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According to experts, gaining a better understanding of the problem, working with partners, and knowing the steps to take can help employers prevent opioid abuse and misuse from becoming an out-of-control problem among their injured workers.

The problem. "It began in late 2000 when Congress passed and the President signed into law legislation that declared a 10-year period beginning January 1, 2001 'the decade of pain control and research.' Congress felt the medical community was not adequately addressing pain," said Dr. Teresa Bartlett, senior vice president and medical director for Sedgwick Claims Management Services. "It's been growing since 2000 to the point where it is the number one prescribed therapeutic category across the country in all of health care, not just workers' comp."

Veolia, a multinational environmental services corporation, has many employees in safety sensitive positions. Their drivers, for example, are carefully regulated by the U.S. Department of Transportation to ensure their fitness for duty.

"If there is a medication identified that could create an impairment, we can't let them operate [heavy equipment]," McDaniel said. "It's not only a potential safety issue but the protracted use of it. So it increases our workers' comp costs."

Costs. Among the costs to the workers' comp system is the expense to wean patients off opioids. "Where there is good intent and hope, we work with addiction specialists and rehab," Bartlett said. "It is not inexpensive."

In such cases, it's important to determine whether rehab will be successful. Sedgwick partners with mental health professionals who conduct psychological profiles before initiating a drug rehab program to wean injured workers off opioids.

"Some people go through the motions because they are required by workers' comp law. Others truly want to get back to some sort of normalcy and don't want to deal with the pain, and the pain that results from needing these drugs to function," Bartlett said. "This just demonstrates the very different motivation in patients."

Nipping it in the bud. The claims that could become problematic are those involving chronic pain, rather than post-surgery or acute pain. Employers may notice certain workers suddenly have problems concentrating, performing, showing up on time or at all.

"Most companies have some form of employee assistance program. That's the first step," Bartlett said. "There are times a person is enough of a concern that an employer can say, 'I don't need to know about it, but I'm worried about your fitness for duty. Based on these factors I need you to go and get an assessment and I need a note from your physician that you are able to work safely.' I've seen those be very successful."

While employers need to tread carefully, there are additional steps they can take to address the issue at the beginning. As Bartlett explains, approximately 40 percent of the population has a negative reaction to opioids. Working in concert with the treating physician is vital.

"We want to manage that first script with a few days supply, so if they have a bad reaction they don't have a lot of unused pills sitting around," she said.

Employers can request the physician check in with the patient to see if the prescription should be continued beyond the initial few days.

"We hear our clients' employees say, 'I couldn't cook for my kids but now I can. I can now walk my dog a block.' It's little improvements," Bartlett said. "If we don't see those improvements we really want to stop the script by partnering and communicating with the physician. There is no therapeutic value here so let's not continue." Bartlett also suggests the use of physician/patient contracts before opioid treatment begins.

Physicians can also be directed to state prescription monitoring programs to see what medications the patient is taking, the number of pills prescribed, and the dates the prescriptions were filled.

"That can be a tool to help physicians understand if their patient is going to other places seeking pain medication," Bartlett said. "If you live close to a border, you might want to check the next state as well."

Finally, the use of pharmacy benefit managers can help target injured workers who could become opioid abusers. "We get alerts at the claim examiner desk level telling us 'here is a script for a narcotic. Here is a second script. You might want to take action,'" Bartlett said. "We are electronically linked with the PBM so that their alerts are coming to us in real time at the point of sale."

Read more at the WorkersComp Forum homepage.

January 28, 2013

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