Opioid abuse: A U.S. epidemic that impacts the workplace

Opioid use has been an ongoing epidemic in the U.S.

The insurance industry has long recognized the challenges America faces with opioids long before the U.S. Department of Health and Human Services declared an epidemic in 2017.

In recent years, we’ve seen prescribers take greater caution, with 2016 marking the lowest prescription rate in a decade.

Although opioid prescriptions have declined, drug-related overdoses and deaths have skyrocketed.

On average, opioid overdoses rose over 30 percent across the country from July 2016 through September 2017 . In that time frame, the Midwest and West regions saw the most staggering increases at 70 percent and 40 percent, respectively.

When looking at deaths due to an overdose, nearly two-thirds are attributed to an opioid. The rise in opioid-related deaths is driven mainly by heroin and illegally-made fentanyl.

Drug potency and availability are two key risk drivers.

The U.S. Drug Enforcement Administration categorizes drugs in five categories, with Schedule I being the most restrictive and Schedule V being the least restrictive. There are several factors that come into play regarding classifications, including potency and availability.

As it relates to potency, it’s important to understand that from a medical perspective, morphine is used as a baseline to assess the strength of drugs.

Examples
Hydrocodone:

• Schedule II: Some medical use, high potential for abuse and dependence
• 1.2 times stronger than morphine
• 99 percent consumed within the U.S.

Heroin:

• Schedule I: No accepted medical use and high potential for abuse and dependence
• Between 2 times and 4 times stronger than morphine
• Widely accessible as a street drug
• Nearly 80 percent of heroin users first misused a prescription opioid

Fentanyl:

• Schedule II: Some medical use, high potential for abuse and dependence
• 100 times stronger than morphine
• Highly controlled prescription distribution; used primarily for cancer pain
• Increasingly illegally manufactured; commonly mixed with heroin and/or cocaine

What does this mean for employers?

As employers assess the needs of their businesses and employees, it’s essential to understand the risks associated with both prescription and illegal drugs.

A detailed drug policy is an important component of creating a safe and healthy work environment. Employers should consider addressing the types of testing, the category of employees who are subject to testing, prohibited substances and methods of testing, as well as the consequences of a positive test. To help promote a compliant and well-rounded approach, policies should be developed in collaboration with human resources and legal counsel familiar with local laws.

But it’s not enough to just develop a drug policy – it needs to be enforced and reinforced, too. Managers should be well-trained to notice and document potential signs of impairment, especially in the event of employee injury and reasonable suspicion. Partnerships with healthcare and workers’ compensation insurance providers may also deliver programs and insights that can help proactively protect employees and businesses.

Zurich’s Narcotic and Opioid Review program delivers results.

Zurich’s Narcotic and Opioid Review program is one way our Medical management services can help drive positive outcomes for injured workers and employers. Through targeted outreach, referrals and escalation, Zurich has reduced opioid utilization by more than 50 percent.

We do this by tapping into data from our pharmacy management program to evaluate a series of factors, including:

• Opioid use: Chronic, high-dose and/or multiple opioids
• Use of Demerol® or a benzodiazepine
• Multiple controlled substance pharmacies and/or prescribers

Based on an analysis of the data, our medical team helps identify alternatives that are in the best interest of the injured worker.

Learn more about our Medical management services.