Experts: Treat Addiction to Mitigate Opioid Crisis

A new study says the focus needs to change from addressing the nonmedical use of painkillers to preventing and treating addiction.

By: Nancy Grover | March 16, 2015

Stemming the opioid problem in the workers’ comp system should be a multi-faceted approach done in a three-tiered process, says a new study. The key, according to the authors, is ensuring providers are educated about opioid prescribing, identifying those who have recently become addicted, and providing treatment for those affected.

The study, published in the Annual Review of Public Health, says the focus needs to change from addressing the nonmedical use of painkillers to preventing and treating addiction.

“Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers,” the study begins. “Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use.”

Opioids and Heroin

Efforts to address the opioid epidemic have, according to some reports, coincided with the increased use of heroin. But the two are not necessary related.

“Not really, especially not the way the media is portraying it,” says Dr. Andrew Kolodny, chief medical officer of the Phoenix House, president of the Physicians for Responsible Opioid Prescribing, and principal author. “It’s becoming dominant narrative — ‘efforts to crack down have had unintended consequences.’ That’s not really accurate.”

Heroin abuse has been increasing “since the beginning of the painkiller problem in 2001,” Kolodny said. “So switching is not happening all of a sudden, it’s been going on from the very beginning.”

Instead, Kolodny says the overprescribing of opioids in the early 2000s created addicts, which likely fueled the rise of heroin abuse. He noted that the age group of people abusing heroin are those under 40 years old.

“Once you’re addicted and you’re young with no medical issues, you can get pills,” he said. “But if you’re badly addicted, it’s hard to get enough pills. … That group winds up on the black market.”

But overprescribing also fosters addiction in older people. The difference, he says, is they are more able to obtain legal painkillers from physicians.

“What’s interesting is the rate of drug overdose deaths is much higher in the 40 plus [age] group that gets pills from doctors, the age group 45 to 50,” he said. “The sharpest increase is in that group and older.”

Physicians, he said, are starting to get the message about opioid abuse and some, at least, are changing their prescribing patterns. However, as the article points out, more physician education is part of the primary prevention step in the process.

“In academia, among leaders in the field, experts, people who read medical journals, it’s very clear. They’ve got the idea,” Kolodny said. “A lot of physicians out there do not read medical journals.”

Addiction

Addiction is defined as “continued use of a drug despite negative consequences.” Injured workers who are physiologically dependent on opioids may become addicts simply by trying to avoid withdrawal symptoms.

“They feel sick when they stop,” Kolodny said. “People think of withdrawal as like having the flu and a panic attack. There is a sense of impending doom. [They feel like] they are going to die. Anyone who’s experienced that will often go to great lengths to avoid going through withdrawal.”

One of the first steps in helping injured workers who are addicted to opioids is identifying them, but that can be difficult.

“With someone who is on opioids that they don’t get from a physician, it’s much easier to spot addiction,” Kolodny said. “People will do all sorts of things to get them — lie, cheat, steal. So the drug-seeking behavior becomes part of the way we identify people with the disease.”

But injured workers who have easy access to large doses of opioids won’t necessarily exhibit those behaviors. “Sometimes they take [the medications] exactly as prescribed and they spend their lives sitting on the sofa,” Kolodny said. “They become depressed and become nonfunctional. What you are seeing is a decline in the quality of their life. If you can attribute that to having been put on opioids even though there is no clear abuse — such as snorting [drugs] or doctor shopping — I’d say that person is addicted. They are continuing to use despite negative consequences.

Treatment

Tertiary prevention strategies involve both therapeutic and rehabilitative measures, according to the article. The goal here is to prevent overdose deaths, medical complications, psycho-social deterioration, transition to injection drug use, and injection-related infectious diseases. Medication as well as psycho-social approaches are recommended.

“Everybody is different,” Kolodny said. “Probably for most people it would be a combination of both. I think at least at the outset there are many people opioid addicted who over time can learn how to manage their addiction by taking one of [the recommended] medications and do pretty well. … But within the first few months or year, they should be getting more than just a prescription, or the likelihood of a good outcome is slimmer.”

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected].

How a Carrier Partner Can Help Navigate a Challenging Management and Professional Liability Market

A combination of a choppy economy with increased claims frequency and severity could lead to rate increases in the Management & Professional Liability market.

By: Risk & Insurance | April 3, 2024

Rates in the management & professional liability (M&PL) markets were on the rise from 2020 to early 2023 and are now falling rapidly.

M&PL divisions manage a number of different insurance products including management liability (D&O), professional liability (E&O), employment practices liability (EPL), fiduciary liability policies, cyber, etc. In 2023 and into 2024, a big influence on the marketplace has been the extremely aggressive and softening public company D&O market.

Though these rates have been softening for management liability, that may change over the next few years as companies continue to adjust their business models motivated by economic uncertainty. Layoffs were up nearly 200% last year, Forbes reported, even as other recession indicators, like the inflation rate, improved. A recession could lead to an increased claim activity and force carriers to raise rates.

“Whenever there is a meaningful downturn in the economy, we tend to see claim frequency pop up,” said George Schalick, Jr., senior vice president of the Management and Professional Liability Division at Philadelphia Insurance Companies (PHLY).

With continued fiscal uncertainty, businesses potentially already burdened with pandemic-related claims should seek a carrier with a long history in M&PL products. They will provide much-needed risk management guidance and be better positioned to support their insureds during market fluctuations.

Why Insureds Might See an Uptick in M&PL Claims

George Schalick, Jr., Senior Vice President of the Management and Professional Liability Division, Philadelphia Insurance Companies

The current soft market might come as a bit of a surprise as it does not track with previous underwriting cycles and economic conditions. Afterall, many privately held and non-profit organizations struggled during the early days of the pandemic with shutdowns and rapidly declining revenues. But the Government assistance programs, like the Paycheck Protection Program loans, helped keep many afloat during the tough times.

“During COVID many organizations stopped doing business until they were able to sort out all of the health and safety challenges,” Schalick said. “They were forced to lock down, but then all the government assistance programs allowed them to keep people employed. The increased volume of claims we anticipated we would see coming from the lockdowns and restrictions that were imposed upon businesses in the U.S. didn’t manifest at first.”

“Just because there wasn’t an onslaught of reported claims at the beginning of the pandemic, doesn’t mean the circumstances that would give rise to a claim being reported didn’t occur. Courts and the judicial system were closed or slowed and now that they are back open, we’re starting to see the circumstances that occurred during the COVID lockdowns becoming claims today,” Schalick said. “Litigation is progressing.”

Added to the delayed pandemic litigation is a concern over newer claims that might be filed as the country inches toward an economic downturn. Though a recession was avoided in 2023, experts think a soft dip could occur in 2024, with 76% of economists saying there’s a 50% or less chance of an economic downturn this year — that almost always results in more management liability claims.

“During the Great Recession in 2008, we saw an almost immediate spike in claims because of the economic conditions and the pressure it placed on organizations. They were making personnel changes with significant belt tightening almost immediately.” Schalick said.

What’s in Store for M&PL Policy Rates in 2024?

Despite an uptick in claims and increased economic uncertainty, management liability rates haven’t increased, resulting in market-wide pricing levels that may not meet the increased pressure of rising settlements and jury verdicts.

“Rates are going the other direction and settlement values are not falling,” Schalick said.

The mismatch between rates, claim frequency and severity is, in part, because carriers experiencing the dramatic soft market in the public D&O market are seeking premium gain in the private and non-profit market.

“In the public company market, the rates have been decreasing significantly. The rates were increasing in the private, not-for-profit market, and rightfully so, but there’s a desire to supplement overall mid-size D&O for carriers who also write private not-for-profit, and they see that as an opportunity to aggregate premium,” Schalick said. “So the always competitive landscape in the private, not-for-profit market has dramatically increased in the last 18 to 24 months.”

Still, companies of all sizes and types should be concerned about management liability rates in the future. Legal system abuse is resulting in increases in both the amount of litigation and the size of verdicts plaintiffs are receiving.

Certain areas of the country are particularly vulnerable to this type of legal system abuse. As a result, insureds in these localities are likely to be vulnerable to rate increases.

“The environment is so positive for the plaintiff that forces premium increases so carriers are able to stay in that market long term,” Schalick said.

Why a Tenured Carrier Partner Can Help Insureds Navigate An Uncertain Market

It’s clear that insureds are facing an uncertain M&PL market over the next few years. Fortunately, carriers with a long history in the M&PL space will be there to offer stability.

Philadelphia Insurance Companies has been supporting this market for 35 years. PHLY is committed to offering long-term rate stability, even as economic and claims trends start to push premiums upwards. They have an appetite for all sorts of companies, large and small, for-profit and nonprofit alike.

“We’ve been at this game for a long time and are one of the most tenured underwriters in this space,” Schalick said. “We like to stay very consistent.”

PHLY has worked with both for-profit and non-profit on management liability policies. With dedicated M&PL teams throughout the company’s 13 regions, PHLY provides the support agents and brokers are looking for on behalf of their clients. The teams know their regions well and can respond to local trends. They’re also dedicated to making the renewal process as easy as possible for their partners and policyholders.

“We have real confidence in our results, so we focus a lot on making the renewal experience as painless as possible for all agents and insureds,” Schalick said.

The company is also investing in tools to help insureds avoid losses. Earlier this year, they launched a new online risk management platform, PHLYGateway, which offers resources for insureds on how to create an employee handbook and trainings on issues such as recognizing workplace sexual harassment and discrimination.

If insureds have questions, they can consult a Best Practices Help Line, provided via the platform. That way, they can get on the spot risk management guidance to help them prevent claims.

To learn more, visit: https://www.phly.com/mplDivision/managementLiability/default.aspx.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Philadelphia Insurance Companies. The editorial staff of Risk & Insurance had no role in its preparation.

Curbing the Opioid Epidemic