Pandemic-Related Isolation and Stress Associated with Increased Psychotropic Drug Use Among Injured Workers

William Clay

According to workers’ compensation PBM myMatrixx, a comprehensive approach to mental health treatment can help effectively manage prescription drug utilization.

Tampa, FL — In the wake of the COVID-19 pandemic, mental health concerns are on the rise. Many Americans are facing high rates of depression, insomnia, anxiety and substance abuse due to pandemic-related factors like increased social isolation and economic uncertainty. A predictable result of this is an increase in prescriptions for antidepressant, anti-anxiety and anti-insomnia medications, collectively known as psychotropic drugs. According to a report from pharmacy benefit manager (PBM) Express Scripts, fill rates for these psychotropic drugs increased 21.0% between February 16 and March 15, peaking during the week ending March 15.1

Similarly, workers’ compensation PBM myMatrixx has been seeing injured workers experience corresponding rates of mental health issues during this time that have also resulted in increased psychotropic drug utilization. In fact, stay-at-home orders and social distancing have created a similar environment to what workers with severe injuries have always faced: homebound isolation, lack of productive activity and exposure to powerful drugs.

According to Phil Walls, Chief Clinical Officer for myMatrixx, psychotropic drugs require careful management and should always be part of a holistic approach to behavioral care. “Severely injured workers have always faced increased exposure to mental health concerns and the pandemic certainly hasn’t helped,” says Walls. “One approach that has shown to be effective for many employers is early psychological evaluation. By proactively assessing mental health at the beginning of an injury, employers can see better outcomes without an increase in psychotropic drug utilization.”

A comprehensive approach to workplace behavioral health

Across the board, mental health conditions are a common problem that too-often goes untreated. Each year, as many as one in five adults in the United States experience a mental illness event, including depression, anxiety and sleep disorders, but only 40% receive treatment.2

Unfortunately, this has had a negative effect on workplaces. Depression is a leading cause of disability worldwide, and the CDC estimates that it could be costing U.S. employers $17 billion or more each year.3 It is also estimated that about 24% of the cost of all workplace accidents and errors are associated with sleep disorders such as insomnia.4

As Walls warns however, treating mental health problems in the workplace exclusively with medication can lead to a number of risks and side effects for patients and employers alike. He explains, “There’s a trend that once someone is prescribed a psychotropic medication such as an antidepressant or a sleep aid, it can be very difficult to get them off of it.” For mental and behavioral health, drugs are not always meant to be a long-term solution. As an example, Walls points to sleep disorders and the prescription of sleep aids such as Ambien, “Insomnia is a great example where helping the patient learn new behaviors is very valuable. A sedative hypnotic, like Ambien should really only be used for a very short period of time. During that period, patients should focus on ‘good sleep hygiene,’ including a regular bedtime, breathing exercises and limiting screen usage, to help overcome insomnia from a behavioral standpoint.”

How one employer successfully reduced psychotropic drug utilization in the pandemic

While studying client data, Walls and his team found an organization that appeared to be beating the trend of increased fill rates of psychotropic drugs. Despite remaining open as an essential service during the pandemic, Publix Super Markets was not showing a similar increase in psychotropic drug utilization among its injured workers. Walls found out the answer when he reached out to Niki Moore, the Case Management Team Lead for Publix Risk Management. Says Walls, “I found out very quickly from Niki that they utilize a multifactorial approach for any case identified with a potential psychological component to make a determination if medication is appropriate for each case.”

In an upcoming virtual panel for WCI on November 12th, Walls and Moore will go in-depth on this success story in the treatment of mental health conditions among injured workers. While this approach does help reduce long-term spending on psychotropic drugs, Walls firmly believes that it is also what is right for the long-term mental health of patients. “Early psychological assessment is a very good thing. Adopting behavioral care early on can have a significant impact on the long-term health of these patients by providing a better understanding of their mental health and risk factors,” says Walls. “It’s the right thing to do.”