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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.

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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.

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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.

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“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

High Net Worth

High Net Worth Clients Live in CAT Zones. Here’s What Their Resiliency Plan Should Include

Having a resiliency plan and practicing it can make all the difference in a disaster.
By: | September 14, 2018 • 7 min read

Packed with state-of-the-art electronics, priceless collections and high-end furnishings, and situated in scenic, often remote locations, the dwellings of high net worth individuals and families pose particular challenges when it comes to disaster resiliency. But help is on the way.

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Armed with loss data, innovative new programs, technological advances, and a growing army of niche service-providers aimed at addressing an astonishingly diverse set of risks, insurers are increasingly determined to not just insure against their high net worth clients’ losses, but to prevent them.

Insurers have long been proactive in risk mitigation, but increasingly, after the recent surge in wildfire and storm losses, insureds are now, too.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy,” said Laura Sherman, founding partner at Baldwin Krystyn Sherman Partners.

And especially in the high net worth space, preventing that loss is vastly preferable to a payout, for insurers and insureds alike.

“If insurers can preserve even one house that’s 10 or 20 or 40 million dollars … whatever they have spent in a year is money well spent. Plus they’ve saved this important asset for the client,” said Bruce Gendelman, chairman and founder Bruce Gendelman Insurance Services.

High Net Worth Vulnerabilities

Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

As the number and size of luxury homes built in vulnerable areas has increased, so has the frequency and magnitude of extreme weather events, including hurricanes, harsh cold and winter storms, and wildfires.

“There is a growing desire to inhabit this riskier terrain,” said Jason Metzger, SVP Risk Management, PURE group of insurance companies. “In the western states alone, a little over a million homes are highly vulnerable to wildfires because of their proximity to forests that are fuller of fuel than they have been in years past.”

Such homes are often filled with expensive artwork and collections, from fine wine to rare books to couture to automobiles, each presenting unique challenges. The homes themselves present other vulnerabilities.

“Larger, more sophisticated homes are bristling with more technology than ever,” said Stephen Poux, SVP and head of Risk Management Services and Loss Prevention for AIG’s Private Client Group.

“A lightning strike can trash every electronic in the home.”

Niche Service Providers

A variety of niche service providers are stepping forward to help.

Secure facilities provide hurricane-proof, wildfire-proof off-site storage for artwork, antiques, and all manner of collectibles for seasonal or rotating storage, as well as ahead of impending disasters.

Other companies help manage such collections — a substantial challenge anytime, but especially during a crisis.

“Knowing where it is, is a huge part of mitigating the risk,” said Eric Kahan, founder of Collector Systems, a cloud-based collection management company that allows collectors to monitor their collections during loans to museums, transit between homes, or evacuation to secure storage.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy.” — Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

Insurers also employ specialists in-house. AIG employs four art curators who advise clients on how to protect and preserve their art collections.

Perhaps the best known and most striking example of this kind of direct insurer involvement are the fire teams insurers retain or employ to monitor fires and even spray retardant or water on threatened properties.

High-Level Service for High Net Worth

All high net worth carriers have programs that leverage expertise, loss data, and relationships with vendors to help clients avoid and recover from losses, employing the highest levels of customer service to accomplish this as unobtrusively as possible.

“What allows you to do your job best is when you develop that relationship with a client, where it’s the same people that are interacting with them on every front for their risk management,” said Steve Bitterman, chief risk services officer for Vault Insurance.

Site visits are an essential first step, allowing insurers to assess risks, make recommendations to reduce them, and establish plans in the event of a disaster.

“When you’re in a catastrophic situation, it’s high stress, time is of the essence, and people forget things,” said Sherman. “Having a written plan in place is paramount to success.”

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Another important component is knowing who will execute that plan in homes that are often unoccupied.

Domestic staff may lack the knowledge or authority to protect the homeowner’s assets, and during a disaster may be distracted dealing with threats to their own homes and families. Adequate planning includes ensuring that whoever is responsible has the training and authority to execute the plan.

Evaluating New Technology

Insurers use technologies like GPS and satellite imagery to determine which homes are directly threatened by storms or wildfires. They also assess and vet technologies that can be implemented by homeowners, from impact glass to alarm and monitoring systems, to more obscure but potentially more important options.

AIG’s Poux recommends two types of vents that mitigate important, and unexpected risks.

“There’s a fantastic technology called Smart Vent, which allows water to flow in and out of the foundation,” Poux said. “… The weight of water outside a foundation can push a foundation wall in. If you equalize that water inside and out at the same level, you negate that.”

Another wildfire risk — embers getting sucked into the attic — is, according to Poux, “typically the greatest cause of the destruction of homes.” But, he said, “Special ember-resisting venting, like Brandguard Vents, can remove that exposure altogether.”

Building Smart

Many disaster resiliency technologies can be applied at any time, but often the cost is fractional if implemented during initial construction. AIG’s Smart Build is a free program for new or remodeled homes that evolved out of AIG’s construction insurance programs.

Previously available only to homes valued at $5 million and up, Smart Build recently expanded to include homes of $1 million and up. Roughly 100 homes are enrolled, with an average value of $13 million.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work.” — Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“We know what goes wrong in high net worth homes,” said Poux, citing AIG’s decades of loss data.

“We’re incenting our client and by proxy their builder, their architects and their broker, to give us a seat at the design table. … That enables us to help tweak the architectural plans in ways that are very easy to do with a pencil, as opposed to after a home is built.”

Poux cites a remote ranch property in Texas.

Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“The client was rebuilding a home but also installing new roads and grading and driveways. … The property was very far from the fire department and there wasn’t any available water on the property.”

Poux’s team was able to recommend underground water storage tanks, something that would have been prohibitively expensive after construction.

“But if the ground is open and you’ve got heavy equipment, it’s a relatively minor additional expense.”

Homes that graduate from the Smart Build program may be eligible for preferred pricing due to their added resilience, Poux said.

Recovery from Loss

A major component of disaster resiliency is still recovery from loss, and preparation is key to the prompt service expected by homeowners paying six- or seven-figure premiums.

Before Irma, PURE sent contact information for pre-assigned claim adjusters to insureds in the storm’s direct path.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work,” said Curt Goetsch, head of underwriting for Ironshore’s Private Client Group.

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“If you’ve got custom construction or imported materials in your house, you’re not going to go down the street and just find somebody that can do that kind of work, or has those materials in stock.”

In the wake of disaster, even basic services can be scarce.

“Our claims and risk management departments have to work together in advance of the storm,” said Bitterman, “to have contractors and restoration companies and tarp and board services that are going to respond to our company’s clients, that will commit resources to us.”

And while local agents’ connections can be invaluable, Goetsch sees insurers taking more of that responsibility from the agent, to at least get the claim started.

“When there is a disaster, the agency’s staff may have to deal with personal losses,” Goetsch said. &

Jon McGoran is a novelist and magazine editor based outside of Philadelphia. He can be reached at [email protected]