How to target the source of workplace opioid abuse
Opioid addiction is having a huge impact on the American workplace. The number of U.S. deaths at work from unintentional drug and alcohol overdoses jumped more than 30% in 2016, according to the most recent data from the Bureau of Labor Statistics’ National Census of Fatal Occupational Injuries. And the Centers for Disease Control and Prevention reports that prescription opioid abuse costs employers $78.5 billion a year in absence, reduced productivity and healthcare costs.
EBA spoke with Terri L. Rhodes, CEO of The Disability Management Employer Coalition, the non-profit organization that focuses on lost work time and improving productivity, about what benefit advisers and employers need to do to blunt the impact of opioid abuse in the workplace. What follows is an edited conversation.
EBA: What can employers and benefit advisers do to address the opioid crisis in the workplace? What kind of services or offerings can they supply to employees who might be abusing pain medication?
Terri Rhodes: The problem is with the physicians and the physician community — and we really have to start there. They are over-prescribing these medications and with little regard to the addictive nature of these pills.
We can demand that the insurance companies who provide reimbursement to these physicians put together appropriate programs that oversee these physicians who are writing these prescriptions. If you write a 30-day prescription, which according to some experts is too much, they don't just last 30 days. They go on and on.
From a benefit perspective, the insurance companies and the prescription benefit management companies must put some controls in place that prohibit and inhibit doctors from over-prescribing these medications. They need sanctions for doing so.
EBA: What form would these sanctions take?
Rhodes: They can be up to or having their prescription licenses taken away, but even monetary sanctions could be effective. The insurance companies don’t teach the doctors about absence management or pharmaceutical management, but they have contracts with hospital networks and physician groups where these doctors are employed. They need to write up agreements [on prescribing medications], and put monitoring systems in place to watch for doctors who are prescribing too many dangerous medications.
Insurance companies can tell them, “You are over prescribing and you can’t do this or we will limit your prescription rights.” There are some physicians who are not allowed to prescribe certain classes of drugs.
We should not have to get that far. We should be able to monitor these things and put in sanctions and punitive ways to stop overprescribing.
EBA: Could a sanction include insurers not covering the cost of pain meds?
Rhodes: No, I don’t think employees should bear the brunt of this. The sanctions should go against the doctors over-prescribing.
This is an age-old problem. In most cases, it’s a family doctor and they know the patient for a long time. But they don’t have the tools and the guidelines, and sanctions where the doctor says, “I am sorry, we cannot prescribe this anymore.”
EBA: What can employers do?
Rhodes: Employers can make sure their insurance contracts with insurance carriers and PBMs have protocols in place and that they actually manage those protocols and provide performance guarantees and statistics that show what is happening.
From the human resource side, we have to have EAP programs that support this. Often this is not considered illegal drug programs and a lot of EAPs don't include prescription medications and so they go under the radar.
Typically, an MRO or a medical review officer isn’t going to see how many prescriptions are used. Those types of programs don't go far enough.
And employers need to provide education around opioid addiction and where to go for help.
EBA: Are benefit advisers doing enough?
Rhodes: I am not aware of benefit adviser doing much. We have included education around this crisis so HR professionals can be aware of what they can do. We make sure if they have an employee on an extended leave of absence and there is a potential for opioid abuse, and you can get them in to see another physician if you suspect it, you can have an independent evaluation done. And then have the employee in treatment to get themselves unwound from addiction.
That is what you can do to manage absence and have people coming back to work. Because we don't want people coming back to work who have these serious addictions. We have safety concerns for themselves and their co-workers.