By Dr. Joel Morton, Founder, President and Medical Director, Summit Pharmacy Inc.
Every day brings another headline about a fatal overdose from painkillers, another celebrity who’s hooked, or a serious crime driven by addiction. Since 1999, overdose deaths from prescription opioids (e.g., Vicodin, OxyContin, oxycodone and methadone) have more than tripled.
Sadly, injured workers are among the addicted, if not the dead. Too often, their first taste of opioids comes during treatment for work-related injury, compounding the misery of the injury itself.
Although doctors can be attractive scapegoats, only 17 percent of abused opioids are abused by legitimate patients with legitimate prescriptions, according to the CDC. Approximately 71 percent of the abused meds came from friends or family. Physicians are doing their best, trying to treat pain without withholding needed medications.
Most common drugs used in overdoses
In 2012, of the 41,502 drug overdose deaths in the United States, 22,114 (53 percent) were related to pharmaceuticals.
Of the 22,114 deaths relating to pharmaceutical overdose in 2012, 16,007 (72 percent) involved opioid analgesics (also called opioid pain relievers or prescription painkillers), and 6,524 (30 percent) involved benzodiazepines. (Some deaths include more than one type of drug.)
In 2011, about 1.4 million (emergency department) ED visits involved the nonmedical use of pharmaceuticals. Among those ED visits, 501,207 visits were related to anti-anxiety and insomnia medications, and 420,040 visits were related to opioid analgesics.
Benzodiazepines are frequently found among people treated in EDs for misusing or abusing drugs. People who died of drug overdoses often had a combination of benzodiazepines and opioid analgesics in their bodies.
To truly protect injured workers – as well as doctors, business owners, carriers and society at large – what we really need are wholesale policy changes to stem opioid abuse, including:
- Stronger Prescription monitoring. Make comprehensive prescription monitoring programs accessible to doctors, pharmacies and others directly involved in patient care. These programs are currently operated by state governments with varying degrees of effectiveness. After speaking with physicians and attorneys across the country, I’m convinced that we should at least consider a national program. As things stand, addicted patients too easily move from state to state, especially in the Northeast, enabling them to surreptitiously double- or triple-dip on prescriptions.
- Single prescriber policy. One patient, one prescriber. This requirement would further reduce the likelihood of doctor shopping. Data from one state recently saw patients dying weekly with prescriptions from as many as five different providers. A single provider of opioids should be trained/knowledgeable in opioid use and the tools needed to monitor a patient’s activity, including opioid contracts and urine testing. While we’re at it, we should consider a single pharmacy policy for patients as well, a measure that would make following medications easier.
- Medication giveback programs. This one’s easy. Cities, counties or municipalities could set aside a permanent drop-off place or have weekly/monthly disposal drives. For example, we could use the local police department or sheriff department as a drop-off area, and make an amnesty box available for folks to dispose of “leftover” opioids. We need to show patients how to dispose of leftover opioids in a way that prevents others from using or selling them.
- Less abusable medications and treatments. Patients need alternatives such as new, innovative opioids that are less abusable, as well as adjunct medications for pain control, e.g., anti-seizure meds, antidepressants, NSAID patches/creams/drops, lidocaine patches and compounded medications. Insurers need to be more prepared to pay for these forms of therapy so patients can receive them more quickly. This timeliness would make patients less apt to receive a quick-acting (i.e., addictive) opioid for a prolonged period. Since pain management is multifaceted, I would also like to see insurers more amenable to covering adjunct pain care such as physical therapy, psychological evaluation, cognitive behavioral therapy and manipulative therapy. If patients in pain were authorized to receive these modalities early on in the pain process, perhaps we could reduce their pain and, thereby, reduce chronic opioid use. For example, mental health evaluations could help prescribers understand which patients are at highest risk of addiction and which treatments make the most sense in that context.
- Opioid-related medical practice. Medical school education is sorely limited when it comes to managing pain. Providers need to be educated better while in school, on rotations and in their residencies on how and when to prescribe opioids. If we train our providers better, we can effect a meaningful change in opioid prescribing. Prescribers, in turn, need to educate their patients on disposal of unused opioids and the danger and illegality of sharing opioids. This begins in med school.
Costs of abuse
In the United States, prescription opioid abuse costs were about $55.7 billion in 2007. Of this amount, 46 percent was attributable to workplace costs (e.g., lost productivity), 45 percent to healthcare costs (e.g., abuse treatment), and 9 percent to criminal justice costs.
As you can see, this multipronged policy approach requires a team approach. Doctors need to be responsible to their patients and use available tools to monitor those who truly need opioid therapy. Insurers need to be more inclined to authorize and permit differing forms of therapy, and more quickly than they do now. Those who make policy, (attorneys, judges, Congressmen, et al.), need to institute programs (drug giveback and prescription monitoring) that will ultimately reduce the diversion of medications to the wrong people.
Five New England governors recently convened to plan the sharing of prescription information to prevent cross-border doctor shopping. I commend them. And I hope everyone who reads this will join the fight against opioid abuse – insidious and devastating, yet addressable by policy and practice – among injured workers and everyone else.
About Dr. Joel Morton
Dr. Joel Morton is founder, president and medical director of Summit Pharmacy Inc.
About Summit Pharmacy
Summit Pharmacy Inc. is the nation’s premier workers’ compensation pharmacy, providing unparalleled service to clients in all 50 states. Founded by Dr. Joel Morton, a former military flight physician, the company is dedicated to preserving the rights of injured workers by helping them get the doctor-prescribed medications they need, while working with attorneys and physicians to expedite the worker’s compensation claims process.