President Donald Trump recently addressed the rapidly escalating epidemic of drug addiction in the U.S., declaring the opioid crisis to be a “public health emergency.” He is right that we are facing an emergency: 59,000 Americans died from drug overdoses in 2016, more than those killed by homicide and traffic accidents.
The public health emergency declaration allows some grant money to be used for a broad array of efforts to combat opioid abuse and eases certain laws and regulations aimed at addressing it. In addition, the White House has created a commission on opioids, which calls for more drug courts, greater training for doctors, and penalties for insurers who do not cover addiction treatment.
{mosads}While these actions are a good start, coping with an epidemic of this magnitude will require solutions from both the public and the private sector. For their part, large employers are assessing the opioid epidemic’s effect on their organizations, employees and dependents, and are taking specific steps to address it. To capture these actions and suggest additional solution, the American Health Policy Institute recently released a paper on Chief Human Resources Officers’ response to prescription drug use among the workforce, “The Opioid Crisis: Thoughts from the CHRO Suite.”
One of the most important aspects in addressing opioid dependency is being able to face and engage the problem. Given the current negative social stigma attached to an opioid dependency, doing so can be difficult. Employees may not reach out for help for either themselves or their dependents because of concern over how others will perceive them and their capabilities as an employee, parent or spouse. In response, employers should advertise that the health plans they offer cover medical, behavioral, and pharmaceutical treatments for substance abuse. This can help in reducing the stigma associated with opioid abuse so that employees will feel comfortable coming forward for help.
Identifying drug use among employees can be complicated. The traditional intersection of drug use and employment come in the form of pre-employment testing. Many employers have instituted some level of pre-employment drug testing, while others impose either random or “for cause” drug testing. However, none of these tests are designed to engage employees and their dependents in dealing with drug dependence. The typical outcome for failing a drug test is some form of discipline or termination. These processes are not designed to engage employees or their dependents and leaves a huge hole in the net meant to help individuals caught up in opioid abuse.
Additionally, with the advent of high-deductible plans and the fact that opioid medications are relatively cheap, organizations may find employees taking opioids and deliberately not running their prescriptions through the company’s health plan to avoid any restrictions or limitations that may be in place. Such claims wouldn’t be managed within any safeguards the employer’s plan may have implemented and make identifying and engaging opioid dependent employees (or their dependents) that much more difficult.
Employers should ensure that their health plans use data analytics to identify physicians with a practice of excessive dosing of opioids, excessive duration of opioids. When opioid abuse is identified, employers may first reach out to the employee and the doctor prescriber. Second, employers may ask their Pharmacy Benefit Manager (PBM) to put a “pharmacy lock” in place, which means that the PBM will only allow prescriptions to be filled from a single designated pharmacy, and once the prescription has run out, no refills will be allowed.
The opioid epidemic has lowered the overall life expectancy of the U.S. population for the first time in over two decades and is currently running around 10 overdose deaths per 100,000 people. In order to combat this problem, government and the private sector need to work in tandem to address prescription drug abuse and provide proper treatment. Employers can contribute by encouraging employees to seek treatment, as well as engaging with the health care provider community to advocate for prescription quantity control. In addition, health plan administrators and PBMs can work closely together to identify and reach out to those who have been prescribed opioids for more than a given timeframe.
Solutions to this crisis must come soon, and they will, if employers, health care providers, government, and the pharma community work together at addressing the problem.
Henry C. Eickelberg CPA, JD, LLM, is a Senior Fellow of the American Health Policy Institute in Washington, D.C., and a former corporate vice president of Human Resources and Shared Services for a Fortune 100 company.