Opiates in the Workplace

Dr. Ben Feinzimer, DO, MS

“911, do you need police, fire, or an ambulance?”
“We need an ambulance. One of my employees passed out and fell…”
“Do you know why he passed out?”

As a former firefighter and EMT turned emergency department doctor the above scenario is a familiar one. In fact, it has become so familiar that many communities around this country have initiated task forces to research and create policy solely focused on its source. Workplace fainting? Really? A task force for passing out, never heard of it! Actually, the syncope or “passing out” is only the result; the cause is the aim of the task force, and that cause is opiates. That’s right, we have drifted so far down the quagmire of opiate dependence that we are now forced to dedicate manpower to a legal, pharmaceutically vetted medicine. In fact, I am personally responsible for teaching law enforcement personnel how to recognize and intervene in an opiate overdose. Cops went into their careers to catch criminals, to protect society from thieves, deviants, and murderers, not from people overdosing on their prescription medications.

Prescriptions, I might add, that were originally touted as the perfect “non-addicting” remedy to all pains. Prescriptions now responsible for 100 deaths each day. Prescriptions that have now led to ridiculous advertising campaigns like the one showing a construction worker gleefully trotting about his worksite cured of his crippling opiate-induced ileus (intestinal blockage) by a new drug engineered strictly to combat the constipation. Opiate prescriptions have generated so much revenue that the pharmaceutical industry would rather invent a second drug to treat opiate side effects, effectively dismissing their risks, than acknowledge the reality – opiates do NOT do what they were designed to do. Instead we add medicines, and we add, and we add. One day we may create a healthcare system where the number one reason for hospital admission in some populations is polypharmacy. Oh wait, that day has already come.

Let’s look at some of the data. In a February posting on Medscape.com Alicia Ault summarized, nicely the major, and at times unbelievable, facts about the opiate crisis. Melissa Leads, consultant to Weatherby Healthcare’s Urgent Care and Occupational Medicine Division added valuable insight as well. Two million people are addicted to opioid medications. Opiate addiction and abuse have resulted in more deaths in Americans age 50 and under than any other cause. Opioid abuse costs the country 80 billion dollars each year. That was billion, with a “b.” According to the National Safety Council 70% of employers said their workplace had been affected by prescription drug abuse. Job performance, absenteeism, and of course safety were amongst the most pressing concerns. Physicians have actually been successfully prosecuted in criminal court for opiate-prescription related injury and death.

The Centers for Medicare and Medicaid Services (CMS) is proposing that beginning in 2019, opiate prescriptions for acute pain be limited to seven days. They have required that doctors search state data banks before writing prescriptions for opiates. But wait, there’s more. They add monitoring recommendations to Medicare Part D prescription plans – be on the lookout for patients using “potentiators” or medications that may lead to opiate abuse (e.g., gabapentin). That’s correct, so dangerous are these opiates that the government doesn’t even trust people using other medicines that may lead to opiate abuse.

No surprise CMS is buckling down. They’ve been chastised by the Ways and Means Healthcare Subcommittee of the US House of Representatives for their “poor job encouraging prevention and treatment” of opiates. It’s not a good day when you’re publicly criticized by Congress. Oh, and just in case you felt comfortable with the new restrictions and monitoring apparently individuals using opiates are abusing other medications too. By the end of 2017 62% of flagged patients showed evidence not only of opiate abuse but were also using benzodiazepines (e.g., Xanax, Ativan, Valium).

So what does all of this depressing, or more accurately, alarming, information mean for employers? Unfortunately it means closer monitoring, improved assistance and intervention programs, and even adaptations to insurance plans. As of January 1, 2018 the Department of Transportation (DOT) made mandatory that employers falling under their drug testing programs include opiates on drug panels. The DEA lists these Schedule II medications because they have “high potential for abuse,” may lead to “severe psychological or physical dependence,” and are “considered dangerous.”

Now, drugs like hydrocodone, also known as Norco or Vicodin; Oxycodone, most commonly known as Percocet; Hydromorphone, known as Dilaudid; and Oxymorphone, known as Opana must all be part of the new testing panels. Some of these medications, like Oxymorphone, are so risky that the FDA has actually insisted upon manufacturer removal. They all slow reaction time, alter judgment, disrupt sleep and mood, and, well, I’m not sure we need any more negative side effects. The new testing requirements mean money for employers. Contract rewrites, attorney review fees, and training will impact budgets. When compared to the dollars dedicated to opiate related damages, however, the proactive phase is undoubtedly better for the workplace than the reactive one, at least in the long run.