If you asked most people to describe an addict, they’d paint a dark portrait of a furtive heroin or meth addict in an urban street corner setting. But as deaths form drug overdoses outpace motor-vehicle related deaths in state after state, today’s addict is more likely the face of your suburban neighbor, your soccer Mom sister-in-law, or your best employee. The street corner has been replaced by the medicine cabinet. And the modern pusher is more likely to be a friend, a relative or a workers comp physician.
Seemingly every day, states are issuing new reports about this rapidly escalating problem:

  • Overdose deaths are now the top cause of accidental deaths in Ohio. “In 2010, 1,544 Ohioans died from “unintentional drug poisoning” (overdose). That’s more than four a day, up from less than one a day in 1999.” According to Tulsa World, drug overdoses now kill more Oklahomans than motor vehicle accidents — an average of two per day.. The state “…was ranked the No. 1 state in the nation in prescription painkiller abuse last year. They underscore a new reality for law enforcement authorities, health care professionals and public policymakers.”
  • Prescription drug dependence is deemed epidemic in East Central Indiana – Since 2009, the drugs have contributed to more than 75 deaths in Delaware and Henry counties alone.
  • Florida is cracking down on pill mills – “Last year [2010], seven people died in Florida each day from prescription drug overdoses, a nearly 8 percent increase from 2009. This is far more than the number who died from illegal drugs, and the figure is not expected to drop much this year.”
  • Report: Kentucky sixth in nation for overdose deaths. “”The last couple of years overdose deaths have outpaced motor vehicle accidents as the leading cause of accidental death in Kentucky.”

A Centers for Disease Control Report — Saving Lives and Protecting People: Prevention of Prescription Painkiller Overdoses — paints a grim national picture. Overdoses of prescription painkillers have more than tripled in the past 20 years, leading to 14,800 deaths in the United States in 2008. Emergency department visits for prescription painkiller abuse or misuse have doubled in the past 5 years to nearly half a million.

What’s causing this alarming epidemic? The Ohio report cited above says that part of the reason is that we are “swimming in opiates in all forms” and points to several factors: a shift in the philosophy toward pain management, the huge volume of direct marketing of drugs to consumers, the increase in avaialable varieties of opioid pain killers on the market, and the funneling of prescription pain killers for non-prescription use.

The Work Comp Connection

At least part of the problem may be one that you as an employer are financing. In workers comp, narcotics now account for about $1.4 billion, or a quarter of the annual drug spend. First, there is the increased reliance on narcotics. Workers with musculo-skeletal injuries are being treated with opiates once reserved for cancer patients. This might be partly attributable to the fact that drugs are generally reimbursed at a higher rate under workers comp than under group health. And there are few user disincentives to curb abuse under workers comp. Under group health, an insured is paying part or all of prescription drug costs, but under workers comp, the employer foots the entire bill. Finally, the payer – which is you (usually through your insurer or TPA) – is all too often asleep at the wheel. Physician prescribing must be carefully monitored.

At Managed Care Matters, industry expert Joe Paduda offers a post about how much opioids will really cost you. He suggests steps that payers must take:

Payers must work with their PBMs (Pharmacy Benefit Mangers) to dramatically reduce their exposure. This requires both parties to:
a) identify long-term users,
b) mine their data to determine which claimants may be abusing/misusing/diverting and involve SIU where appropriate,
c) channel appropriate claimants to addiction screening, allocate the resources necessary for weaning and recovery and recognize this will include behavioral therapy will find they can.


ESI Employee Assistance Program can help address employees with substance abuse issues – whether problems stem from illicit or prescribed drugs, or any combination of drugs and alcohol abuse. We also offer Drug Free Workplace and D.O.T. compliance programs.


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