Shifting Our Focus to Preventing Negative Outcomes from Opioids
Providing people who want to work, the opportunity to work is not only important to individual families but also the economy. When workers are injured, they may lose that opportunity. Preventing work injuries from happening in the first place is far and away the best way to keep workers from becoming injured workers. When injuries do happen, it is imperative for all involved, to focus on getting workers healthy and back to their lives.
Once an injury has taken place, a lot can happen during the course of treatment that ultimately will lead to positive or negative outcomes. Preventing negative outcomes from the treatment associated with an injury is just as important as preventing the workplace injury in the first place. To prevent injuries we implement and encourage proper training, awareness and safety protocols. Similar protocols should be used to prevent negative outcomes during the course of treatment so injured workers can return to the most productive life possible.
How can we prevent negative outcomes from happening in the course of treatment of an injured worker? If the course of treatment was process mapped, we might find several gaps in care that could affect outcomes. Importantly, a major gap in care for many would relate to the opioid epidemic. The Centers for Disease Control and Prevention (CDC) report that as many as 1 in 4 patients receiving long-term opioid therapy in a primary care setting, struggle with addiction.1 And, “we now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths.”2 At their best, opioids are valuable tools in mitigating intense acute pain helping injured workers get through the toughest portions of their pain and onto the road to recovery. At their worst, opioids are an intensely addictive therapy that has led to 91 Americans dying every day from overdoses.2
While recent initiatives such as improving access to care for those addicted to opioids, and expanding access to the life-saving drug naloxone used in opioid overdose are important steps towards addressing the epidemic for those that have already developed a negative outcome, we also need to focus on preventing negative outcomes from happening in the first place. To do this, it has become clear that there needs to be a multifaceted approach that identifies a goal and establishes a methodology to achieve that goal for the injured worker. Process models would challenge us to capitalize on available resources and remove wasted steps to be able to identify, maintain and sustain process improvement towards improving opioid epidemic related problems. The process of treatment within Workers’ Compensation is a team effort among many people who influence the care an injured worker receives and as such an approach that utilizes each team member’s expertise as a resource will be useful.
The pharmacist role is an evolving and often underutilized available resource that can be instrumental in a multifaceted approach towards preventing negative outcomes. As experts in medication, pharmacists’ skills and knowledge are valuable resources and they have the ability to contribute to integrated care teams by detecting and resolving or preventing drug related problems, helping to ensure the safe and efficacious use of medicines and providing comprehensive drug information to patients and other health care professionals, thereby reinforcing prevention of negative outcomes.
As an industry, we must focus on our role in appropriate and safe pain management. This focus must take into consideration the CDC’s calling on dispensing pharmacists to be on the front lines of addressing prescription opioid abuse and overdose.3 Dispensing pharmacists as part of a Workers’ Compensation PBM must take this front-line role to a value-added level and develop specific program solutions focused on opioid related problems such as Prescription Drug Monitoring Program (PDMP) reviews and education of injured workers and communication with their physicians regarding high-risk drug combinations, high risk opioid doses and safer alternative treatment regimens.
Some drug combinations can be extremely dangerous. For example, there has been much written about the “holy trinity” of drugs: opioids, benzodiazepines and carisoprodol (Soma) and the serious danger inherent in taking 2 or 3 of these together.4,5 Can we really afford to use a pharmacy or PBM that doesn’t have a standardized approach to this combination or one who does not take action before the combinations of medications are dispensed? We need specific programs that reach out to the patient and prescribing physicians on these specific risky drug combinations prior to their dispensing.
Pharmacists who can access state PDMPs can help identify patients at increased risk of overdose, such as those taking high dosages or obtaining opioids from multiple prescribers. They can then help monitor the patient and their prescriptions allowing for proactive consultation with the injured worker and prescriber prior to dispensing high-risk medications.
In addition to consulting with physicians regarding opioid addiction and high-risk drug combinations, it is important for the pharmacist to be able to alert a prescriber to pertinent legislative rule(s) for their state and their patient’s morphine milligram equivalent (MME) before the pills are dispensed. Choosing a PBM with this capability can be critical to preventing negative outcomes.
As injured workers are educated about what medications may work best for them as well as potential risks of various medications or combinations of medications, they are provided the opportunity to become advocates for themselves. We need to ensure that dispensing pharmacists have experienced insight into pain management within Workers’ Compensation, which they can then use to educate patients. Pharmacists as part of the injured worker’s treatment team can use a variety of ways to educate patients including direct phone calls and subsequent informational pieces that address pain management e.g., “If not opioids, then what?”
Many injured workers are scared that their pain will be unmanageable without opioids. Learning that outcomes and pain management are often improved through the use of tapers, other non -addictive medications, non-drug therapies like; cognitive behavior therapy (CBT), massage, movement therapies, socialization, healthier food and lifestyle decisions, will provide the injured workers the resources and support to get on the road to recovery and return them to what they deserve: the opportunity to return to a productive life. The equipped dispensing pharmacist must be an integral member of the medical treatment team to make that a reality.
We can, as an industry, work towards this goal of keeping workers participating in the workforce and in their life by ensuring that we involve knowledgeable, experienced dispensing pharmacists in the treatment plan of our complex cases before a potentially risky pain medication regimen is determined, prescribed and dispensed.
Let’s help protect our most important national resource: our workers before they become statistics, by focusing on prevention as well as management of this problem.
- CDC Opioid Overdose, Guideline Information for Patients, 2016 https://www.cdc.gov/drugoverdose/prescribing/patients.html. accessed 5/5/2017.
- CDC Opioid Overdose, Understanding the Epidemic, 2016. https://www.cdc.gov/drugoverdose/epidemic/ accessed 5/5/2017
- CDC Guideline, Prescribing Opioids for Chronic Pain, 2016. https://www.cdc.gov/drugoverdose/pdf/pharmacists_brochure-a.pdf accessed 5/52017.
- Fudin J. The Perfect Storm: Opioid Risks and ‘The Holy Trinity’. Pharmacy Times. 2014.
- HorsfallJT, Sprague JE. The Pharmacology and Toxicology of the ‘Holy Trinity’. Basic Clin Pharmacol Toxicol. 2017 Feb;120(2):115-119. doi: 10.1111/bcpt.12655. Epub 2016 Sep 26.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Specialty Solutions Rx. The editorial staff of Risk & Insurance had no role in its preparation.