Four Steps Employers Can Take to Help Alleviate the Opioid Crisis

A Recap of MMA's Opioid Crisis Seminar

November 8, 2018
  1. Recognize the problem.
  2. Create a culture that makes employees feel safe talking about it
  3. Communicate openly, honestly and often
  4. Provide the right resources

Marsh & McLennan Agency recently hosted an in-depth seminar on how the opioid crisis is affecting the workplace and what can be done to better control it.

Speakers included:

  • Dr. Bret Haake, VP of Medical Affairs for HealthPartners and Regions Hospital, and Professor of Neurology at the University of Minnesota;
  • Kate Spitzer, RN at the University of Minnesota Medical Center;
  • Cassandra Rudy, claims consultant for Marsh & McLennan Agency;
  • Kimberly Dornbrook-Lavender, PharmD, BCPS, Director of Clinical Pharmacy for Medica;
  • and Kate Bischoff, HR Consultant at tHRive Law & Consulting  and Adjunct Professor of Mitchell Hamline’s HR Compliance Certificate Program.

All agreed that opioid use was out of control and in need of serious attention from government, providers, insurers, and patients.

But all of them also agreed that the opioid problem was potentially manageable and that employers can have a fundamentally profound effect on creating positive outcomes.

Dr. Bret Haake led off the program by reminding everyone that the death of “Prince” Rogers Nelson in 2016 helped to focus a spotlight on the opioid problem. However, since that time, not nearly enough has happened to end the crisis. According to Dr. Hakke, patients need to be educated to the fact that they can choose another pain control option.

According to Dr. Haake, everyone – employees and employers alike – needs to understand that an opioid is not just one pill. A lot of drugs make up the opioid family, including:

  • Heroin
  • Fentanyl
  • Codeine
  • Vicodin/hydrocodone
  • Percocet/oxycodone
  • Dilaudid/hydromorphone
  • Methadone
  • Ultram/tramadol
  • Morphine

In other words, any medication derived from the opium poppy or that chemically work the same will:

  • Block pain
  • Mimic naturally occurring compounds (endorphins and enkephalins)
  • Decrease both physical and psychic pain
  • Disconnect a person from things that disturb them

But Dr. Haake added that taking opioids produces diminishing returns. With every opioid pill a patient takes to block pain, the patient will actually feel more pain than before when the opioid effect wears off. That elevated pain requires even more opioids to relieve it, and so on. That’s why, even after major surgery, getting patients off opioids the first or second day after surgery is vitally important.

What makes pain better?

Ibuprofen and Tylenol have been proven to be better at managing pain, and they decrease inflammation as well. Positive thought and exercise along with good health practices have been shown to be effective pain controllers.

Reassurance and education are key to keeping employees off opioids or getting them off those prescriptions if they’ve started.

Kate Spitzer, RN at the University of Minnesota Medical Center, alerted everyone to the reality that pain is what the patient says it is, whether that pain is acute or chronic. To one person, the same pain level rates a “4” while another will rate it a “9.”

She continued by connecting pain to effects on our daily lives: decreased mobility and job performance; slower healing process; less social interaction; and even anxiety and depression. In addition, there are other signs of abuse to watch for in the workplace, including confusion, extreme drowsiness, constricted pupils and dramatic mood changes.

Like Dr. Haake, she discussed alternative pain control options including:

  • Tyenol
  • NSAIDs (Advil, Toradol, Aleve)
  • Aspirin
  • Lidocaine patches
  • Voltaren gel
  • Neurontin (Gabapentin), Lyrica, Tegretol for nerve pain
  • Ice and heat
  • Aromatherapy
  • Acupuncture
  • Guided meditation
  • Relaxation techniques
  • Proper body mechanics

The keys to successfully dealing with opioid issues in the workplace are recognizing signs of dependence and consistent communication with the employee and the healthcare provider.

Cassandra Rudy, a workers’ compensation Claims Consultant from Marsh & McLennan Agency discussed the consequences of opioid use for the employee as well as the employer in terms of the employee’s ability to recover and the subsequent cost to the employer.

When employees use opioids during the first 15 days after surgery, it results in longer duration of disability, higher medical costs, three times the risk of further surgery and six times the risk of continued opioid use.

When an employee is given two or more prescriptions for an opioid narcotic, the consequences are high: increased medical and workers’ comp costs, more lost time from work, longer duration of paid temporary disability, higher indemnity, claims that remain open, and a higher likelihood that attorneys will be involved. When an employee is taking more than 100 morphine equivalents per day the risk of accidental overdose and the rate of morbidity and mortality skyrocket.

Ms. Rudy suggested that there are Centers for Disease Control standards of care employers and employees can follow to help ameliorate the problem:

  • Making sure employees get physical exams and that providers have access to pain histories, past medical history and family history
  • Obtain abuse and dependency history for patients and blood relatives
  • Do random urine drug testing (see next section for more on this)
  • Consider other treatment options and only use opioids when other treatment options prove ineffective
  • Start patients on the lowest possible opioid doses
  • Implement pain treatment agreements between patient, provider, insurer and employer
  • Monitor pain and treatment progress carefully and document everything
  • Use safe and effective methods for transitioning patients off opioids and onto other methods for controlling pain

Employers should also create an effective Return-to-Work program that includes light duty and follows standards for narcotics pain management.

But again, the issue of recognizing and managing opioid abuse is the result of open, honest communication between patient and provider and employee and employer.

Source: Center for Disease Control and Prevention, U.S., 2016, Recommendations and Reports / March 18, 2016 / 65 (1); 1-49

Kimberly Dornbrook-Lavendar from Medica spoke about how combatting the opioid crisis is multifaceted, and that opioid utilization management is critical to successful outcomes. That includes ensuring that only the patients who absolutely require opioids get prescriptions – and then only for a specific period, limiting quantities and requiring “step therapy” that includes authorization of every change in the employee’s opioid use.

Ms. Dornbrook-Lavendar described Medica’s process for monitoring opioid prescriptions:

  • Use pharmacy claims data to target utilization of drugs in high-risk classes
  • Focus on controlled substances and inappropriate use and misuse-related indicators such as poly-pharmacy, multiple providers and high-total controlled substance claim volume 
  • PBM partner identifies initial cases and conducts initial provider outreach
  • Unresolved cases or those identified as being potentially inappropriate are referred to Medica for internal review by a multidisciplinary team quarterbacked by the Clinical Pharmacy team
  • Case reviews have resulted in referral to Care Management, Clinical Quality and Special Investigations

Effectively combatting the opioid crisis requires partnership and collaboration between prescribers, payers, policy makers, community representatives, along with employees and employers.

Kate Bischoff, employment law attorney, came at the problem from the HR and legal perspective, and dived right into the issues of opioid problems in the workplace.

  • Eight in 10 employers are concerned about the opioid crisis at work
  • 70 percent of employers are impacted by opioid addiction
  • Employers lose $42B in productivity
  • 11.8M Americans abuse prescription drugs
  • More importantly, 116 people die from opioid-related addiction every day

This raises the question: Should you test for opioids? To answer that question, Ms. Bischoff recommended that employers ask the following:

  • Do we currently have a drug testing policy (and when was the last time an attorney reviewed it)?
  • Does it include reasonable suspicion as a basis to test?
  • What is the basis for your reasonable suspicion?
  • Are we absolutely sure we want to test? Use of opioids is not considered a disability but opioid addiction per se, is a disability.

The truth is, employers can and should address behavior that indicates the possibility of opioid use, but that doesn’t necessarily require a test.

If employers decide to drug test, they should be aware that testing in the state of Minnesota, along with other states, has certain requirements and limitations as well as consequences. If the results are positive, an employer is mandated to perform specific steps and, in Minnesota, you can’t terminate employment because of opioid addiction. You must offer treatment first, including the time off to get treatment, but you’re not required to pay for it. If the employee refuses treatment, then you can terminate. (You may, however, still have to do a disability analysis before termination.)

If you do decide to test, consider the following:

  • Funding the treatment
  • Treatment is covered by FMLA, so you need to be compliant
  • Reassigning the employee to different work

Ms. Bischoff went on to discuss the issues of recognizing the possibility of opioid addiction and having a culture of open communication available to deal with it. Here are a few of what she felt may be considered “shocking” suggestions to help employers recognize and deal with opioid use and addiction in the workplace:

  • Give managers the ability and time to actually manage
  • Train managers well and retrain them regularly
  • Ask managers to check in with employees when they see:
  • Changes in behavior
  • Changes in work performance
  • Changes in interactions
  • An Employee assistance program
  • Employee leave
  • Treatment

Above all, demonstrate compassion. Part of having a culture that not only allows but encourages open conversation about problems is the best way to help create the best possible solutions.

If you’d like to know more about creating a culture that supports honest communication, read our article on “Building an Open Culture That Promotes Honest Communication.”

Video of this seminar is online HERE.