As more entities study the impact of America's opioid crisis, reports are emerging that reveal a tragic tale unfolding for not just the addicts, but also the communities in which they live. The cost of the epidemic is born across several segments of society, and, because those segments also impact non-opioid affected people, essentially, everyone pays for the damage that is being caused by this insidious affliction. Businesses, in particular, are paying more for the care of injured workers who are prescribed, then become addicted to opioids, and they are paying for longer recovery periods, too.

In this second post of a four-part series on the opioid issue, CompEx MSA hopes to share the details about the size of the challenge it poses, especially in the workers’ compensation industry. Future posts will offer some hopeful notes about how its ugly tide may be turning. In addition, research has suggested some possible responses employers might adopt as they contemplate how the crisis, now or in the future, might negatively impact their enterprise and how they might avoid the consequential costs.

Workers’ Comp, On-the-job Injuries and Opioid Addiction

Injuries at work are not news. According to the National Safety Council, somewhere in America, a worker is injured on the jobevery seven seconds. That statistic extrapolates out to 510 injuries per hour; 12,300 a day; 86,500 per week and over 4,500,000 injuries per year. For employers, the lost time due to on-the-job injuries totals over 100,000,000 production days annually. Many, if not most, of those injuries will require some form of pain-controlling medication, and for those, since the mid-1990's, opioids have been the pain-reliever of choice by countless physicians. Employers are also responsible for covering the cost of these medications, too.

Further, not every injury is comparable to all injuries and not every injury requires the level of pain relief provided by an opioid medication. Those workers in the most dangerous occupations often suffer more significant injuries and require higher levels of pain relief for longer periods than workers who don't work in those riskier jobs. These three common types of injuries can occur at almost any worksite, while the more serious injuries occur more frequently in those occupations that expose workers to bigger risks and more significant injuries.

Typical Types of Workplace Injuries:

• Overexertion is involved in one in three work-related injuries (34%). People lift heavy objects that overtax their capacity, or they lift them incorrectly, magnifying the risk of injury. Repetitive motions are also part of this category.
• Inadvertent contact with objects is also fairly common, occurring in approximately one in every four workplace injuries. Being struck, caught, compressed or crushed by moving equipment such as forklifts or heavy objects stored overhead can cause a range of injuries from slight scratches to potentially fatal bodily trauma.
• Trips, slips, and falls are also quite common, occurring in 25% of all workplace injuries. Workers slip on slick surfaces or on detritus littering the floor; trip over chairs, ladders, or other items they don't see, or fall down stairs, over chairs or other obstacles.

The injuries suffered in these types of worksite incidents are rarely life-threatening but may require pain medication during the acute and recovery phases.

Riskiest Occupations

Certain types of work create more significant risks of worse injuries simply by their very nature:

Service workers

Police officersand firefightersobviously risk personal injury simply by doing their jobs every day. For police people, the most common work-related injuries are soft-tissue sprains generated by wrestling with a non-compliant offender. For firefighters, more than half (57%) of their workplace injuries - which are also sprains and strains - occur at non-fireground sites. In 2016, more than 62,000 American firefighters reported on-the-job injuries (24,000+ were at the site of an active fire).

Construction Workers

In 2016, there were more than 77,000 construction-related injuries, and more than 11,000 of those were back injuries. Hand injuries accounted for another 1,000+ injuries. Further, almost all construction workers will report at least one job-related injury in their career, making construction the industry with the most number of workplace injuries that require medical attention and (potentially) pain relief medication.  (Note, too, that 5,190 construction workers lost their liveson the job in 2016, which represents more than 20% of all work-related fatalities that year. However, the construction industry employs only 4% of the entire U.S. workforce.)

America's Top Ten Most Dangerous Jobs

Several industries are responsible for most of America's on-the-job injuries, and most, if not all non-fatal injuries usually require some level of pain management during both the acute and recovery phases:

From tenth to first, these are America's most dangerous jobs:

10. Grounds maintenance workers;
11. Supervisors of construction workers;
12. Agricultural workers, including farmers and ranchers;
13. Truck drivers and other transport workers;
14. Structural iron and steel workers;
15. Waste material collections workers;
16. Roofers;
17. Aircraft pilots and flight engineers;
18. The fishing industry, and
19. Loggers.

Work-Related Injuries and Opioid Prescriptions

Recent studies suggest that workers with large employer health care coveragecomprise more than one-third of all opioid prescriptions. Of those, workers aged 55 to 64 had the highest number of opioid prescriptions in 2016, consuming 22% of all such prescriptions compared to only 12% for younger adults. Women get more prescriptions (15%) compared to men (12%), and the workers in the South get the drugs at a higher rate (15%) than those in the West (12%) or the Northeast (11%).

Are Opioids Worth the Risk (or the Expense)?

The question for employers is whether opioid medicines are actually helping them get their workers back on the job sooner than they would be without the opioid (or its risks). At least one recent study says no.

Researchers working through the auspices of Princeton Universitydetermined that opioid medications received by workers cost their employers an average of three times as much as non-opioid pain medications and that those workers treated with the opioids also stayed off the job for longer periods than their non-opioid-treated colleagues. After controlling their data for worker age, industry and regional variables, the study (which was focused on work-related low-back pain) noted that it produced at least some evidence of an overuse of opioids over longer terms, and that some workers would or could return to work faster if they had been given non-opioid pain medications in the first place.

Other studies support those conclusions. In a 2017 Blue Cross Blue Shield (BCBS) study:

• Worker/patients who filled at least one high dose prescription for opioids had 'much' higher rates of developing 'opioid use disorder' (addiction) than those who took lower doses;
• Women over 45 had a higher rate of developing opioid use disorder than did men;
• Longer-term opioid use and use disorders develop at the highest rates in the South and Appalachian regions, and
• Opioid prescriptions that for chronic conditions are twice as likely to extend past six weeks and three times as likely to trigger the 'high-dose' threshold that frequently leads to opioid use disorder.

Further, those people who develop opioid use disorder are also most likely to develop a heroin addictionafter their opioid prescriptions (and opportunities for prescriptions) expire. Those people who become addicted to opioid pain relievers are 40 times more likely to turn to heroin when their opioid supply dries up.

There are several conclusions that can be drawn from the research:

• Opioids are often not the best option for pain management of work-related injuries;
• Employers whose workers are prescribed opioids pay more for those medications for longer periods than they do for workers who aren't given the opioid drugs, and
• Employers with workers on opioid-based protocols usually wait longer (and pay more) for those employees to return to work if they recover sufficiently from their injury to return at all.

Not only do America's employers lose over 100,000,000 production workdays annually because of work-related injuries, but they also pay exorbitantly for the opioid pain medications used to treat those injuries, too, through higher costs made over longer periods of time. Recent studies appear to indicate that there are only a few benefits to opioid prescriptions for injured workers and that those are decidedly off-set by their drawbacks and costs.

In our next Opioid Epidemic post, we will look at what governments around the country are doing to address the challenge.