Opioid painkiller addiction rates in the U.S. have risen to epidemic proportions since their widespread adoption two decades ago.
“These heavy-duty painkillers have become a real scourge; people are dying from this problem. The overdose problem is real with good people,” said Michael Clarkson, chair of the drug testing practice group at law firm Ogletree, Deakins, Nash, Smoak & Stewart. “You can be prescribed these drugs for legitimate use and get hooked on them. You can get hooked on them very easily and find it very hard to get off of them.”
Nearly 55 percent of the 41,340 drug overdose deaths in the U.S. during 2011 — the most recent year such data were collected by the U.S. Centers for Disease Control and Prevention — involved pharmaceutical drugs. Opioid painkillers, such as oxycodone, hydrocodone and methadone, were involved in almost 17,000 pharmaceutical overdose deaths, confirming the predominant role opioid painkillers play in drug-overdose deaths, according to the CDC.
Combating the problem has become a major public health issue, as policymakers at the state and federal level have enacted laws to limit an individual’s access to painkillers and better monitor the legitimate use of the drugs.
The painkiller epidemic affects all facets of American society, particularly the workplace. Opioid addiction not only threatens the health and safety of individuals and their families, but also employees addicted to painkillers represent multiple risks for employers.
According to the Workers’ Compensation Research Institute, or WCRI, 55 to 85 percent of all injured workers in the United States received narcotic painkillers between 2008 and 2010, despite medical recommendations to limit such prescriptions to extreme pain or when other methods fail.
‘It’s only been getting attention in the popular media for the past few years. But when you’re an EAP like I was, you have a direct knowledge of what’s going on.’
—Vincent Ceraso, American Addiction Centers
Treating painkiller addiction is not as easy as taking a powerful opioid to dull the pain. Employees who have become addicted to the drugs can create several issues for employers, such as liability risks, health and wellness concerns and a less efficient and productive workforce, Clarkson said.
Drug Background and Epidemic
Dongchun Wang, an economist and researcher at the WCRI, said the workers’ compensation community noticed there was a serious painkiller addiction problem about five years ago. “They were stunned to see the magnitude of this issue, both in terms of frequency — how many workers received opioids — and volume — how much a worker receives per prescription,” she said.
Michael Blackburn, a retired Providence, Rhode Island, fire department chief and current drug and addiction counselor for the American Addiction Centers, echoed Wang’s claim that the painkiller epidemic exploded around the start of the decade.
At the time, there were 254 million prescriptions for opioids filled in the U.S., according to a 2010 study published by Johns Hopkins Bloomberg School of Public Health. Another study published in 2010 by the Pain Management Center of Paducah (Kentucky) found that, although the U.S. accounts for just under 5 percent of the global population, Americans have consumed 80 percent of the opioids supplied in the world.
While some members of both the workers’ compensation and drug addiction recovery communities say painkiller abuse reached epidemic proportions four to five years ago, other experts argue that point came about a decade ago. Ted Shults, a toxicologist and founder of the American Association of Medical Review Officers, said the beginning of the problem can be traced to a marketing shift by pharmaceutical companies in the 1990s.
“They started to push the idea that pain is one of five vital signs [of life], and it would be unethical not to treat it,” Shults said. “That’s more marketing than science.”
As a part of the pharmaceutical companies’ marketing strategy, workers’ compensation programs and providers were told that the use of opioids would reduce treatment costs by allowing injured workers to get back to work quicker, while simultaneously eliminating the need for other treatments like physical therapy.
Opioid Abuse Warning Signs for Employers
Physical warning signs
• Bloodshot eyes, pupils larger or smaller than usual.
• Changes in appetite or sleep patterns. Sudden weight loss or weight gain.
• Deterioration of physical appearance or personal grooming habits.
• Unusual smells on breath, body or clothing.
• Tremors, slurred speech or impaired coordination.
Behavioral signs of drug abuse
• Drop in attendance and performance at work or school.
• Unexplained need for money or financial problems. May borrow or steal to get it.
• Engaging in secretive or suspicious behaviors.
• Sudden change in friends, favorite hangouts and hobbies.
• Frequently getting into trouble (fights, accidents, illegal activities).
Psychological warning signs of drug abuse
• Unexplained change in personality or attitude.
• Sudden mood swings, irritability or angry outbursts.
• Periods of unusual hyperactivity, agitation or giddiness.
• Lack of motivation — appears lethargic or “spaced out.”
• Appears fearful, anxious or paranoid with no reason.
Source: Vincent Ceraso of the American Addiction Centers
Over time, this claim has proven itself inaccurate. According to the Express Scripts “2013 Workers’ Compensation Drug Trend Report,” Narcotic painkillers “continue to be the costliest therapy class for work-related injuries, accounting for 32 percent of overall pharmacy costs.”
Vincent Ceraso, an American Addiction Centers drug addiction counselor and machinists’ union employee assistance program trainer in Rhode Island, corroborated Shults’ claim by saying the prescription painkiller epidemic has been kept quiet for more than a decade. “It’s only been getting attention in the popular media for the past few years. But when you’re an EAP like I was, you have a direct knowledge of what’s going on.”
Earlier this year, Chicago filed a lawsuit in the Circuit Court of Cook County, Illinois, against five pharmaceutical companies, including Johnson & Johnson, saying their promotion for the use of the drugs was not based on concrete scientific evidence. Chicago’s attorneys argue opioid manufacturers deliberately mislead the public and the medical community about the safety of their drugs.
According to the city’s complaint, pharmaceutical companies “overstated the benefits of using opioids long term to treat chronic noncancer pain, promising improvement in patients’ function and quality of life, and dismissed or minimized the serious risks and adverse outcomes of chronic opioid use, including the risk of addiction, overdose and death. There was and is no reliable scientific evidence supporting defendants’ marketing claims, and there is a wealth of scientific evidence to the contrary.”
The city is suing for unspecified monetary damages, civil penalties and court costs, in addition to asking the court to order the drug manufacturers to cease their alleged unlawful promotion of opioids and correct their misrepresentations. Two California counties also filed similar lawsuits earlier this year against five pharmaceutical companies.
The abuse of opioid painkillers has created other public health issues and led to additional health care costs as emergency room visits for opioid misuse have doubled over the past five years, according to the CDC. Further, subject-matter experts explained painkiller addictions commonly lead to heroin addictions because heroin produces the same high but is cheaper and easier to obtain than prescription drugs.
The federal government classifies opioid painkillers as Schedule II drugs under the Controlled Substances Act. There are five different classes. Drugs in lower-numbered schedules are considered more dangerous and hold a greater chance for abuse than higher-numbered schedules.
Schedule II drugs “are defined as drugs with a high potential for abuse, less abuse potential than Schedule I drugs, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous,” according to the U.S. Drug Enforcement Agency.
The most commonly used opioids are hydrocodone and oxycodone, the WCRI’s Wang said. Vicodin is a popular hydrocodone-based painkiller, and Oxycontin is a popular oxycodone-based painkiller.
While the origins of the painkiller epidemic may be traced back to the pharmaceutical companies’ marketing shift two decades ago, the current situation is mired in great complexity. Doctors and workers play an important role in the proliferation of painkiller abuse and addiction.
“When you talk to a doctor, he’s going to do what he does best, and that might be to prescribe medication to relieve your pain. But when you think about it, a doctor’s specialty is hardly ever addiction,” Ceraso said. “Maybe if more doctors were aware of what we’re seeing, they would think about other treatments. But I don’t want to put the onus on the doctor either, because people come in and say, ‘I can’t miss work.’ So it’s not always the doctor’s fault either.”
Addiction is a common health concern that can affect anyone. Clarkson called it an “equal opportunity destroyer.” Most painkiller addicts are people who never had a drug problem before they started taking prescription opioids, experts say.
As a response to the skyrocketing rates of abuse and addiction, 48 states have created prescription drug monitoring programs to prevent doctor shopping, a process by which individuals go from doctor to doctor accumulating painkiller prescriptions, Wang said.
‘Employers should be proactive if there’s a problem. You don’t want to wait until some guy’s hand gets mangled in a machine or somebody overdoses.’
—Michael Clarkson, Ogletree, Deakins, Nash, Smoak & Stewart
The workers’ compensation community has also taken steps to reduce the number of opioid prescription addictions. The first is encouraging better adherence to the evidence-based guidelines for long-term chronic opioid therapy by medical professionals. A key component of the guidelines is psychological evaluations of patients taking opioid painkillers. According to the WCRI’s research, less than 5 percent of patients receive psychological evaluations.
Employers can also have a significant impact on the health of their employees who are taking painkillers, thereby protecting the efficiency of the workforce and reducing potential liabilities.
A drug-testing policy is an obvious first step. However, experts cautioned a drug test is only as effective as the medical review officer that examines employees’ drug tests.
“The MRO is the first line of defense, and the doctor is second,” said Clarkson, echoing Wang’s argument that medical professions take greater care to follow the evidence-based guidelines for opioid therapy.
When it comes to protecting the health of employees, EAPs are critical options for both employees and employers, experts said. Assistance programs allow an employee addicted to painkillers to get help anonymously and to receive advice on how to proceed with their recovery.
Clarkson referred to EAPs as a “lifesaver.” Once an employer becomes involved after a worker seeks help from an assistance program, drug and addiction counselors noted most employers want to help an employee recover.
“Ninety-nine percent of the time, we have no issues with the employer when it comes to the recovery of an employee. Usually employers are very understanding when it comes to addiction,” Ceraso said.
Clarkson recommends employers have a prescription disclosure policy, in addition to a random drug-testing policy, to fill the cracks that some employees may slip through.
Employer education about the warning signs of addiction is perhaps the most effective way to ensure business is not negatively affected by the painkiller epidemic. Legal experts also recommends employers educate employees on the warning signs of addiction.
“Employers should be proactive if there’s a problem,” Clarkson said. “You don’t want to wait until some guy’s hand gets mangled in a machine or somebody overdoses.”