Not since we learned of the perils of tobacco or alcohol have weseen anything more destructive than opioid abuse.

While legislators do their best to catch up to the problem,integrated absence management (IAM) professionals are addressingthis epidemic on the front lines in the workplace.

At the 2016 DMEC (Disability Management Employer Coalition)Annual Conference, psychologist Michael Coupland and doctors StevenFeinberg and Jacob Lazarovic described key realities all IAMprofessionals need to know if they are to both assist employees andhelp employers address the costs imposed as a result of the opioidcrisis.

Here are some startling statistics from the U.S. Department of Health andHuman Services:

• 78 people die each day from an opioid-related overdose.
• 580 people a day start using heroin as a result of opioidaddiction.
• $55 billion a year is spent in health and social costsattributed to prescription opioid abuse.
• $20 billion a year is spent in emergency and inpatient care foropioid poisonings.
• 2.1 million Americans are addicted to opioid painrelievers.
• With an addiction rate of 3.27%, opioid use predicts longertime off work with a delayed return to work.

Beyond these statistics, opioids also have numerous adverseeffects that often lead to additional drug therapies to managethese conditions (e.g., cognitive problems, sexual dysfunction,somnolence, constipation, etc.).

To help deal with the damage and complications associated withopioids, IAM professionals can keep the following front andcenter:

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Opioids are unusually addictive

Pain is real, serious, and can be debilitating. Opioids helpease the pain and reduce the suffering of many people. However,this same opioid use can result in debilitating abuse.

Opioids work by essentially supplanting the brain's dopaminereward system. Therefore, for those addicted to these drugs, it is very difficultto obtain pleasure through any means other than consuming them.Opioids are among the most highly addictive drugs, legal orillegal, in widespread use today. They are a synthetic heroin, soif unavailable or too expensive, people can turn to illegal drugslike heroin to obtain the dopamine experience.

Not suited for chronic pain

The biomedical model says pain is caused by short-term trauma.Opioids can be appropriate and effective for situations such assurgery, bone fractures and the like. The appropriate usage wouldbe up to six weeks after the acute injury. There are a fewexceptions, such as major bone, spine, or joint surgeries whichshould not exceed 12 weeks in total duration. If there is nosubstantial pain relief or functional improvement in activities ofdaily living, or if there are untoward sideeffects, their useshould be discontinued.

On the other hand, chronic pain is a biopsychological phenomenonand requires a biopsychological model to understand and effectivelytreat it. Similar to our behavioral health treatment approaches,pain is the result of numerous factors. These include a person'scurrent psychological state, childhood and other experiences, andcurrent relationships and interactions with the environment,including the workplace and health care providers.

These complex and interrelated factors cannot be addressedthrough a pill. Moreover, the resulting addiction and possibleabuse as a result of the inappropriate use of opioids, can becomeanother overwhelming biopsychological variable. The use of opioidsfor chronic pain can quite literally result in a “cure worse thanthe disease.”

Prevention through screening and treatment

So what can be done to help address the very real pain problemsthat gave rise to the opioid crisis? As with so many disability andabsence issues, the key is awareness, early detection, andintervention. We can apply many of our insights and treatments ofbehavioral health interventions in this process.

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It is generally accepted that there is a three- to six-monthwindow before signs of chronic pain become chronic pain syndrome,at which point opioids are often the default treatment. Employersshould be aware of the signs and symptoms associated with chronicpain syndrome. However, it must be acknowledged that it isoften out of the employer's purview to do anything, thoughawareness and diligence is a start. Such symptoms generally includethe following:

• Stress, depression, and anxiety.
• High pain ratings/drug dependency.
• Disability out of proportion to physical findings.
• Litigation focus.
• Somatization which is the production of recurrent and multiplemedical symptoms with no discernible organic cause.

Effective interventions

If these signs are identified, effective interventions can beused to manage chronic pain and prevent opioid or other drug useand abuse. While employers cannot specifically address thisproblem, they can consult with a disability carrier, workers'compensation carrier or third party administrator. One approachwould be cognitive behavioral therapy (CBT), which has proven veryeffective in addressing varied disability-related issues,especially return to work. CBT is functionally oriented. Inthe case of pain, increased function at work and home is associatedwith less pain. CBT and similar interventions are alsoindividualized and contain an educational dimension.

The net result is that control shifts to the individualemployee. A person comes to understand the cause and meaning ofpain and learns to live with it. He or she becomes an individualwith a manageable pain problem, rather than a chronic painpatient/victim. When that happens, absence, disability, and othercosts (including litigation) are greatly reduced. Additionally, theemployee maintains a quality of life, rather than spiraling intothe world of addiction.

Serious social problem

Opioid abuse and addiction is a large social problem. While IAMprofessionals cannot solve it, they can effectively address it inthe workplace by using the innovative screening, prevention, andtreatment tools that have transformed our understanding andmanagement of all behavioral health issues.

Terri L. Rhodes is CEO of the Disability Management EmployerCoalition (DMEC). Opinions expressed in thisarticle are the author's own.