Opioids and workers' compensation: Why employers should care

Opioid misuse often starts with a legitimate doctor’s prescription and trip to the pharmacy, rather than a meeting with a drug dealer.

As a result, even individuals who would never seek out illicit drugs can fall prey, and they have.

America’s opioid addiction epidemic threatens every demographic, with drug overdose deaths up among men, women, all races and adults of nearly every age, according to the U.S. Centers for Disease Control and Prevention .

For employers, this means that even employees who don’t fit the stereotypes of drug users could struggle with this potentially deadly addiction.

Opioid painkiller misuse not only threatens the general wellbeing 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. A 2016 National Safety Council survey  showed that 99 percent of doctors are prescribing the drugs for longer than the three-day period recommended by the CDC.

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.

In addition to the risk of tolerance and addiction, according to the CDC , 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?

There were more drug overdose deaths in the U.S. in 2014 (the most recent year for which statistics are available) than there were in any previous year on record, and more than 6 out of 10 of those overdoses involved an opioid according to a U.S. Department of Health and Human Services factsheet . On an average day, more than 78 Americans die from an opioid-related overdose and more than 650,000 opioid prescriptions are dispensed, the factsheet says.

Opioid abuse has become so pervasive that any employer should be conscious of the possibility that an employee could be affected.

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 wellbeing of your employees, whether they themselves are abusing 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.

Other aspects of opioid use and addiction that could affect you include:

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.

Increased workers’ compensation costs:

Studies cited in a Lockton Companies whitepaper  have shown that when injured workers are prescribed opioids, their total claim costs can be four to eight times those of similar claims where no opioids were prescribed. The cost of the drugs themselves is part of the reason for higher claim costs, as the most popular opioids are not yet available as generics. Using these medications can also delay return to work due to safety issues and drowsiness, which results in higher wage-loss benefits.

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, 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 clinical 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  and the U.S. Drug Enforcement Administration has developed a model to help communities fight opioid abuse . The states of Minnesota and 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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