Prescription opioid abuse is a public health epidemic in the United States, and drug overdose death rates have tripled since 1990. In parallel, the sales of prescription painkillers have increased by 300 percent since 1999.
Approximately 2.4 million Americans used prescription drugs non-medically (without a valid prescription) for the first time, with an average of approximately 6,600 new users per day in 2010. Opioid abuse is a real and emerging risk for businesses to consider. CNA’s 2015 Risk Outlook: Construction Prescription Opioid Abuse: Risk Factors and Solutions highlights the prescription drug abuse epidemic, utilizing records from multiple sources in addition to CNA claim data specific to the construction industry and offers solutions to avoid return-to-work pitfalls.
The opioid abuse epidemic is taking a toll on many aspects of the U.S. economy, including construction businesses’ workers’ compensation losses. The National Council on Compensation Insurance (NCCI) found that prescription costs per claim are continuing to rise in the United States, with an alarming 25 percent of costs attributed specifically to prescription opioids.
The issue is two-fold in the sense that injuries leading to opioid abuse are:
- cost-drivers for businesses; and
- create an increased probability that employees who abuse opioids can lead to increased injuries to themselves and others that will ultimately negatively impact productivity and profitability.
Similarly, the delay of return to work can affect operations and negatively impact a company’s bottom line. Workers in the construction industry are especially at risk for prescription opioid abuse. It is estimated that 15.1 percent of construction workers across various specializations have engaged in illicit drug use, including both illegal and legal prescription drugs. While there is limited data illustrating the incidence of opioid abuse among injured construction workers, analysis of CNA claim data indicates the cost of opioid use is greater in construction than in other industries.
What are Opioids?
Prescription opioids are medications typically used to relieve pain and are prescribed by a practicing physician. When used according to prescription, they are meant to reduce the intensity of pain signals by attaching to opioid receptors in the brain, spinal cord and other organs. Side effects of opioid use include drowsiness, mental confusion, nausea, constipation and, in some cases, reduced respiration. Common prescription opioids include hydrocodone, oxycodone, morphine and codeine. Common proprietary names for these opioids include Vicodin, OxyContin, Percocet and Kadian.
Use of opioids can cause dependence or addiction, such as a physical dependence that occurs when there are normal adaptations to chronic exposure of the drug. However, addiction, which includes dependence, is distinguished by compulsive drug seeking even when the person knows the consequences. Research also indicates that opioid abuse is associated with patients experiencing chronic pain with injuries often impacting three or more areas of the body.
CNA Claim Data Validates Opioid Abuse Trends
Analysis of CNA claim data indicates that prescription opioid spend in construction is problematic. From 2009 to 2013, the percent of opioid spend of the total prescription drug spend in construction remained relatively stable at about 20 percent (Figure 1). In addition, compared to the average of other CNA recognized industries combined, the opioid spend in construction is consistently 5 percent to 10 percent higher.
CNA claim data could also categorize employees into three groups by their probability of painkiller abuse (low, medium and high). Potential abuse was calculated utilizing a number of factors, including opioid drug spend and number of prescriptions filled over time. In all cases, the incurred costs for injured employees flagged for potential painkiller abuse was much higher compared to employees for low probability of abuse. After three years of follow up, claimants flagged for high probability of opioid abuse resulted in 3 percent higher costs compared to claimants who were not flagged for abuse.
According to Figure 2, the frequency of injured employees with a high probability of painkiller abuse can be depicted by state, In general, the darker areas indicate higher frequencies of painkiller abuse among injured construction employees.
What Can an Employer Do?
Combating potential prescription opioid abuse in the construction industry involves, but is not limited to, the following prevention strategies.
- Educate employees about responsible prescription opioid use. When used responsibly, opioids can be an effective tool to mask acute pain. It’s also important to educate workers about the potency of these drugs, how they work, how they interact with other drugs and how they can become addictive.
- Understand the risk factors of opioid abuse. Understanding and communicating the risk factors for opioid abuse is vital for prevention in the construction industry. Employees should learn about doctor shopping, physician dispensing and other risk factors supported by evidence.
- Provide support and safe return-to-work programs to injured employees. If a worker is injured, it is important to provide strong social support from fellow workers, especially the immediate supervisor and management, so that they may safely return to work. The most important person in returning an employee back to work is the immediate supervisor. A strong social support system can help the worker and prevent any further injury to themselves or others. Research indicates strong social networks are positively beneficial to combat alcohol and drug problems. When implemented, a program of key steps can result in fewer lost days and decreased wage loss for employees, and will redirect the focus from the injured worker’s disability to promoting work ability, leading to greater employee morale.
- Communicate treatment options. If treatment is necessary, it is important to educate the worker on options, including counseling and pharmaceutical treatment. Drug addiction is a brain disease that can be treated effectively. Treatment options include behavior modification or pharmacological interventions. Behavioral treatments help the addict deal with cravings, avoid situations where drugs are present and strengthen social support. Pharmacological interventions include the use of addiction medications. Research indicates a combined approach may be best.
- Ask the right questions. The American College of Occupational and Environmental Medicine (ACOEM) suggests these sample questions to ask a physician:
- Is the physician using evidence-based treatment guidelines?
- Are physicians using principles of informed choice with their patients while advising them of the risks and benefits?
- Does the physician set expectations for discontinuation with limiting quantities of opioids to treat acute pain?
- Are functional goals outlined at every visit?
For more information, view the webinar Prescription Opioid Abuse in the Construction Industry: Risk Factors and Solutions, hosted by Associated Builders and Contractors and presented by Michael Kim.
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