In combating the epidemic of addiction, the U.S. Surgeon General has just announced plans to tackle alcohol and drug abuse, nationally—especially opioid addiction—urging doctors, policymakers and the public to ramp up efforts to combat the growing U.S. healthcare crisis.

The numbers are real!  Since 2000, the rate of overdose deaths involving opioids—Fentanyl, Percocet, Vicodin, and others—has increased by 200 percent, according to the Centers for Disease Control and Prevention (CDC).  And, in 2014 alone, nearly 30,000 people died from a drug overdose involving some type of opioid, including prescription pain relievers and heroin—more than in any previous year on record.  Per recent prescribing guidelines issued by the CDC, doctors must change how often and to whom they prescribe drugs like OxyContin, Percocet or Vicodin.  No longer can doctors assume that people who are in legitimate pain are not at risk for Opioid addiction, as was standard medical practice for decades, the report notes.  What’s important is that the CDC’s analysis shows that the longer a person takes Opioids, especially at the higher doses, the greater the risk for serious effects, including addiction, overdose, and death. The statistics apply for all use the drugs – even those legitimately prescribed to combat pain.   While most people taking Opioids don’t become addicted, nearly everyone who takes the drugs longer than a couple of weeks or so becomes dependent on them.

Prescription Opioids are presently the number one workers’ compensation cost driver (in dollars) that controls the ultimate price of medical and indemnity losses.  In addition to the escalating expense involved in opioid prescription, use and abuse, is the addiction to these drugs. The situation is dangerous to employees and employers, and in some cases, fatal.

Never has there been a more destructive influence on the cost of workers’ compensation claims from a single source than the abuse of opioid prescriptions for the management of chronic pain.  Nationally, an estimated 55 to 86 percent of all injured workers are receiving Opioids for chronic pain relief. According to the NCCI, the costs for prescription narcotics per claim are rising in the U.S. In fact, medical costs are now approximately 59 to 60 percent of the total cost of workers’ compensation claims.  Of those medical costs, narcotic drugs account for approximately 25 percent.  Significantly, the construction industry has seen the greatest increase in workers’ compensation claims resulting from narcotic painkiller addiction; thus, a leader in managing the higher expense of drug use and abuse.

Workers’ compensation claims data shows that adding extended Opioid use will more than likely triple to quadruple the cost of a single claim. What key factors cause Opioid use to significantly increase the medical and indemnification costs?

1. Employees are less likely to return to work
2. Increased doctor visits
3. Less focus on recovery and more focus on gathering drugs
4. Additional medical testing
5. The likelihood of a claim ending up in litigation is 75% when Opioid use is longer than 14 days.

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When you combine the over-prescription of Opioids with the common diagnoses of pre-work injury depression or anxiety disorders in individuals, you can easily see the connection to a bigger problem. The combination is becoming toxic and is taking hold of real people….when serious work injuries occur…people can take a wrong turn in over-use of Opioids and become hooked.

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Drug addiction is not pretty nor does it have a pretty face.  In reality, Opioid addiction in the workers’ compensation arena touches all injured employees regardless of their propensity for drug abuse.  It reaches all people regardless of your income status, overall good healthy, and regular medical visits aside from work injury treatment.   Frankly, the average worker has never had a major injury and has never been prescribed narcotics, so they do not understand the impact these strong, mind alternating prescriptions can have on them emotionally. But, the adverse impact is possible with every injury and every employee.

Opioids impact the receptors in the brain and cause a euphoria or high.  All Opiates are rather effective anxiolytics (anti-anxiety) that have traditionally been used with positive results as anti-depressants.  The positive affects of Opiates start when they initiate the release of a cascade of dopamine in the brain, which creates feelings of pleasure and reinforces the behavior, i.e., ingestion of the substance. Because of the intense high produced by the interaction of several opiates and the brain, the drug, once ingested, remains extremely addictive, sometimes causing measurable symptoms of addiction in fewer than three days.

Although Opioids have been used with positive results, studies show that construction workers, for example, have a higher rate of undiagnosed depression than U.S. workers in other fields.  The most common diagnoses are depression, panic disorder and generalized anxiety, but the range covered personality disorders, eating disorders, suicide risk and substance abuse as well as mood disorders.  This high occurrence suggests a lack of social support and coping strategies when it comes to dealing with substantial mental distress.  Possible reasons for this lack of help-seeking behavior could involve reputational concerns and the fear of losing their job.

When you combine the over-prescription of Opioids with the common diagnoses of pre-work injury depression or anxiety disorders in individuals, you can easily see the connection to a bigger problem. The combination is becoming toxic and is taking hold of real people. Research tells us that those whose lives are taken over by drug addiction are often from stable homes with strong families.  But, when serious work injuries occur, these regular people can take a wrong turn in over-use of Opioids and become hooked. And once you’re hooked, it is so very hard to get away from these drugs.  The adverse effect begins with the individual, extends to that person’s family and friends, and then spirals down to impact the employer and its business.

Unfortunately, doctors have historically prescribed Opioids far more broadly than is medically advisable, often as a method of managing chronic pain.  Several states require that doctors check an electronic prescription database to see whether patients are receiving Opioid painkiller prescriptions from other doctors before writing a prescription for the drugs.  It’s crucial that doctors think carefully about whether to prescribe an opioid painkiller in the first place — and that patient’s think carefully about whether to begin treatment with those drugs, especially if they have a history of addiction and depression.

As employers, the best strategy is to be armed with valuable information about the dangers of Opioid use to better manage claims.  Positive intervention that focuses energy on high-risk claim situations before serious problems develop can yield the best results.  Some of these interventions include: proactively meeting with injured employees to discuss return-to-work strategies, Opioid education seminars with both employees and prescribing physicians, and partnering with local doctors who can educate your employees on managing pain and deliberate avoidance of physicians who prescribe and distribute opioids themselves versus of those who partner with pharmacies.

Thinking Ahead

The human and monetary costs associated with Opioid use by employees are clear but can be potentially offset by implementation of substance abuse programs for employees, including education, employee assistance program (EAP) services, and access to confidential treatment. The National Safety Council (2014) recommends that companies consider taking the following actions:

• Establish a drug-free work environment enforced by random drug testing. Managers should develop rules with legal counsel and human resources to ensure inclusion of risk management, injury protection, and liability information. Terms should be clearly articulated and distributed in writing to all employees. In developing the company’s drug use policy, employers also may want to include a medical review officer to evaluate the policy and results from testing.
• Managers need to familiarize themselves with the company’s drug policies pertaining to prescription medication use, as well as regulations on fitness for duty and return to work. For instance, appropriate use of certain prescribed medications may be covered by the American Disabilities Act and, therefore, may not be subject to violation of drug testing.
• Training for supervisors should provide education on how to identify Opioid use disorder behaviors. Similarly, understanding strategies on how to effectively intervene and communicate with employees who may be struggling increases the likelihood of individuals receiving treatment in a timely manner.
• Employee wellness programs can provide valuable education about the risks associated with Opioid use, including impairments in driving, concentration, strength, coordination, balance, and judgment. Individuals taking Opioids also should be reminded about contraindications with alcohol or other medications, such as antidepressants, sedatives, or other psychoactive drugs, which can further impair their cognition and functioning.
• An EAP is a vital resource for directing employees to confidential treatment as needed, including inpatient detoxification, medication-assisted therapy (e.g., buprenorphine, naltrexone), and psychotherapy. Screening, treatment, and aftercare should be benefits covered by the company’s health plan. Employer- sponsored interventions can help defray costs associated with having to replace an employee altogether, such as loss of continuity and productivity.
• Prescription benefit manager technology can be used to alert physicians to potential misuse or abuse.  For example, such as attempted early refills, the prescription of opioids with other medications that may be contraindicated, and visits to multiple physicians for the same prescription—known as “doctor shopping.”
• Informing employees about their rights and treatment options creates an environment more conducive to help seeking. Employees who want help may understandably worry about whether they will lose their job while in treatment. The Americans with Disabilities Act offers some protection, as does the Family Medical Leave Act. What constitutes a “typical” treatment plan varies by an individual’s diagnosis, severity, and level of functioning. Offering short-term and long-term disability allows employees to continue collecting an income if they need to enter rehabilitation, which will require them to take time off from work.
• Finally, employers can help mitigate stigma associated with substance use disorders by educating employees about the biological nature of addictions. Substance use disorders are brain-based illnesses; they are not diseases of failed willpower or character weakness. Creating a tolerant, understanding work environment helps increase the likelihood that employees will feel comfortable seeking assistance.

ABOUT THE AUTHOR

Kristen Long is Managing Director of the Midwest Region – Construction Practice for Arthur J. Gallagher of Chicago, www.ajgrms.com.  A.J. Gallagher is the broker for CFA Core360, the CFA’s member-only insurance program for complete and individualized business insurance lines specific to the cast-in-place concrete industry. You can reach Kristin at Kristen_Long@ajg.com.