Since the 1990s, the use of opioids to treat moderate to severe pain has increased dramatically. The current federal administration has declared it an epidemic. Surgeon General Vice Admiral Jerome M. Adams is on a mission to change the course of its use and address this epidemic that affects every family in our great country.
This epidemic is directly impacting employees and employers. It affects nearly every age group, with a propensity to impact the adult working class and their covered lives to a great degree.
Factors That Have Influenced the Increased Use of Opioids
Prior to the late 1990s, the use of opioids to treat moderate to severe pain was not widespread. However, in the late 1990s, the pharmaceutical companies who marketed opioids to the medical community reassured them that patients would not become addicted to prescription opioid pain relievers. Health care providers began to prescribe opioids at greater rates. This subsequently led to the misuse of these medications before it became clear that these medications could indeed be highly addictive.1
For employers this economic burden alone is significant, but it does not include employer issues such as:
- Replacement costs, both temporary and permanent
- Unexpected/unplanned absences
- Short- and long-term disability costs
- Coworker impact on workloads
- Coworker impact on deadline issues
- Business impact on deliverables
- Impact on employee morale
- Impact on retention goals and attraction goals
With the mainstreaming of ambulatory surgery centers, patients are being sent home within hours of a surgical procedure with strong pain medications that are not carefully monitored by clinical professionals. This is potentially leading to more opioids being prescribed without good quality control and oversight procedures.
Potential opportunities for misuse or long use include procedures such as:
- Knee replacements
- Hip replacements
- Back surgeries
- Neck procedures
- Spine surgeries
- Most orthopedic surgeries (eg, shoulder surgeries)
- Chronic illnesses such as rheumatoid arthritis
- Chronic myalgia
- Dental surgery
What Can Employers Do?
1. Reduce Distribution
We need to inform and provide coverage for these medications when they are appropriate; however, we must reduce the use and ability to get these harmful medications when they are not. That means limiting the prescribing of opioids to no more than 3 to 5 days, since opioid tolerance can begin as soon as the fifth day of taking it.
Here’s what can happen when a patient takes opioids: The cascade goes from the body becoming tolerant to opioids at the cellular level to the body becoming dependent on more of the same drug to get the original therapeutic effect, to the patient being addicted and seeking more and more to get any effect.
So why are we continuing to support the overuse of this medication when it is bound to produce side effects that are unacceptable for patients and our loved ones? Employees suffering from moderate to severe pain, including cancer pain, should continue to have the most appropriate pain medicine available to them. However, controls need to be put in place to avoid any potential abuse of these medications.
2. Increase Awareness/Education
As an employer, you can play a vital role in providing good awareness information and education on these issues to your employees, covered lives, and retirees. This is a huge opportunity.
In addition to information about opioid misuse, employees and their covered lives should be informed about the lifesaving antidote naloxone, also known as NARCAN® for emergency use when an opioid overdose is suspected. It is now available in many states without a prescription.
3. Enlist Community Support
Employers can work directly with their local law enforcement departments to provide forums and community-wide outreach opportunities. Your state government affairs teams can foster a close working relationship between your law enforcement officials and your political leaders to begin to drive not just awareness but a strong community call to action.
An excellent place to also begin dialogue is with your local emergency room professionals. They see the effects of this epidemic firsthand. These professionals can provide a very powerful message on their firsthand experience with patients in your community.
Your ultimate goal is to marshal a community-wide effort around this issue. Getting a dialogue started and pulling resources with a communication plan using local and regional governmental resources can be useful and a major step forward.
4. Support Rehabilitation
What can employers do to support those employees who are opioid dependent?
- Self-funded employers can integrate their behavior health benefits with their medical and pharmacy benefits.
- Self-funded employers can ensure Employee Assistance Program support for both employees and covered lives is a priority for both groups.
- Fully ensured employers can use larger buying groups and seek out national behavior practitioners that have good track records.
- Both self-funded and fully ensured employers should ask their medical health benefit insurers to certify and recommend behavior health insurers that meet high standards.
- All insurers should provide long-term rehabilitation coverage and multiple admission coverage to address readmission needs of this difficult and complex medical/behavioral issue.
- All employers should require health insurers to provide rehabilitation coverage in a manner that is closely aligned to their medical coverage.
- Unionized employers should maximize their behavioral benefit so that any unionized employee and their covered lives get extensive inpatient and outpatient coverage along with multiple admission needs as necessary.
The Time for Action Is NOW
Over the years, employers have taken a strong leadership role in providing excellent access to health education programs, health and wellness programs, and state-of-the-art medical providers for issues that affect their workforce.
It is incumbent that these same employers now take a leadership role in addressing the opioid crisis facing our nation. With their expertise, knowledge, and experience, they can have a significant impact on this epidemic facing our nation.
— John T. Herrick, MS, is VP of Strategic Services for Aventria Health Group.
The views and opinions expressed are those of the author and do not imply endorsement by Aventria Health Group.
Reference 1. National Institute on Drug Abuse. Opioid overdose crisis. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis. Published March 2018. Accessed October 8, 2018.