Alternatives to Opioids

5 Ways to Help Injured Workers Avoid Opioid Misuse

To improve the odds of injured workers recovering from injuries without opioids, employers have tools and strategies at their disposal.
By: | August 20, 2018 • 7 min read

While opioid medications have taken Public Enemy No. 1 status in the last few years, they do have their place. Opiates make sense for patients with cancer-related pain, traumatic injuries like burns and amputations, invasive surgeries and certain other conditions. That said, an enormous spectrum of conditions are still being unnecessarily treated with opioids.


Both the health care industry and the workers’ comp industry are working to turn that around. Employers can join in the effort by giving injured workers the support they need to recover without opioids. Here are five ways employers can help.

1) Educate Your Workforce

Most people tend to simply accept whatever prescription the doctor writes without questioning it. Despite widespread public attention on opioids, some people still may not grasp the havoc that opioids can wreak on the body. There are plenty of addicted patients who likely never would have agree to take them had they understood what they were ingesting.

Employers can help their workforce become better educated health-care consumers. Include myths and facts about opioids in your rotation of safety and workers’ comp training topics. Make sure workers understand opioids are known to cause all manner of discomfort from itchiness to nausea and constipation — even respiratory depression.

Mark Pew, senior VP, Product Development & Marketing, Preferred Medical

Some people quickly develop a tolerance to the drug, meaning they require ever high doses to manage pain. Worse, some actually experience an increased sensitivity to pain, and wind up taking yet more opioids in an attempt to manage the increased pain. This can result in not only addiction, but respiratory failure and death.

Educating workers on the alternatives to opioids should also be a part of the equation, said Mark Pew, senior VP, Product Development & Marketing for Preferred Medical.

“It’s important for them to understand the benefits versus the risks of opioids. But they also need to know that there are other things at their disposal – things that they can do for themselves or ask their doctor for.”

Those things include deep diaphragmic breathing, mindfulness, yoga, massage therapy, dry needling, acupuncture, cognitive behavioral therapy and more, said Pew. If necessary, short-term NSAIDS or Gabapentin might be a consideration in some cases.

2) Manage Expectations

There’s a world of difference between managed pain and zero pain. The bottom line is that injuries hurt, and so do surgeries. Managing the pain to a tolerable level is a reasonable goal. Eliminating the pain probably isn’t, not at first. Pain is a normal part of the healing process, and it improves over time. “Pain-free” is a mindset that took hold in the US at the height of the opioid marketing push. Turning that mindset around is a challenge.

In a pain relief video posted to YouTube, Dutch hand surgeon Teun Teunis noted, “In the U.S., if you break your ankle and have surgery, you take one of the strongest opioids available. In the Netherlands, you take acetaminophen, a non-opioid pain reliever, just as in most other countries. And pain intensity and satisfaction with pain relief are no different. It seems that when a Dutch person breaks their ankle and needs surgery to repair it, they think, ‘This is going to hurt.’ But in the United States, we think, ‘Why am I hurting?’ ”

For non-complex injuries and minor surgeries, it’s often possible to manage with non-opioid analgesics like acetaminophen, ibuprofen or a staggered combination of the two. If pain is disrupting sleep, patients can supplement with a low dose of an opioid medication at night for a day or two.

One thing injured workers should avoid — especially in the early stages of an injury or immediately after minor surgery — is letting the pain build up. They should be taking non-opioid analgesics at the recommended intervals, or at the first sign of discomfort. Waiting too long can allow the pain to become unbearable, and convince patients to use the supply of opioids they left the ER or the surgery center with.

3) Increase Resiliency with Wellness

The body’s natural healing abilities can be greatly enhanced by a person’s overall health and wellness. Employers can be proactive by cultivating a robust wellness culture. Fit and healthy workers are better able to avoid prolonged pain after an injury.

“It’s important for them to understand the benefits versus the risks of opioids. But they also need to know that there are other things at their disposal – things that they can do for themselves or ask their doctor for.” — Mark Pew, senior VP, Product Development & Marketing, Preferred Medical

Habits such as smoking and inactivity and comorbidities such as obesity can have a dramatic effect on pain severity and duration. As pain drags on, people lose patience with feeling pain and may turn to opioids to make it finally stop.


A healthy diet, good muscle tone, well managed blood pressure and good stress-management skills are all goals that employers can help their people work toward, said Pew.

“From a wellness standpoint, you can set the standards,” said Pew. That might mean swapping out soda for vitamin water or candy for protein bars in the vending machines. It might mean providing standing desks, or advocating for walking meetings, or reminding workers to get up and walk around every hour. It might mean bringing a nutritionist in to teach people how to cook with less oil and less sodium.

“You can convey this attitude and let it permeate [through the organization],” said Pew. “It sends a subtle message that the best way to deal with life’s curveballs is to develop some resiliency.

“We need to focus on the whole person so when the injury occurs, they’re more fit psychologically, emotionally and physically, so that the injury isn’t catastrophic, and they’re not out of work as long.”

4) Have a Robust Return-to-Work Program

Employers may not be thinking of it in these terms, but a strong return-to-work program is an excellent pain-management tool. It sounds simplistic, but simply having something else to focus on is a technique that works.

“Of course you don’t want to ask them to do more than they’re capable of, but getting them back into the work environment is so important,” said Pew.

He recalled that two years ago at the National Workers’ Compensation and Disability Conference®, Marcos Iglesias, one of his clinical mentors and now the medical director for Broadspire, “made this comment that stuck with me — that ‘worklessness is a comorbidity.’

“The inability to do work is just as bad as hypertension, smoking, or kidney disease.” Said Pew.

“It’s because the sense of value, the sense of accomplishment, the sense of collaboration that you get from working, you can’t get from sitting at home feeling sorry for yourself, watching TV commercials about drugs and about personal injury attorneys — both of whom are turning you into a victim.”

During recovery, a worker might be able to do a modified version of his or her existing job or it may be a slightly different job. Whatever the case, it’s important that the work be meaningful.

“Partial duty shouldn’t be something so insignificant and so mind-numbing that it’s worse than sitting at home,” said Pew, noting that companies with limited light duty options sometimes choose to send workers to non-profit facilities during their recovery.

“Even though they may not be at their regular work, they’re doing good someplace, they’re not just sitting home in the dark basement feeling sorry for themselves” and thinking about their pain, he said.

5) Work with Treating Physicians

Engaging directly with treating physicians is a good strategy for ensuring that workers aren’t being prescribed opiate medications unnecessarily. But an employer or payer’s ability to engage with treating physicians may be limited depending on the state.


“Connecticut has ex parte rules that you absolutely positively cannot speak to [an injured workers’] physician, and the physician is purely the choice of the injured worker,” said Pew. “While in states like Georgia, the employer selects the panel of physicians and workers have to [utilize] those physicians. In Texas and California, employers can create networks of physicians and there are benefits for employees  who use that network.”

If employers are able to select their physician panel, it’s important to select doctors who are experienced and who understand the nuances of occupational health, said Pew, and to ensure that their sole focus is return to work and return to function.

“Fill your network with doctors who are very competent, who follow evidence-based medicine, and that have demonstrated proof, over time, that they deliver people back to work and back to function quickly — but not so quickly that they reinjure themselves,” he said.

Employers who can’t influence clinician selection may still be able to help injured workers avoid opioid pitfalls by providing case managers or nurse triage providers who are closely aligned with the company’s philosophy on selecting opioid alternatives whenever possible. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

In the Fast-Paced World of Retail, This Risk Manager Strives to Mitigate Risks Proactively and Keep Senior Leaders Informed

Janine Kral works to identify and mitigate risks, building strong partnerships with leaders and ensuring they see her as support rather than a blocker. 
By: | October 29, 2018 • 4 min read

R&I: What was your first job?

My very first paid job was working on my uncle’s ranch in British Columbia in the summers. He had cattle, horses and grapes — an unusual combo. But my first real job out of college was as a multi-line claims adjuster at Liberty Mutual.

R&I: How did you come to work in risk management?

Right out of college I applied for a job that turned out to be a claims adjuster at Liberty Mutual. I accepted because they were offering six weeks of training in Southern California, and at the time that sounded really fun. I spent about three years at Liberty Mutual and then I spent a short period of time at a smaller regional insurance company that hired me to start a workers’ compensation claims administration program.

I was hired at Nordstrom as the Washington Region Risk Manager, which was my first job in risk management. When I started at Nordstrom, the risk management department had about five people, and over the years it has grown to about 75. I’ve been vice president for 11 years.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

I would say that technology has probably been the biggest change. When I started many years ago, it was all paper and no RMIS.


R&I: What risks does the retail industry face that are unique?

We deal with a lot of people — employees and customers. With physical brick and mortar settings, there are the unique exposures with people moving in and out in a public environment. And of course, with ecommerce, we have a lot of customer and employee data, which creates cyber risk — which is not necessarily a unique risk in today’s environment.

R&I: Can you describe your approach to working with senior leaders and front-line staff alike to further risk management initiatives?

It starts with keeping the pulse of what’s happening with the business. Retail moves really fast. In order to identify and mitigate risks proactively, we identify top risk areas and topics, and then we ensure that we have strong partnerships with the leaders responsible for those areas. Trust is critical, ensuring that leaders see us as a support rather than a blocker.

R&I: What role does technology play in your company’s approach to risk management?

Janine Kral, claims adjuster, Nordstrom

We have an internal risk management information system that all of our locations report events into — every type of incident is reported, whether insured or uninsured. Most of these events are managed internally by risk management, and our guidelines require that prevention be analyzed on each one. Having all event data in one system allows us to use the data for trending and also helps us better predict what may happen in the future, and who we need to work with to mitigate risks.

R&I: What advice might you give to students or other aspiring risk managers?

My son is a sophomore in college, and I tell him and his friends all the time not to rule out insurance as a career opportunity. My advice is to cast a wide net and do your homework. Research all the different types of opportunities. Read a lot — articles, industry magazines, LinkedIn. Be proactive and reach out to people you find interesting and ask them about their careers. Don’t be shy and wait for people and opportunities to come to you. Ask questions. Build networks. Be curious and keep an open mind.

R&I: What are your goals for the next five to 10 years of your career?

I have always been passionate about continuous improvement. I want to continue to find ways to add value to my company and to this industry.

R&I: What is your favorite book or movie?

My favorite book is Shantaram by Gregory David Roberts. It’s a true story about a man who was in prison in Australia after being convicted of armed robbery, and he escaped to India. While in India, he passed himself off as a doctor in a slum. It’s a really interesting story, because this is a convicted criminal who ends up helping others. I am not always successful in getting others to read the book because it’s 1,000 pages and definitely a commitment.

R&I: What’s the best restaurant you’ve ever eaten at?

Fiorella’s in Newton, Massachusetts. Great Italian food and a great overall experience.


R&I: What is your favorite drink?

“Sister Carol.” I have no idea what is in it, and I can only get it at a local bar in Seattle. It’s green but it’s delicious.

R&I: What is the riskiest activity you ever engaged in?

Skydiving. Not tandem and without any sort of communication from the ground. Scary standing on a wing of a plane, but very peaceful once the chute opened, slowly floating down by myself.

R&I: If the world has a modern hero, who is it and why?

I can’t think of one individual person. For me, the real heroes are people who have a positive attitude in the face of adversity. People who are resilient no matter what life brings them.

R&I: What about this work do you find the most fulfilling or rewarding?

It’s rewarding to help solve problems and help people. I am proud of the support that my team provides others. &

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]