Why We’re Still Talking About Opioids

Nancy Grover

Phoenix, AZ (WorkersCompensation.com) – A lot of people – including workers — are taking pain meds. And yet, there’s no indication that Americans are feeling less pain.

Those are just two of the somewhat surprising facts on the opioid crisis revealed during last week’s Workers Compensation Research Institute’s Annual Issues and Research Conference. Despite some recent good news, such as fewer prescriptions for opioids being written for injured workers, the battle to prevent unnecessary prescribing in the first place and getting the right treatment for those who are dependent or addicted is a slow, arduous process. Experts say there is no magic bullet; but a concerted, collaborative multi-pronged effort is crucial to effectively address the issue.

The Statistics

The numbers on opioid-related overdoses and/or deaths continue to astound many experts. “Even if the crisis has reached a peak, it has reached a peak at a high level,” said Professor Alan Krueger of Princeton University and former chair of the White House Council of Economic Advisors.

Krueger presented some of the latest data on opioid-related overdoses and deaths. For example, there were 49,068 opioid-related overdoses in 2017, based on provisional data. That compares to 42,249 in the previous year. Among the drugs involved in overdose deaths that year, fentanyl was at the top at nearly 30,000 deaths. Heroin was next, involved in almost 16,000 deaths. Next in line were opioid pain medications, cocaine and methamphetamine.

Data from working-age people show the percentage of those who take pain meds. When asked if they had taken pain medications the previous day, 44 percent of men not in the labor force said they had. But an additional 20 percent of employed men also said they had. Among working women, even more said they had taken pain medications the previous day – nearly 26 percent. “So using pan medications is quite prevalent among workers,” Krueger said.

Despite the consumption of medications – including opioids, a survey of men indicated they feel the same level of pain now as they did in 1997.

Krueger cited several causes for the persistent opioid crisis, including that doctors trained at the lowest-ranked medical schools write more opioid prescriptions than those trained at the highest-ranked schools. The results of one study “suggest that better training for physicians, especially general practitioners would help curb the nation’s opioid epidemic — the U.S. would have had 56.5 percent fewer opioid prescriptions and 8.5 percent fewer overdose deaths if all general practitioners had prescribed opioids at the same rate as those from the top-ranked school, (Harvard).”

A further breakdown of research on workers on pain medications shows that those aged 50 and higher were more likely to be prescribed an opioid than younger workers, according to WCRI’s own research. Younger workers were not only less likely to receive opioids on a chronic basis, but also less likely to receive higher dosages.

In terms of specific industries, mining and construction workers had the highest percentages of opioid prescriptions among workers receiving pain medications and had higher rates of receiving chronic and high-dose opioids and receiving opioids on a longer-term basis.

Massachusetts’ Efforts

Among workers in Massachusetts, workers in the construction and fishing industries had particularly high rates of opioid overdose deaths. In the construction industry it is “about six times the rate expected,” said Dr. Letitia Davis, of the Massachusetts Department of Public Health. “Fishing is a much smaller industry but the rates were similar, six times the overall death rate. It tends to be in physically demanding jobs where overdose rates were higher.”

Among women in Massachusetts, those in food prep and services and healthcare support were more likely to experience opioid overdoses. The findings came from a study of opioid deaths by industry for the years 2011 to 2015.

Conducted by the Department of Public Health and funded by the Centers for Disease Control and Prevention, the study was undertaken because of the significantly high rate of opioid-related deaths.

The study was aimed at describing opioid-related deaths by industry and occupation, exploring factors that may contribute to differences in risk, and generating information to target interventions in high-risk worker groups.

They found several factors among workers with higher rates of opioid overdose deaths:

  • Higher levels of job insecurity, especially due to seasonal work
  • Lower amounts of paid sick time
  • High rates of self-reported musculoskeletal disorders and pain
  • Higher rates of occupational injuries
  • Above average backgrounds of drug use

“We need interventions now to address opioid use in high risk industries,” Davis said. “We need appropriate pain management following an injury and access to addiction treatment. The workplace provides a unique opportunity to do this.”

Davis outlined a plan to prevent opioid use, misuse and overdose among high risk worker groups using primary, secondary and tertiary strategies.

  1. Primary: prevent pain and injury, and create health and safety committees and programs
  2. Secondary: after an injury, provide access to treatment and appropriate pain management; provide paid sick leave, and implement return-to-work accommodations.
  3. Tertiary: for post substance use disorder, provide access to treatment and recovery support, utilize EAP and/or peer support programs, provide training in the workplace on the use of Naloxone.

Also, organizations can address cultural issues regarding help seeking and stigma.

On a broader level, states have enacted legislation to limit the number of pills that can be prescribed, created more drug courts to treat addiction as a health problem, and are looking to alternative treatments for pain.

“All are important steps,” Krueger said. “We have not done enough.”

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