Not since we learned of the perils of tobacco or alcohol have we seen anything more destructive than opioid abuse.
While legislators do their best to catch up to the problem, integrated absence management (IAM) professionals are addressing this epidemic on the front lines in the workplace.
At the 2016 DMEC (Disability Management Employer Coalition) Annual Conference, psychologist Michael Coupland and doctors Steven Feinberg and Jacob Lazarovic described key realities all IAM professionals need to know if they are to both assist employees and help employers address the costs imposed as a result of the opioid crisis.
Here are some startling statistics from the U.S. Department of Health and Human Services:
- 78 people die each day from an opioid-related overdose.
- 580 people a day start using heroin as a result of opioid addiction.
- $55 billion a year is spent in health and social costs attributed to prescription opioid abuse.
- $20 billion a year is spent in emergency and inpatient care for opioid poisonings.
- 2.1 million Americans are addicted to opioid pain relievers.
- With an addiction rate of 3.27%, opioid use predicts longer time off work with a delayed return to work.
Beyond these statistics, opioids also have numerous adverse effects that often lead to additional drug therapies to manage these conditions (e.g., cognitive problems, sexual dysfunction, somnolence, constipation, etc.).
To help deal with the damage and complications associated with opioids, IAM professionals can keep the following front and center:
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Opioids are unusually addictive
Pain is real, serious, and can be debilitating. Opioids help ease 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 dopamine reward system. Therefore, for those addicted to these drugs, it is very difficult to obtain pleasure through any means other than consuming them. Opioids are among the most highly addictive drugs, legal or illegal, in widespread use today. They are a synthetic heroin, so if unavailable or too expensive, people can turn to illegal drugs like 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 as surgery, bone fractures and the like. The appropriate usage would be up to six weeks after the acute injury. There are a few exceptions, such as major bone, spine, or joint surgeries which should not exceed 12 weeks in total duration. If there is no substantial pain relief or functional improvement in activities of daily living, or if there are untoward sideeffects, their use should be discontinued.
On the other hand, chronic pain is a biopsychological phenomenon and requires a biopsychological model to understand and effectively treat it. Similar to our behavioral health treatment approaches, pain is the result of numerous factors. These include a person’s current psychological state, childhood and other experiences, and current relationships and interactions with the environment, including the workplace and health care providers.
These complex and interrelated factors cannot be addressed through a pill. Moreover, the resulting addiction and possible abuse as a result of the inappropriate use of opioids, can become another overwhelming biopsychological variable. The use of opioids for chronic pain can quite literally result in a “cure worse than the disease.”
Prevention through screening and treatment
So what can be done to help address the very real pain problems that gave rise to the opioid crisis? As with so many disability and absence issues, the key is awareness, early detection, and intervention. We can apply many of our insights and treatments of behavioral health interventions in this process.
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It is generally accepted that there is a three- to six-month window before signs of chronic pain become chronic pain syndrome, at which point opioids are often the default treatment. Employers should be aware of the signs and symptoms associated with chronic pain syndrome. However, it must be acknowledged that it is often out of the employer’s purview to do anything, though awareness and diligence is a start. Such symptoms generally include the 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 multiple medical symptoms with no discernible organic cause.
If these signs are identified, effective interventions can be used to manage chronic pain and prevent opioid or other drug use and abuse. While employers cannot specifically address this problem, they can consult with a disability carrier, workers’ compensation carrier or third party administrator. One approach would be cognitive behavioral therapy (CBT), which has proven very effective in addressing varied disability-related issues, especially return to work. CBT is functionally oriented. In the case of pain, increased function at work and home is associated with less pain. CBT and similar interventions are also individualized and contain an educational dimension.
The net result is that control shifts to the individual employee. A person comes to understand the cause and meaning of pain and learns to live with it. He or she becomes an individual with a manageable pain problem, rather than a chronic pain patient/victim. When that happens, absence, disability, and other costs (including litigation) are greatly reduced. Additionally, the employee maintains a quality of life, rather than spiraling into the world of addiction.
Serious social problem
Opioid abuse and addiction is a large social problem. While IAM professionals cannot solve it, they can effectively address it in the workplace by using the innovative screening, prevention, and treatment tools that have transformed our understanding and management of all behavioral health issues.
Terri L. Rhodes is CEO of the Disability Management Employer Coalition (DMEC). Opinions expressed in this article are the author’s own.