“Opioids” was once a medical term to describe drugs associatedwith pain relief but has since become a part of the every dayAmerican vernacular.

High profile celebrity deaths and the sheer volume of opioidsbeing consumed each day have propelled these powerful drugs intothe spotlight and caught the attention of the mainstream media.

Today, opioid abuse is contributing to an excessive number ofearly deaths, robbing far too many individuals of theirlives.

Society is beginning to fight back against the opioid andprescription drug epidemic. The employer community has seen drug misuse diminishproductivity and deplete talent resources. The good news isprogressive organizations are beginning to implement measures tocombat its impact.

Related: Tackling the opioid epidemic

Construction companies and contractors know the implications ofshowing complacency and the devastating impact opioid or drug abusecan have at a job site. Seldom are there second chances whenconstruction workers are operating heavy equipment, scaling heightson scaffolding, or completing a crucial team task. To assistconstruction companies, contractors, and other employers inaddressing the opioid and prescription drug epidemic, it isimportant to understand the scope of the problem, how opioidsaffect the brain, and strategies for managing the use of thesepowerful drugs.

Related: How construction technology helps turn high-riskscenarios into safer situations

Epidemic proportions

According to recent statistics released by the Centers forDisease Control (CDC), the size and scope of the opioid crisis arestaggering. The CDC estimates the yearly cost for opioidrelated overdoses is $20.4 billion and for nonmedical use ofprescription opioids is $53.4 billion. The toll in terms ofhuman life is even more shocking; in 2016, of the 47,085 drugoverdose deaths, 71% were due to prescription opioids. Looking at thesituation in another way, 91 people die from opioids each day.

The CDC also estimates that 1.9 million people abuse or becomedependent on opioids each year.Further, one in every 32 patientswill die from opioids if on a dose greater than 200 morphineequivalent doses (MEDs). Methadone represents less than 2% ofopioid prescriptions yet has been found to account for 30% ofopioid related deaths.

The addictive power of opioids cannot be underestimated.In a report released earlier this year, the CDC reportedthat 50% of those taking an opioid for 30 days will be on the drug3 years or longer. The addiction is so intense that many inthe medical community take precautions to avoid the 90 day cliff.Statistics show that 60% of patients taking an opioid at 90 daysare still taking an opioid 5 years later.

Related: Prescription drug costs, by thenumbers

Understanding addiction

Medical researchers have learned that opioids attach to thereceptors in the brain that release endorphins. Opioids stimulatethese receptors and initially increase pleasure and relieve pain.Repeated stimulation of these receptors creates a tolerance thatrequires more drug for the same effect. Over a relatively shortperiod of time, the receptors become blocked or desensitized to theopioids. In turn, this impacts a person's mood, behavior,breathing, and perception.

Too often, doctors allow dosages to escalate in response to aperson's complaints of pain even though there is no objectivemeasure of pain. Studies show that overall the effectiveness ofchronic opioid therapy to address pain is modest and effect onfunction is minimal. While opioids are known to relieve pain,many patients do not fully understand the medical side effects thatcan include drowsiness, mental confusion, nausea, constipation,immunosuppression, decreased testosterone, respiratory depression,hyperalgesia, addiction, and dependence and tolerance.

Reigning in the use and abuse of opioids and other powerfulprescription drugs requires working with high quality physicianswho are committed to delivering improved outcomes for both theemployer and employee. There are some best practices physicians canuse when prescribing opioids. These include:

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        • Focus on improving function
        • Conduct risk assessment prior to prescribing
        • Conduct random urine drug screen
        • Check prescription drug monitoring program website
        • Conduct pill and patch counts each visit
        • Create an exit strategy with the first trial prescription
        • Use drug holidays in chronic cases
        • Have an opioid agreement with the patient

As an example, the introduction of an opioid contract between aphysician and patient can be effective. Here's how it works: Priorto the physician prescribing opioids, the patient agrees to takethe medication based on the frequency and dosage prescribed. He orshe also agrees to disclose all medications that are currentlybeing taken, and to notify the physician of any changes. There isalso an acknowledgement and agreement to abide by the employer'sreturn to work policy, among other provisions.

Urine drug screens can be another effective tactic formonitoring opioid usage. These screens help identify aberrantbehavior, reveal undisclosed drug use or abuse, and verifycompliance with treatment. They should be considered whenphysicians notice unusual or suspicious behavior at any timeincluding when a patient reports losing their prescription,requests early refills, uses multiple prescribers, demonstratesintoxication, or exhibits slurred or slow speech.

Related: A deeper insight into the risks and challengesfacing senior construction executives

Additional proactive measures

There is also activity on the national front aimed at curbingthe misuse of opioids. The Drug Enforcement Administration (DEA) announced areduction in the amount of opioid medications that can bemanufactured for sale and research in the U.S. by 25% in2017-2018. New CDC guidelines provide clear guidance andwarnings to physicians prescribing opioids. The guidelines alsoadvise physicians to try other alternatives first. The SurgeonGeneral issued a letter to all physicians encouraging them to treatpain safely and effectively according to CDC guidelines.

It is not uncommon for those with opioid addictions to turn toheroin. It is believed that about 75% of heroin on the streets isnow laced with fentanyl, which is 50 times stronger thanmorphine. Further, fentanyl can create chest wall rigidityand lock jaw such that cardio pulmonary resuscitation (CPR) is notan option in some overdose situations. The administration ofthe drug narcan is the only option for reversing the effect inthese cases. Even then, there are no guarantees.

The opioid and prescription drug crisis is debilitating on theUS workforce and taking an undeniable toll on individuals and theirfamilies. Increased awareness is helping to spotlight itsdevastating effect. Employers can and should actively work withtreating physicians to ensure their workers are cared for in themost appropriate way. Pain relief alternatives are available andhelp is waiting for those who chose to make the first step inbreaking the chains of addiction.

Teresa Bartlett, M.D., is senior vice presidentof Medical Quality at Sedgwick.

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