Workers’ Comp Professionals Share 4 of Their Best Opioid-Fighting Tactics

As the opioid epidemic wears on, these employers are taking action to fight addiction in the workplace. Here are four ideas you can steal.
By: | January 15, 2020

Opioid addiction is powerful. An injured worker who becomes addicted to opioids is at risk of losing more than just their job; they could lose their life.  

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“Most of the people that are on opioids for a long period of time live till that next pill. They know exactly when they can take it. They have an alarm set, and they know,” Kim Pfingstag, manager of occupational health and recovery, International Paper, said. 

Pfingstag recently spoke on combating opioid use in workers’ comp during a panel at the 2019 National Workers’ Compensation and Disability Conference® & Expo.   

While the opioid crisis has been gripping the country as a whole, it can feel magnified in the workers’ compensation industry. 

“I realized that we had a problem in the country, obviously, but it seemed to be magnified in the workers’ comp industry,” said Michele Settel, president of Ascential Care Partners. “Percentage wise, we had so many more people on opioids.” 

This problem has been tackled in a variety of ways within the workers’ comp space, to varying degrees of success. 

State formularies have stepped in to limit what opioids are available to workers’ compensation patients, and nurse case managers have been working with injured workers to get them off opioids.

Dawn Watkins, director of integrated disability management, Los Angeles Unified School District

Employers also have a place in working to stop the opioid epidemic. Patti Colwell, workers’ comp program manager, Southwest Airlines, and Dawn Watkins, director of integrated disability management, Los Angeles Unified School District, have both worked with their company’s workers’ compensation programs to reduce opioid use among injured workers. 

They spoke with Pfingstag at NWCDC 2019 about what’s worked for them when it comes to the fight against opioids. Here are six of the best tips they shared.    

1) Educate Your Injured Workers Before the Prescription Starts

The moment to begin discussing how to safely use and get off opioids begins the moment the prescription is written, not after an injured worker has begun using the medication.  

“Something we put into place more recently was for a nurse case manager to be alerted when anybody gets a first fill of opioids, so they can have an educational discussion with them on what they’re about to get into,” Pfingstag said.

 “That really helps them to understand what this medication is they’re going to take, why they don’t want to be on it for too long. And that has really helped additionally to drive down the number of fills.”

Colwell and Watkins have also implemented educational methods for their programs. They recommended labelling opioid prescriptions with a “warn me” tag so that injured workers know to ask their doctors about the dangers and second fill letters, which warn injured workers about the risks of a second fill of an opioid.

“Honestly, if you ask injured workers what drugs are you on? They don’t know that they’re on an opioid. They hear in the news that opioids are bad, and maybe certain ones they know by name, but often they are not aware of the drug clause and the dangers. So just to tell them, “This is a dangerous opioid. You have to be careful.” Just at the point of sale, it makes a big difference,” Colwell said.   

2) Utilize Your Nurse Case Managers

Nurse case managers can play a key role in helping injured workers who have been prescribed opioids. 

“We’ve got triggers that alert the adjuster and the nurse of the first fill of an opioid,” Colwell said.

Once the nurses are notified, they reach out to the injured worker to talk about how to safely use an opioid and to make sure they’re moving towards recovery and not addiction.  

“We found that the nurse establishes that relationship with those employees, and they know their life story and everything. So they get to be a trusted advisor, and that has done wonders for our program,” Colwell said. 

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Settel, who introduced Ascential’s RxAdvise program, which pairs injured workers’ using controlled medications with a nurse case manager,  has also found that nurse case managers can play a key role in helping get patients off opioids. 

“I really feel that what we do is so critical to getting people back to a quality of life and getting people off of these drugs,” she said. 

She believes that nurse case managers can play a valuable role in helping get injured workers off of opioids. Their RxAdvise program involves a weaning and tapering program, which ensures that a nurse case manager is available to help injured workers through that process. 

“Somebody is monitoring to make sure you’re safe. Making sure you’re taking the medications that you should be and not taking anything else that could hurt your recovery,” Settel said. 

“They’re working with the injured worker, the provider, the peer reviewer to implement that weaning and tapering program. And that really truly is full circle.” 

3) Review, Review, Review

Reviewing which doctors are prescribing opioids and which claims have opioid prescriptions can help your program reduce the number of injured workers receiving opioids.

Patti Colwell, workers’ compensation program manager, Southwest Airlines

“The company was really open to just throwing every single resource at the issue. We did some similar things, we have pharmacy management and then pharmacy reviews,” Pfingstag said.

One thing reviews can do is identify doctors who are over-prescribing opioids. 

“I worked with my third party administrator and my pharmacy. I wanted to know who were the doctors that were prescribing this stuff,” Watkins said. 

“I was able to get that information and found out that most of the scripts were written by a handful of doctors. And I said, ‘how do I get them off of my account?’ That was the next step.”

I went to a different medical provider network that didn’t include these doctors, and included doctors that had a better track record. That was one approach,” she added.

Reviews don’t just help you identify which doctors may be over prescribing opioids, however. They also can help detect which injured workers may have been on opioids for too long. 

“I think, when I look at the opioid issue in a workplace I think there’s two sides to take of it. You’ve got to look at stopping the pills from getting in in the first place. If you can look at alternatives before someone gets on the medication, but then also you’ve got the backend for those really long standing claims and you have to address those as well,” Pfingstag said.  

4) Find Alternative Treatments

It’s no secret that alternative treatments to opioids are gaining popularity in the workers’ compensation industry. 

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States like Ohio have taken up PT-first initiatives, which require people with work related back injuries to receive physical therapy before they get an opioid prescription. 

While other states, like New York, have updated their workers’ compensation laws to make alternative treatments like acupuncture, occupational therapy and physical therapy easier for injured workers’ to access. 

“We need to be open to another way of helping people recover, another way of reducing our costs and getting the outcomes that we want,” Watkins said. “It was a long time before I embraced acupuncture. Now we all pay for it in every state. It’s an accepted treatment.”

 If it’s going to get you the results that you need, I suggest you open your mind to alternative types of treatment,” she added. &       

Courtney DuChene is a staff writer at Risk & Insurance. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]