The Impact of Opioid Use and Abuse on Medical Community, Businesses, Social Organizations and Individiuals and Their Families

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1 The Impact of Opioid Use and Abuse on Medical Community, Businesses, Social Organizations and Individiuals and Their Families

2 THE MAGNITUDE OF THE OPIOID EPIDEMIC THE COSTS TO LOCAL, STATE AND NATIONAL ECONOMY

3 Opioids and Disability from Work Go Hand in Hand Prescribing opioids excessively and too early after an injury may lead to additional risks for the employee and the employer Early use of opioids resulted in disability an average of 69 days longer then injured workers who received no opioids Early use of opioids also a 3x times increased risk of surgery Early use of opioids leads to a 6x increase in risk of dependence National Safety Council and NORC research( research group at University of Chicago) show opioid users miss twice as much work

4 Drug Testing and Employment Opportunities Many employers do drug test and prospective employees on opioids are not eligible for employment if using impairing medication Quest Diagnostics reported in May 2017 that the rate of positive drug tests hit it s highest level in 12 years in 2016 Quest reported nationwide positive drugs tests of 4.2%, in Minnesota the rate was 3% Many employers that drug test do not test for opioids Treatment professionals estimate 3 out of 4 people abusing prescription opioids are employed

5 Drug Testing and Employment Opportunities (continued) St. Louis Federal Reserve reported that manufacturing contacts in Louisville and Memphis reported difficulty finding experienced or qualified worker, in part due to some candidates inability to pass drug tests A March 2017 study of US companies with 50 or more employees found 71% of employers reported being affected by prescription drug use by employees (National Safety Council, University of Chicago and non-profit Shatterproof) 2016 study of 200 Indiana employers reported that prescription drug abuse affects 80 % of companies In Indiana 1.5% of workers looking for low skilled jobs are neither working or looking for work due to opioids

6 Children are the Unseen Victims of the Opioid Epidemic Parental drug abuse is the most common primary reason children are placed in foster care in Minnesota Many children have been orphaned, sent to foster home or with relatives Those who stay with addicted parents learn to fend for themselves, living with fear, anxiety and depression They often develop behavior and learning problems They have difficulty forming trusting relationships Betty Ford Center indicated that they are typically the first hurt and the last helped

7 Children are the Unseen Victims of the Opioid Epidemic (continued) In the past 20 years the percentage of families in the Betty Ford Program has grown from less than 10% to 25 % Of the children placed outside of their homes, 27.1% of children placed for the first time was due to parents substance abuse. This is the first time substance abuse surpassed neglect as reason for alternative placement Emergency department opioid misuse diagnosis in children an emerging public health crisis per American Academy of Pediatrics Pharming and 1 in 4 teens have used powerful narcotics for nonmedical reasons

8 Opioids as a Gateway to Heroin Prescription Oxycontin and Vicodin have effects similar to heroin Heroin is highly addictive and often times is cheaper and easier to obtain than opioids Nearly 80 % of Americans using heroin reported misusing opioids first CDC reports that more than 1 in 4 people who inject drugs reuse the needles and many have not been tested in the last year causing HIV outbreak and increased Hepatitis C reported CDC states non-hispanic white males years living in large metropolitan areas is where abuse has seen largest increase, most drastically in the Midwest. Taken hold of the white suburbs. Ages have the highest death rate.

9 US Life Expectancy Falling In 2016 life expectancy dropped as the number of deaths due to opioid drug overdoses surged Total drug overdose rate rose in 2016 to 21% or 63,600 according to CDC Life expectancy fell by 0.1 year to 78.6 years, this was the second year of decline in life expectancy for the first time since 1962 and 1963 Opioid deaths have been on the rise since 1999, but surged from with an average increase of 18% 2016 rate of overdose death was up across all age ranges with the highest rate in year olds As the US opioid addiction epidemic has worsened, many state attorneys generals have sued- Perdue Pharma recently laid off half of their work force

10 Opioid Costs in the Workplace Human resources, legal and treatment experts indicate that opioids are the primary reason for increased healthcare costs. Healthcare costs related to the opioid crisis reached $217.5 billion from There is increased absenteeism which reduces productivity and increased employee turnover. Opioid overdose deaths is estimated at 62,000 in 2017 The greatest cost comes from lost earnings due to overdose deaths and is estimated to be $800,000/person with an average age of 41. Cost for inpatient treatment is expensive and 40-60% have a relapses

11 THE USE OF OPIOIDS FOR CHRONIC BENIGN PAN ARE THEY A GOOD OR BAD TREATMENT OPTION?

12 The Goals of Chronic Pain Treatment Plans Decrease pain by at least 30 % Increase in functional capabilities Provide non-opioid tools to manage their pain to include psychological issues

13 Long Term Opioid Use The longer opioids are prescribed the higher the dose needs to be which leads to more side effects Development of tolerance, need to keep increasing the dose Hyperalgesia, where the opioids cause an increase in perceived pain Opioids are known to cause constipation, hypogonadism and other conditions which then need to be treated with additional prescription medications Opioids lead to decreased function because they can cause drowsiness Many opioid users are very sedentary this causes an additional decrease in function. Loss of core strength Drowsiness from opioids and napping during the day lead to insomnia at night and additional medications may be needed- polypharmacy Respiratory depression and death due to accidental overdose Irregular heart rhythms Sleep disorders Increased risk for fractures Dry mouth and tooth decay

14 Treatment Plans for Chronic Pain That Have Support of CDC, ACOEM and National Physician Specialty Groups Use of medications such as anti-inflammatories, muscle relaxers, neuropathic drugs (to treat radiating pain) which have been shown to be as effective as opioids TENS units Acupuncture Injections and nerve blocks if decrease pain and increase function Active, participatory physical/occupational therapy including a home exercise program Tai Chi and Yoga Healthy diet and exercise and good sleep habits Smoking cessation Ice and heat

15 Treatment Plans (continued) A limited number of sessions of Cognitive Behavioral Therapy (CBT) Other options such as biofeedback, mindful relaxation and breathing, virtual reality, etc. Inpatient withdrawal and/or functional restoration for higher doses Journal of the American Medical Association March 6, 2018 concluded that treatment with opioids was not superior to treatment with non-opioid medications for improving pain related function over 12 months. Results do support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain. Pain intensity was better in the non-opioid group over 12 months and the adverse medication-related symptoms were more significant on the opioid group.

16 CONCRETE STEPS TO MINIMIZE DAMAGES DUE TO OPIOID ABUSE

17 Businesses Increase communication and training for managers and supervisors to raise awareness (Drug and alcohol policy and employee awareness of what to do if there is reasonable suspicion to believe a coworker is affected by illegal drugs or alcohol) If a drug or alcohol problem is identified, encourage employee to seek treatment (Does you plan cover this) Limitations on safety sensitive jobs (other drugs besides opioids that can be sedating) Ask if your health plan and work com carrier have programs to monitor and address any unsafe opioid prescribing EAP Programs

18 Society Police, fire, first responders, pharmacists access to naloxone to reverse opioid overdose Opioid medication stored safely and properly disposed of when no longer using (Drug take back day, FDA recommendations for safe disposal) Education on non-opioid treatment for pain by parents, schools, medical providers Often a zero-one pain level is not an achievable goal

19 Work Comp Carrier and Health Plan Initiatives Hire an RN full time to manage prescription drug review program Review reports that are requested through our pharmacy benefit program Educate providers, claims, telephonic nurse case managers and employees on the MN Medication Treatment Parameters as well as the Longterm Treatment with Opioid Analgesic Medication Rules Making sure providers are aware of the MN Department of Human Services opioid prescribing guidelines CDC guidelines/checklist sent with letters Individualized letters sent to prescribers along with concerns as well as a copy of the appropriate rules or guidelines per above

20 Work Comp and Health Plan Initiatives (continued) Drug review lunch and learns Resources available to claims and nurse case manager on intranet and any significant information is ed and/or covered in monthly claim meeting Address any medication or combinations of medications that put the employee at higher risk such as opioids and benzodiazepines Drug review nurse available for round tables on any files with drug review concerns and they also have weekly time MD to review any medication concerns identified.