, that can diminish alertness.

State laws differ on employee drug testing, and additional legal issues such as compliance with the Americans with Disabilities Act can come into play, so it’s wise to consult legal counsel before instituting a formal policy.

What’s being done to combat the trend of opioid abuse?

Medical providers, pharmacists, insurers and government agencies are all taking steps to combat the epidemic.

Doctors are assessing patients’ risk factors for misuse of opioids more carefully before prescribing them. More doctors and pharmacists are also participating in prescription monitoring programs, which are statewide databases listing all prescriptions of controlled substances and when those prescriptions are filled.

These systems allow doctors, dentists, pharmacists and law enforcement to see whether a patient is getting multiple prescriptions from different doctors, or filling the same prescription in multiple places.

Some physicians also use narcotics contracts to better control patients’ use of opioids. These contracts typically prohibit a patient from getting pain medication prescriptions from other doctors. Many physicians will obtain random drug testing to ensure that patients are taking their medications as prescribed.

Insurers are often requesting peer-to-peer reviews when they question whether an injured employee is being prescribed the most appropriate medications. In these cases, a pharmacist and pain management specialist will look at the case and talk with the treating physician about their course of action. SFM has expert staff who review opioid prescriptions and works with treating physicians and claimants to help wean them off the drugs.

Lastly, the CDC has issued federal guidelines for prescribing opioids for chronic pain. The states of Minnesota, Wisconsin, and many others, have issued state treatment guidelines.

Additional resources

• National Safety Council opioid resources
• Opioid Epidemic Response: Employer Toolkit

This blog was originally published in December 2022 and updated in February 2024 with new information and additional research.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Many employers don’t realize how much control they can have over their workers’ compensation premiums.

Because premiums are based partially on your loss history, you can avoid future premium increases (and maybe even see some reductions) if you take steps to prevent injuries and ensure your claims are well managed.

Of course, it’s always a good idea to get ahead of potential injuries. Being proactive and building a safety culture in the workplace helps. This can include:

• Creating safety committees
• Implementing safety walks
• Checklists to encourage safety
• Regular safety discussions between employees and leadership

Below are some of our top tips for controlling your losses and, as a result, your workers’ compensation premiums.

1. Have a list of transitional jobs ready for when you need it

List light-duty, transitional jobs that fit within a variety of work restrictions.

That way, when employees are injured, you can easily identify jobs that fit within their restrictions and get them back to work quickly. Delays of even a day or two can increase claims costs substantially by triggering wage-loss payments that would otherwise be unnecessary.

2. Consider all your options to bring the employee back to work quickly

Bringing employees back to work when they’re still recovering can sometimes require a little creativity. A few options include:

• Reducing the employee’s work hours or work days
• Bringing the employee back in a different position at a reduced wage
• Modifying the employee’s equipment or work area
• Swapping tasks with other employees or reorganizing work within the injured employee’s group
• Arranging for temporary work in a different area of the company
• Creating a new lighter-duty job that will be transitional and temporary

Many employers don’t realize that if they bring injured employees back to work at less than their full pre-injury wage, their workers’ compensation insurance will make up most of the difference.

3. Have a relationship with an occupational health clinic

Quality of treatment counts for a lot in medical costs and outcomes.

To find a good clinic, ask officials there whether they have experience treating injured employees and accommodate return to work so the employee can heal while on the job. Ask what information they’ll need from you in the event of an injury, such as an injured worker’s job description.

4. Have a point person for return to work

It helps to have one person who is accountable for getting injured employees back to work as soon as medically possible.

This generally includes staying in contact with the employee, working with the treating doctor and involving the employee’s supervisor.

5. Ensure that employees understand and follow any work restrictions

When injured employees don’t follow their doctors’ restrictions, it can result in costly claim complications.

Take the time to go through employees’ restrictions with them and discuss any aspects of the job that could cause them to do work beyond what their doctor has permitted. Also make sure they know they should follow their restrictions both at work and outside of work.

6. Stay in contact with your injured employees

Let injured employees who are off work know that you are concerned about their injuries and recovery, that you value what they bring to the organization and that you are looking forward to their return.

Keep up on the status, expectations and return-to-work date for each injured employee. Have a plan and stay in touch with the employee, supervisor and claims representative to make sure things stay on track.

7. Report injuries right away

As soon as you learn of an injury, the clock starts ticking toward state deadlines for paying or denying benefits.

Reporting right away keeps you in compliance with these laws and regulations, and allows your claims representative to be responsive to your employees. Delayed reporting can result in longer-duration claims and higher costs. (See our injury reporting page for ways to report.)

Watch out for communications breakdowns. Employees and supervisors need to know who to contact when an injury occurs, and your organization’s point person for reporting claims needs to act with a sense of urgency.

8. Analyze past injuries

Anytime an injury occurs, conduct an accident analysis to identify what caused it and how similar accidents can be prevented in the future.

You can also use your loss history reports to help spot problem areas and identify opportunities to improve safety.

9. Develop a wellness program

Studies show there is a connection between health issues — such as obesity, diabetes and hypertension — and higher workers’ compensation costs.

But that’s only one benefit of finding ways to encourage wellness among your workforce. Encouraging healthy lifestyles can also raise productivity and reduce health care costs.

Bonus tips

Hire smart

Make sure you’re hiring the best possible employees. Legally, you can’t ask job candidates whether they’ve had past workers’ compensation claims, but you can explain the job and its requirements and ask during the interview or in an application whether the applicant can perform the essential functions of the job. Be sure to explain the importance of safety, especially in jobs involving physical labor. Take the time to look into candidates’ backgrounds and talk to their former employers.

Pay close attention to safety

Establish good safety rules and watch for things that cause workplace accidents. Look for any patterns in what’s causing injuries. Correct employees with unsafe habits and promote the importance of workplace safety.

Originally posted May 2017; updated January 2025.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

It’s not hard to find a story on prescription drugs in the headlines.

Maybe you’ve seen news reports on topics such as:

• Prescription drug abuse, which has reached epidemic proportions
• Arguments of overmedication and the push for non-pharmaceutical or non-narcotic alternatives
• Lack of affordability, with pricing increases far outpacing inflation

These issues and many more can come into play when prescription drugs are needed to treat work injuries.

That’s why SFM works hard to make sure injured employees’ medications are managed well. As part of that effort, we partner with pharmacy benefits manager, myMatrixx .

myMatrixx negotiates pricing for prescription drugs and monitors whether comparable, lower-cost drugs might be available. But its services go beyond cost savings. SFM and myMatrixx work together to see that injured employees are getting the best prescription drug treatments for their injuries and aren’t being put at risk for addiction or dangerous interactions.

The safety of our injured employees is critical.

As a pharmacy benefits manager, myMatrixx acts as an intermediary between SFM and pharmacies, negotiating and paying for medications needed to treat work injuries and connecting the appropriate representative when the medications require approval.

myMatrixx has pharmacists on staff who work together with SFM’s medical experts.

How does SFM ensure injured workers are getting safe and effective prescription medications?

myMatrixx provides SFM with reports that give us the opportunity to monitor injured employees’ prescriptions. This allows us to address dangerous combinations of drugs, prescriptions that are higher or lower than recommended doses of medications, and ineffective treatments for injuries.

For example, in one case an employee complained that his prescription drug wasn’t helping him. SFM discovered he wasn’t taking a high enough dosage for it to work.

If there is any concern about a drug(s), SFM can send a letter to the employee’s doctor. Optimal, safe and appropriate medication management is our goal.

How do SFM and myMatrixx control prescription drug costs?

The cost of prescription drugs in the U.S. increased 15.2 percent from 2022 to 2023, according to an October 2023 report from the U.S. Department of Health and Human Services. In fact, more than 4,200 drug products saw price increases.

However, it should be noted that the Inflation Reduction Act, passed in 2023, has a provision aimed at lowering prescription drug costs.

Still, prescription drug spending increased 8.4 percent to $405.9 billion in 2022, according to the Centers for Medicare and Medicaid Services .

Costs for individual drugs can vary widely, sometimes for no obvious reason. Here are a few examples of surprising variations in prescription drug pricing:

• When a manufacturer changed its pricing in January 2023, one drug’s cost went up 3,000 percent
• Some drugs can vary from $15 per dose to more than $140 at pharmacies within a single ZIP code
• A generic medicine could cost $7 or $393 depending on where it was purchased

The world of prescription drug pricing can be complicated at best and downright baffling at worst.

This is why working with a pharmacy benefits manager is so important.

myMatrixx negotiates with its network of 65,000 pharmacies on drug pricing and monitors prescriptions to identify whether identical or comparable drugs might be available at lower prices.

What is SFM doing to prevent opioid addiction?

One major reason prescription drugs have been getting so much attention recently is the sharp increase in prescription painkiller addiction as well as other medications and/or concerning combinations of medications, both legal and illegal.

SFM helps prevent addictions and advocates for weaning patients off the drugs, or at least getting them to a safer dosage.

Company officials send letters to treating physicians of injured employees who’ve been prescribed high doses of opioid painkillers or other drugs of concern, asking them to develop plans to wean the patients off of the drugs. With increased awareness of the dangers of opioids as well as other prescription medications/combinations and the concerns for prescription use disorder or addiction, more and more doctors are complying.

According to CDC, chronic pain is a pervasive health condition affecting as many as one in five adults and nearly one-quarter of them have used a prescription opioid in the past 3 months and this is associated with increased risk for misuse, addiction, morbidity and mortality.

In some cases, injured employees themselves request to be weaned off the drugs due to safety concerns after seeing the letters outlining the risks.

Sometimes, simply tapering down the medication over time isn’t a safe option. In cases of long-term, high-dose opioid use, other dangerous drug combinations, or both, SFM has sent injured employees to rehabilitation programs. These programs focus on non-medication pain management treatment/alternatives as they help people stop using their opioid painkillers.

Overall, SFM has been successful in helping many of our injured employees taking opioids or other prescription drugs discontinue use or decrease to a safer dosage.

Originally published November 2021; updated January 2024.

Your employee was injured at work. You took care of the employee’s immediate medical needs and reported the incident to your workers’ compensation insurer.

What’s next?

You can help prevent similar injuries, get the employee on the road to recovery and ensure a smooth claim process by doing the following:

1. Investigate the incident

The goal of investigating isn’t to find fault, but to understand exactly what happened so you can make sure the same type of injury doesn’t happen again.

Go to the scene of the accident and talk with witnesses to learn what happened. Take photos. Save any equipment involved. Our post on workplace accident analysis tells you how to prepare to investigate incidents and even provides a checklist that can help you think through what happened and how your organization can prevent similar incidents in the future.

2. Consult with your claims representative

Notify your SFM claims representative right away if the employee will be off work. This ensures that the claims representative will have enough time to get wage-loss benefits paid before your state’s deadline.

When the injured worker is released back to work, call your representative. Make sure you’re aware of the status of the claim and the employee’s treatment schedule, and don’t hesitate to ask questions.

3. Stay in contact with the injured employee

Make a call or a visit as soon as you can. It’s important to answer any questions an injured employee has about the expected recovery and return to work.

It’s not uncommon for injured employees to become isolated or depressed and fear they won’t have a job to return to. Reaching out to them early and often reassures them you care about their well-being and are looking forward to their return to work.

For more details on this topic, read our post about staying in contact with injured employees.

4. Arrange for return-to-work

As soon as a doctor clears the employee to return to work, find a way to bring the employee back, even if medical restrictions prevent returning to his or her pre-injury job. Options include finding a temporary light-duty position, reducing hours or adjusting the employee’s regular job to accommodate restrictions.

Make it clear when, where and to whom the employee is to report.

If the accommodation means the employee will be earning less pay, either because of reduced hours or the position pays less, SFM can make up some of the difference by paying temporary partial disability benefits.

Learn more about return-to-work with the post about why return-to-work matters now more than ever to your bottom line.