As employers are increasingly drawn into the opioid crisis, they need to draft clear workplace drug policies, educate their workers on the dangers of addiction and work closely with insurers and pharmacy benefit plans to spot and prevent potential problems, experts said Tuesday.
A panel of government, industry, health and workplace leaders at a forum at the University of Maryland BioPark provided some good news about the crisis, even amid a litany of sobering statistics and cautionary tales.
“This crisis is particularly complicated,” Clay Stamp, executive director of Maryland’s Opioid Operational Command Center, said at the Greater Baltimore Committee-sponsored event. He noted the stigma of opioid addiction and its twin sources of prescription abuse and illicit drug sales were a powerful combination.
Stamp said the medical community’s efforts to rein in unnecessary opioid prescriptions were beginning to pay off. In 2016, he said, Maryland physicians wrote roughly 4 million opioid prescriptions; last year, that number dropped to 3.4 million.
Dr. George Apostolides, chief of colorectal surgery at Greater Baltimore Medical Center, said the emergence of new pain medications has given physicians better and more options for treating patients’ pain.
He said his team at GBMC has been using Exparel, a non-opioid medication, for colorectal and abdominal procedures. The medication not only is an effective pain reliever, but it has not shown any serious side effects, cuts down patients’ stays at the hospital – thus saving money – and can be prescribed in limited doses, he said.
A representative of Pacira Pharmaceuticals, the drug’s manufacturer, said Medicare is expected to add Exparel to its coverage list for 2019 and many insurance plans already do so.
Denise Galambos, vice president of human resources for BGE, said the company now works closely with its pharmacy benefit manager to spot problems. BGE limits, to seven days, the amount of an opioid medication prescription. Longer prescriptions need to be approved, she said.
BGE follows many of the steps recommended in the GBC best-practices guide, she added, including training supervisors to recognize signs of potential drug problems. She noted that a sizable chunk of BGE’s 3,000 employees are subject to random drug testing and all receive regular evaluations to ensure they are medically fit for their job duties.
Despite evidence of some progress, others noted the programs for treatment are still fragmented and smaller employers aren’t as well-equipped as their larger counterparts for dealing with drug problems.
Terri Harrington, senior vice president for MacKenzie Commercial Real Estate Services, described how she spent hours on the phone contacting 10 different medical services, hotlines and the like in a vain effort to find help for an individual. Ultimately, he went to a hospital emergency room, she said.
“Our systems are woefully inadequate,” agreed Gayle Fortner, CEO of HealthCare 21 Employer Coalition of Tennessee.
Employers, health care systems and government agencies need to be more aggressive in examining available data, which often reveal important clues about where problems lie, she said.
For instance, at one time 34 percent of the opioid prescriptions being written each year in Tennessee were in the city of Knoxville, Fortner said. That city’s population was 186,000 in 2016, according to federal data. Nashville and Memphis each have more than 650,000 residents.
One patient in the state had managed to get 33 prescriptions written – for 3,000 opioid doses – in a single year.
“Most employers are not looking at their data,” Fortner said.
Maryland was relatively late in establishing an effective prescription drug monitoring system to track where abuses exist, said Dr. Stephen Fisher, medical adviser to the CEO of Chesapeake Employers’ Insurance Co., the largest workers’ compensation insurer in Maryland.
Recent research shows that a substantial amount of relatively minor injuries – what he called “strains and sprains,” still are treated with opioids.
“People don’t understand what they’re taking,” Fisher said, “and they don’t understand the threat.”