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PREVENTING OPIOID ABUSE
Opioid drugs can provide short-term relief to individuals suffering from severe pain. But their high cost and high rates of misuse and abuse can create problems for employers. We have seen the abuse within the PCOC Insurance Program. Read on! The Problem Opioid pain relievers (also called narcotics) include morphine, heroin, oxycodone and the synthetic opioid narcotics. Narcotics work by binding to receptors in the brain and blocking the feeling of pain. The problem of opioid misuse starts in physicians' offices. Medical experts recommend using opioids only for short-term pain relief due to acute conditions such as cancer, when a patient does not respond to other therapies. The National Institutes of Health recommends, "Almost always, you should limit their use to no more than three to four months." However, between 55 and 86 percent of all workers' compensation claimants receive opioids for chronic pain relief, estimated Keith E. Rosenblum, a senior risk consultant with Lockton Companies. Many studies show that after 90 days of continuous use, opioid treatment is more likely to become lifelong. And long-term use can diminish a person's natural abilities to modulate pain and create a tolerance for the drug. Over time, a person will require higher doses for effective pain relief, which can lead to abuse, addiction and increased risk of overdose. The number of accidental deaths associated with the use of prescription opioids has increased dramatically since 1999. In fact, the number of accidental deaths resulting from prescription opioid use now exceeds the number of deaths from heroin and cocaine overdoses combined, reported the Centers for Disease Control. Researchers have also linked long-term opioid use to poor workers' compensation claim outcomes. A study published in the Journal of Bone and Joint Surgery in 2009 reported that higher dose levels were associated with higher costs for indemnity and medical costs for disability. Opioid users were also less likely to return to work. Among injured workers completing a functional restoration program, those who were using opioids at the time of admission were half as likely as the users to return to work during the year after treatment. The Solutions The American College of Environmental and Occupational Medicine recommends that occupational physicians consider other treatments before prescribing opioids. "...these...may include exercise, topical medications, distractants (e.g., heat), NSAIDs, low-dose heterocyclic anti-depressants, anti-convulsant agents, and self-applied palliative modalities such as transcutaneous electrical nerve stimulation (TENS)." It also stresses the importance of active exercise and return to work in conjunction with opioid use. Although medical treatment guidelines recommend periodic drug testing and psychological evaluation for long-term users of opioid drugs, few physicians observe the guidelines. Only 24 percent of long-term opioid users in one study received at least one drug test. Ideally, treating physicians should screen workers' compensation claimants for prior opioid use before prescribing, since prior use increases the risk of tolerance and addiction. Second, treating physicians should require drug testing at regular intervals to monitor patients for compliance. Are they using the drug, and at the level prescribed? Many opioid users will stop using the drug on their own initiative, while those who become dependent will "doctor shop" and obtain prescriptions from more than one physician. Better management of prescription painkillers can lead to better coordination of care among multiple providers, earlier intervention with patients at risk of addiction or overdose, and better treatment outcomes. All of these can reduce unneeded costs for employers and make valued workers more likely to return to work after an injury. For more information on controlling workers' compensation costs, please contact the PCOC Insurance Program department of Jenkins Insurance Services at (877) 860-7378 or, email us @ ProPest@Leavitt.com.
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