Headlines warning about the growing epidemic of opioid substance abuse permeate newsrooms across the country as opioid related deaths continue to rise and addicts emerge that differ from the stereotypical profile. This crisis is leaving many baffled on how to proactively address the growing magnanimity of this issue within the United States. To learn more about the issue and its effects on the community, the CBIZ Kansas City office hosted a seminar featuring subject matter expert panelists from a variety of relevant industries. The experts came together to discuss the epidemic, and ultimately agreed that the conversation surrounding it must begin and end with better education. Here are five discussion points from the panel that give a holistic view of the opioid epidemic.
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1. Anyone is susceptible to opioid substance abuse disorder after a minimum of 3 weeks.
Anyone who has done research on the opioid epidemic will tell you that opioid abuse is a physiological, amoral, non-discriminatory affliction. As CBIZ Pharmacy Consultant Mike Zucarelli pointed out, the chemical effects of opioids are the same for everyone. “There are other options that can be effective pain management tools,” Mike said. Acupuncture, massage therapy, Tylenol/Ibuprofen, physical therapy, etc. can be alternative methods for addressing a patient’s pain. Opioids are designed to hit the pain receptor in the brain to relieve suffering, but they are also designed to hit the dopamine receptor (or the pleasure center), releasing up to 100x the amount of dopamine produced for other activities. It is no wonder, then, that some people taking the drug for only 5-7 days post-surgery could experience withdrawal symptoms.
2. Heroin has become a more affordable and more accessible opioid substitute.
FirstCall is a crisis agency where Susan Whitmore presides as President/CEO. When an audience member asked about the correlative relationship of opioid addiction to heroin abuse, Susan Whitmore explained it was a perfect storm that allowed the two to feed into each other. Heroin and opioids affect the brain in a similar way, and so victims of substance abuse disorder can switch from one to the other. As opioid addiction began to spike and prescriptions rose throughout the United States, a new system for receiving heroin also emerged onto the scene. “Previously, people associated heroin with drug cartels and gang violence,” she said. “Back in the 90s, we began to see a home delivery model become popular.” Over time, this enabled those silently struggling with drug abuse disorder to further safeguard their secret, as drugs could be delivered directly to their homes. This lessened their risk of being caught while making access to the drug a more streamlined and accessible process. Now, with prescription pain medications priced higher than heroin, it is even more appealing to those struggling with addiction to make the switch from one to the other.
3. Employer involvement must be framed entirely around work performance.
Julianne Story, a partner at Husch Blackwell law firm, gave valuable insight from a legal perspective on how to approach the issue of addiction as an employer. Because staffing constitutes the biggest expense for almost any company, it should be safeguarded. The effect of substance abuse on workforce safety and productivity can be far more costly than providing resources and/or treatment to employees. “In most instances, an employer will have invested resources in an employee – even a newly hired employee,” Julianne said. “As a result, if the employment relationship can be salvaged, most employers will want that opportunity.” She acknowledges, however, that it can be difficult to navigate that initial conversation with an employee in a compliant and helpful manner. Julianne highlighted the necessity of having objective evidence to formally inquire into an employee’s potential addiction. Once the objective evidence is available, the discussion must be “job-related and consistent with business necessity (EEOC).” Simply inquiring out of undocumented suspicion or subjective evidence will land the employer in a difficult situation should the employee in question feel singled-out or threatened in any way. An employer can also be well within their rights to mandate treatment as a term and condition of employment, especially if their job duties regularly involve a potential risk to their safety & the safety of others.
4. Crisis call centers aren’t just for victims of substance abuse disorder.
Susan said that at FirstCall, around half of their inbound calls in 2017 were from family members of those suffering from substance abuse disorder. In addition, their overall call intake increased 100% in 2017, which she attributed in part to more parents calling the hotline out of concern for a child. Many families struggle with how to address a loved one who they discover is abusing opioids, especially because they often don’t realize what is happening until the person has been abusing for a long time. FirstCall is one of many organizations that aims to help all those affected by drug abuse, and can offer guidance to family members, victims, and employers on the best protocol for talking to victims of the disorder. The hope is that as people continue to realize the severity of the epidemic, they will begin to come forward and recognize they can play a proactive role in bringing an end to it.
5. There is no “silver bullet” solution…but there is hope.
Especially in the political arena, Charlie Shields, President and Chief Executive Officer at Truman Medical Centers warns that many make the mistake of thinking there is one solution that will bring the opioid epidemic to a standstill. In reality, it will take more than one specific action item to ultimately be successful. For example, many states are implementing initiatives that limit fills for someone who has never taken opioids before to only 7 days of medication, whereas a typical script provides enough medication for 30 days. Mark Fendler, President of the pharmacy benefit management company MedTrak, mentioned that many pharmaceutical software systems now have checkpoints in place that force the pharmacist to go through extra hurdles when filling prescription dosages that are noticeably high. Proper utilization of a PBM (Pharmacy Benefit Manager) can also be helpful; they provide retrospective claims review that help identify people who are “pharmacy shopping” and trying to get prescriptions filled at multiple locations. The doctor can then be notified so that he/she is aware of the issue. Charlie Shields later went on to mention a practitioner at TMC who built his clinic on the foundation of alternative pain management, refusing to prescribe opioids. “People are now being referred to him because of his model, and it’s been very successful.”
The solution that all panelists agreed would be most effective was greater education and awareness surrounding the opioid epidemic. Pharmacies, physicians, families, employers, drug companies, and benefit firms all have a part to play in making sure they are taking the necessary precautions in their respective field. Charlie said one of the biggest issues is how to prevent the addiction in the first place. “Most of these programs start with people who are already addicted and make it more difficult for them, but they don’t solve anything for those who might be prone to the development of a substance abuse disorder.” Pharmacists need to do their due diligence with added patient education before filling a highly potent script; doctors need to ensure patients understand the powerful effects opioids can have before they prescribe them; drug companies need to provide the proper disclaimers on their drugs; and employers need to have difficult conversations when they are warranted. Perhaps most importantly, however, the general population needs to be aware of the dangers of the opioid epidemic so that they understand how to avoid the disorder completely or spot it in those around them. While the opioid epidemic is jarring and brings to light a host of concerns, proper education allows everyone to play their part in its prevention and dissemination.
If you or someone you know is suffering from a substance abuse disorder, please feel free to call the FirstCall Alcohol/Drug Prevention & Recovery 24/7 Crisis Hotline at 816-361-5900. For more information and additional resources, check out the following websites:
Accurate, Online Information on Substance Use Disorder:
National Institute on Health
Drugs, Brains and Behavior: The Science of Addiction
Find a Treatment Center:
Substance Abuse and Mental Health Administration
Behavioral Health Treatment Services Locator