Opioids and workers' compensation: Why employers should care

In the U.S., about 48,000 people died from a synthetic opioid-related drug overdose in the 12 months prior to June 2020, and more than 10 million people misused prescription opioids in 2019, according to 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.

Opioid painkiller misuse not only threatens the general well-being of employees, but can 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. Due to increasing opioid prescriptions for chronic pain, and a related increase in overdose deaths, the CDC issued guidelines for prescribing opioids for chronic pain . The guidelines instruct physicians to prescribe opioids for chronic pain only when other options have been exhausted.

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. 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.

The CDC advises physicians continually monitor any patients taking the drugs to ensure the benefits outweigh the harms.

The CDC also lists the following alternatives to opioids to treat chronic pain that “may actually work better and have fewer risks and side effects”: acetaminophen, ibuprofen, cognitive behavioral therapy, physical therapy, exercise, antidepressants, seizure medication and injections.

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

In 2020, nationally there were on average 43.3 prescriptions written for every 100 people, although some counties had rates that were nine times higher than this, according to CDC prescribing rate maps .

Opioid abuse has become so pervasive that any employer should be conscious of the possibility that an employee could be affected. Rates of overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, increased 10% from 2017 to 2018. Over 31,000 people died from overdoses involving synthetic opioids (other than methadone) in 2018 according to the CDC.

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 this type of 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 a prescription drug review nurse on staff who reviews opioid prescriptions and works with treating physicians and claimants to help wean them off the drugs.

The Centers for Disease Control and Prevention 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

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

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