The opioid epidemic: Light at the end of the tunnel?

How understanding the past leads to a brighter future for injured workers

 

For nearly three decades, the United States has experienced a significant and steady increase in drug prescribing, dependency and fatalities associated with opiates. But new preliminary federal data indicates that the number of Americans who died from drug overdoses finally fell by 5% between 2017 and 2018. What’s the reason behind the sudden decline? And what can we do to continue on this path of ending opioid abuse for good? In the midst of any crisis, it can be difficult to see the light at the end of the tunnel. But a new approach to the way we treat injuries may just help us out of the opioid darkness and into recovery.

How we got here

Historically, drugs like oxycodone, hydrocodone, codeine and morphine were prescribed primarily to patients who had been diagnosed with a terminal disease or severe injuries/conditions; they were intended to treat pain over a short duration. Drug manufacturers weren’t aware of — or chose not to disclose — the addictive quality of the meds; as a result, physicians began prescribing these medications to patients with minor conditions and injuries for far beyond the expected duration of treatment. We became a society that treated symptoms, instead of treating patients.

Before we had access to information like we have today, many patients simply followed and trusted the recommendations of their treating physician. They generally didn’t question the list of drugs prescribed. When a patient declared pain, a physician was taught to treat it as soon as possible. And in many cases, that meant writing a script. Of course, there were (and still are) physicians truly focused on helping patients. But the epidemic progressed as “pill mill” physicians became more common — handing out opioids in exchange for payment. And the expectation that treatment and results should be instant set the tone for how injuries have been treated. Instead of providing patients with sustainable methods for recovery, medication often became the standard and first course of treatment. In some cases, that’s an unavoidable and necessary part of treatment. But for many others, it’s nothing more than a band-aid solution.

Today you can hardly turn on the nightly news without hearing about an opioid-related story. Pharmaceutical companies reap the financial benefits while communities continue to pay the price of abuse and overdose. As drugs like fentanyl and heroin find new homes, families are debilitated by the disease of addiction. Employers lose valuable members of their organization and see an increase in workers’ compensation claim costs.

Putting it into perspective

Opioids have left a tremendous impact in the world of workers’ compensation. According to the CDC, 44% of all workers’ compensation claims received an opioid in 2016 in 40 of our 50 states. Imagine a scenario where a worker files a claim for a job-related injury resulting in back pain.

The expectation is that he’ll be given steps for sustainable recovery and treatment so he can return to work. But when he’s prescribed an opioid to temporarily treat pain, it can create a domino effect — and a straightforward workers’ compensation claim has grown from back pain (which may have been manageable without medication), to an opioid dependency. The side effects of the overly strong drug causes a vicious cycle for the injured worker, who may now need other medications to treat headaches, hallucinations, depression, muscle stiffness, insomnia or nausea — adding to the expense and longevity of the claim.

Taking a stand

So with everything we’re hearing, why has the CDC noticed a decline in opioid-related deaths over the last two years? Experts say it’s a combined effort: the government working to hold drug manufacturers and distributors accountable; organizations using early intervention strategies and alternative courses of care for chronic pain; and communities launching awareness campaigns. In the past, pharmaceutical companies could ignore obvious signs that the drugs manufactured in their facilities were being abused. But state regulations have since tightened, making it more difficult for them to overlook their responsibilities.

Federal prosecutors have brought thousands of lawsuits to the public eye, raising awareness of how prevalent the opioid epidemic is. In 2017, McKesson Corporation paid a civil penalty of $150 million due to violations of the Controlled Substances Act. But they aren’t the only company getting a wake up call. Earlier this month, an Ohio-based distributor, Miami-Luken, was indicted for their alleged role in the distribution of millions of opioids to a pharmacy in a West Virginia town of only a few thousand people. And Purdue Pharma, the maker of OxyContin, settled a lawsuit with the state of Oklahoma just a few months ago for $270 million. Although the privately held company denied allegations that they marketed the drug as less addictive than it really is, the FDA claims OxyContin was at the center of the overdose epidemic by the early 2000s — just five years after it was approved.

While there has been progress in terms of overall prescribing patterns and opioid-related fatalities, there is considerable work to be done. The United States still has significant patterns of abuse, and lawsuits against pharmaceutical companies are still underway. But a new approach to the treatment of injuries can help us continue to move in the right direction — treating patients instead of symptoms and getting employees back to health, work and productivity. Here’s a list of seven things an employer can do to drive better outcomes for their injured workers:

 

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