It is Time to Move Past Maslow's Hammer in Pain Management
Abraham Maslow first published the famous proverb “if all you have is a hammer, then everything looks like a nail,” in 1966 in The Psychology of…
Opioids are a constant headline in nearly every media source almost every day. Rightfully so, since drug overdose, primarily from opioids, is now the leading cause of unintentional death and has cost US companies billions of dollars in decreased productivity, absenteeism, inflated medical claims, and disability. Since 1999, the death rate from opioid overdose has more than quadrupled, and every twenty-four hours, more than ninety people will die in the US due to drug overdose.
Despite all the chatter, all the data, and all the airtime dedicated to opioids too many companies, large and small, are ignoring the reality of the destruction in their own companies. “Not my employees, not my company,” is a constantly stated delusion.
US industry spends billions of dollars each year on travel safety to minimize the cost of motor vehicle accidents. And yet, U.S. businesses have under-reacted to the devastation that the US Department of Health and Human Services is calling “the biggest drug crisis in American history.”
Why? Because, we have mistakenly associated the crisis to people who are unemployed, homeless, and the downtrodden. Or, perhaps the reason is that it’s a painful conversation to have. After all, most opioids are legal and often prescribed by a doctor. Regardless of the reason, it is time for all business leaders, managers, and supervisors to step back from the conjecture and the speculation and consider seven questions and act accordingly.
Do the math. If you have 14 workers over age 50, one of them is likely addicted to opioids. If you have 50 workers between the ages of 20 and 34, you likely have one young person abusing opioids. But, only one? One opioid addict could be costing you between $20,000 and $80,000 annually. And if you’re a small business, that’s a lot of money. And, if you’re a large business, that’s an enormous liability. So, do the math and measure your risk.
More than 259 million opioid prescriptions were written in 2015. With the skyrocketing use of opioids it is important for all managers and supervisors to not only be current on workplace policy but to recognize the signs of opioid use and impairment. Use of any medication that can compromise mental alertness or coordination, even if it is prescribed by a doctor, can jeopardize the safety of the employee and co-workers. It is the responsibility of the manager and the company to keep the workplace environment safe.
Managers must know that the Americans with Disability Act (ADA) may protect the right of an employee’s use of medication. However, if that medication might impair job performance, managers must be educated on how to engage and offer reasonable accommodations or even offer a modification of job responsibility.
Managers must be able to recognize the signs of impairment from medications and determine a reasonable threshold for testing employees for drug use. Those parameters must be consistent with policies and legal. Safety is paramount, but communication is critical.
Employees, like all people, want to be treated fairly and want relief of their pain. They do not necessarily want opioids with their associated side effects and risk of addiction. Research shows that opioids are no more effective than Tylenol, ibuprofen, or Advil for pain associated with most work injuries. In fact, there is little evidence that opioids are effective for the treatment of back pain, and yet, they continue to commonly be prescribed for it. Employees who understand this are much less likely to agree to be treated with opioids if given the choice.
Does your workers compensation staff provide this information, how about company employed medical staff? Are they educating your employees about opioids and their treatment choices?
The employee must be educated before the time of prescribing. Even though opioids are prescribed by their physician, the employee must know to discuss their concerns about taking them as soon as the medical provider recommends it. Workers must be warned that an opioid prescription can have a significant safety impact on driving and use of machinery by altering a person’s judgement, reducing muscle strength, and impairing coordination. This can lead to an individual receiving a driving under the influence (DUI) citation. Employees also need to know that they can be mandated to take sick time if opioid use impairs their ability to do their job safely or well and alternative duties are not available. (is that consistent with ADA?)
Employer sponsored EAP’s are a cost-effective solution to providing treatment to workers with OUD. The cost to replace an employee can run as high as 100-200% of the employee’s annual compensation, not to mention the loss of knowledge, experience and productivity. Most employers purchase EAP’s and understand the benefit to the bottom line. However, few employees with an OUD use them for fear of negative repercussion. And fewer employers utilize an opioid medical advisor to help focus and oversee the work of the EAP.
EAP’s should help employees to understand the benefit of the program and minimize the fear of negative ramifications from seeking treatment. Employees must understand the support for OUD and other aspects of confidential opioid decision-making that is available through their various company benefits. Advocating for EAP is a critical part of promoting a drug-free workplace.
Workers taking opioids can become dependent much more quickly than they realize and can experience negative physical effects if they try to stop. This becomes strong motivation to keep taking opioids even if the worker wants to stop. Workers must be educated to understand the difference between dependence and addiction and the importance of intervening before a serious addiction develops. The EAP is a vital resource in getting employees timely help.
Several medications are available for the treatment of workers with OUD. Suboxone is an effective alternative to opioid weaning or to stopping opioids “cold turkey” with better long-term outcomes. The advantages of suboxone include a lower potential for abuse and a high success rate in the treatment of opioid dependence. Because of serious biochemical changes that have occurred as a result of the abuse of opioids, many will have to remain on medication for several months or a year and some for the remainder of their lives.
Medications for the treatment of OUD are significantly underutilized due to lack of providers eligible to provide the treatment, coverage, and other limitations on access. Managers and supervisor the key to promoting the option of medication assisted treatment and should be comfortable with initial and ongoing support for workers.
The DEA requires that the all medical providers have a waiver from the DEA in order to prescribe Suboxone. Companies should encourage their company care doctor or the providers to which they refer their employees to obtain the DEA waiver and to develop a comprehensive opioid withdrawal treatment program for their employees with OUD.
Your pre-existing policies for alcohol and illicit drug use in the workplace are not a satisfactory substitute for opioid specific policy. Your company should seek opioid specific professional guidance in tandem with your legal counsel to ensure that your policy includes protection for risk management, injury prevention, and liability. Practical policy that works in conjunction with all federal and state specific guidelines is the goal.
Pain is the most common complaint when people seek medical treatment. And yet, during four years of medical school our doctors receive only 8-9 hours of training on how to manage pain, and most doctors report they feel undertrained and unknowledgeable in treating pain.
Once your injured worker receives an opioid prescription, whether it is medically justified or not, the “horse is out of the barn.” Some injuries justify the use of opioids, but many do not. It is critical that our medical providers know how and when to make that determination. And, the best credentialed and intended physicians may not be able to list opioid management as a skill set.
A prescription for an opioid medication often gives an employee the idea that an injury is more severe than it really is. This can prolong recovery and prohibit many from being able to return to work at all. The pain from many, if not most, work injuries can be managed equally well with therapy, ice, heat, Tylenol, and Ibuprofen.
An average workers compensation claim without an opioid prescription is around $13,000. An average claim with one long-acting opioid medication is $114,000. In addition, employees with addiction function at about 75% productivity, so the direct cost to companies is 25% of salaries on that factor alone.
So, you can see that preventing just one employee from unnecessarily being placed on an opioid medication can save your company a great deal of money. Almost every company, large and small, has some level of opioid abuse that is costing them thousands of dollars in profits, significant loss of productivity, and very possibly the loss of human life.
If you have, that’s great and frankly, you’re ahead of the curve. If you haven’t, start now. It’s that simple. Get started developing policies and procedures that involve your health plan, management education and employee education. Know where you stand. Know how to prevent opioid abuse, how to identify it, how to intervene and how to correct the problem.
If you’re pondering these questions and wondering what the answers are in your company, you’re asking yourself the right questions. More importantly, you need the right answers. You need to bring in a professional to onboard your executive team to the realities of opioid abuse and help you answer and respond to all those questions positively and affirmatively. Contact me and I’ll be happy to conduct an executive leadership opioid onboarding session to both test your knowledge and provide the initial direction necessary to reduce your various risks and impacts of opioid abuse.