Building an effective opioid and prescription drug management program
Power tools, raw materials and heavy machinery are combined to produce the unparalleled satisfaction of seeing a building reach higher, a highway stretch farther or a repair project completed. These architectural and engineering feats would not be possible without the talented and skilled construction workers who battle physical challenges, extreme weather conditions and demanding schedules every day.
Worker safety is imperative, however, job-related accidents do occur that sometimes result in serious injuries. Strained backs, torn rotator cuffs, knee injuries, broken bones and concussions are just a few of the human capital costs that can arise. When this happens, immediate medical care is critical to ensure the injured worker embarks on an effective path to recovery. In severe cases, this can also involve the use of opioids or other prescription drugs as part of the treatment regimen.
While opioids and prescription drugs can be effective pain management tools, they can be subject to potential abuse or misuse. When left unchecked, the consequences to injured workers, their families and loved ones can be devastating. Today, national headlines are marred by what has become an opioid and prescription drug crisis.
Related statistics are alarming. According to the Centers for Disease Control and Prevention (CDC), an estimated 1.9 million people abuse or become dependent on opioids each year. Further, the data indicates that 78 people die each day from opioid overdose and there are an estimated 28,647 opioid fatalities in the U.S. each year. Moreover, 80% of all opioids dispensed in the world are dispensed in the U.S. even though U.S. citizens account for only 4.6% of the global population. And, 99% of all hydrocodone dispensed worldwide is dispensed in the U.S.
Financial costs associated with current prescribing patterns are not negligible. At a cost of $1.4 billion annually, opioids have become one of the highest cost therapeutic drugs for workers’ compensation injuries. Employers report increasing work injuries, higher absence rates and lower productivity related to the misuse of opioids. Further, opioids and other painkillers raise concerns about safety at the jobsite and may potentially increase the risk of harm to other workers.
Sedgwick data supports these findings and concerns. The organization’s data indicates that approximately 56% of injured workers on a prescription, take opioids; and on average, the duration of claims increases 53 weeks when opioids are involved. Even more alarming, 23% of workers admit to using an opioid for a non-medical reason. The Agency Medical Directors Group found that 60% of workers’ compensation patients taking opioids 90 days following an injury were still on opioids five years later. When this happens, an injured worker’s quality of life is diminished and employers lose valuable skilled labor.
Construction Industry Challenges
And yet, studies show the overall effectiveness of chronic opioid therapy to address pain is modest and effect on function is minimal. The question becomes how can construction companies and contractors ensure that their injured workers do not become a part of the opioid and prescription drug crisis while helping them safely and effectively address pain on their pathway to recovery.
The construction industry certainly has some unique challenges in addressing this crisis. For one, many in the construction workforce are independent contractors or union members called upon on a job-by-job basis. As many construction workers are often not employees of the company, but members of a union, construction firms have to be aware of their rights and obligations as well as their contracted employees’ rights and obligations. Rules may differ by state as well as by union. Contractors have to know what they can and cannot require in various other situations, such as after an accident. Does a worker have to divulge that they are on legally-prescribed pain medication? Can a construction firm ask if they suspect a worker is taking medication? What risk does a firm assume if they allow that worker to operate heavy machinery? How do they know not to allow it?
It is critically important for construction companies to stay informed about the latest industry developments, maintain strong working relationships with the unions that provide them with qualified workers, and understand what steps they can take to manage and mitigate the risk of opioid and other prescription drug addictions on their jobsites.
Labor unions and company management must work together to determine policies, resolve grievances and address most other workplace issues including drug testing. Many labor unions have policies in place requiring annual drug testing. For instance, Ironworkers International, which represents more than 100,000 journeymen and apprentices in the U.S. and Canada, is a founding member of the Drug-Free Workplace Alliance. The union’s formal program was developed with the Ironworkers Management Progressive Action Cooperative Trust (IMPACT) and is built around a comprehensive drug testing policy designed to provide a pre-qualified, drug-free workforce to contractors.
Labor unions and company management must work together to determine policies..."
States are also taking a harder look at what they can do to control overuse and addiction. In recent months, several states have passed laws to support more control on opioid prescribing. States such as Massachusetts, Maine and New York now limit the first opioid prescription to a seven-day supply. Also, the CDC has set new guidelines for physicians prescribing opioids. Among the updated provisions are: encouragement for physicians to try other treatment regimens before prescribing opioids; creation of an exit strategy for patients when opioids are prescribed; establishment and execution of an opioid agreement; suggestion to check the prescription drug monitoring program website; use of urine drug screenings to monitor proper use of prescriptions; and a thorough assessment of a patient’s risk for abusing or misusing opioids. The guidelines are also valuable in identifying patients who are at a higher risk for harm from opioids. It is also notable that the CDC lowered the morphine equivalent dosage (MED) threshold from 120 to 50 mg. An MED is a standard that allows for comparison of different types and levels of drugs being prescribed, and this action signaled a drastic reduction.
In addition to being armed with the latest facts and industry updates, there are other steps construction companies and contractors, can take to combat this growing opioids and prescription drug problem. There are a number of common initiatives that companies, working closely with various unions as well as their insurance companies, can look to alter as part of their return-to-work programs.
Injured workers and physicians alike need additional education regarding the use of these powerful drugs and the alternative options available such as requiring opioid specific education for prescribing physicians, taking Tylenol and ibuprofen at the same time, physical therapy, acupuncture and cognitive behavior therapy.
Urine drug screening
Baseline urine drug screenings and random screenings can help determine if an injured worker is taking only prescribed medications and at the proper doses. Such a review must include drugs and substances taken for both personal health conditions as well as those related to on-the-job injuries.
Opioid risk assessment
It is important to be aware of such resources as the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients in Pain (SOAPP). These online tools help evaluate personal and family history risks, and can aid in the identification of high-risk patients.
Some physicians require injured workers to sign an opioid agreement before prescribing such medications. These documents help ensure potential side effects, and risks are discussed and understood by those patients receiving the prescription. Additionally, injured workers must agree to such terms as filling prescriptions at only one pharmacy, treating with only one physician for pain management and prescription medications, to take the opioids only as prescribed, to not take illicit drugs or drink alcohol while being treated for pain, and to disclose all other medications currently taken.
A pain coach can be designated to work with injured workers to address such issues as potential opioid risks and help identify alternative treatments and coping strategies. Additionally, they can help wean patients off long-term use of certain drugs and assist in alleviating social and family stressors.
Behavioral health specialists
Case management nurses and behavioral health specialists can assist in identifying psychosocial factors that may be hindering an injured worker’s recovery or return to the workplace. Customized plans are developed for each injured worker and are specific to individual circumstances.
There is too much at stake for construction companies, contractors and affiliated unions to ignore the impact that opioids and other prescription drugs can have on the health of their injured workers and the safety risks they can pose on the jobsite.
Not Just an American Problem
In Canada, according to the Canadian Centre on Substance Abuse, nearly 15% of the population is using an opioid pain reliever. Of those users, about 2% report abusing their drugs. Canada does not have national-level data for deaths related to prescription opioids, however the statistics for Ontario alone are alarming, with the overall rate of deaths due to opioid use increasing 242% between 1991 and 2010.
In July 2016, Canada’s Minister of Health issued a statement addressing the growing opioid crisis. In addition to making the overdose antidote naloxone more readily available, the country is undertaking an action plan that includes:
Better informing Canadians about the risks of opioids by mandating standard warning stickers and patient information sheets and commissioning a review of best practices.
Supporting better prescribing practices through promoting prescription monitoring programs, examining pharmacy records, promoting information sharing and supporting Canada Health Infoway’s e-prescribing solution.
Reducing easy access to unnecessary opioids, adding clear contraindications for approved opioids, requiring a prescription for low-dose codeine products and making Risk Management Plans mandatory for certain opioids.
Supporting better treatment options for patients by continuing to provide greater and faster access to naloxone, expediting the review of non-opioid pain relievers and re-examining special requirements for methadone so that multiple options are available when considering treatment options.
Improving the evidence base through bringing together experts to discuss how to improve data collection and Canadian evidence standards.