Tag Archives: harvard medical school

6 Shocking Facts on Opioid Abuse

What is your most pressing employee health issue today?

It’s not cholesterol, weight, sitting or probably anything else you are prioritizing. Instead, by far the major health menace facing your employee population is the opioid epidemic — which, according to Harvard Medical School psychiatrist John Kelly, has reached “DEFCON 5.”

DEFCON 5 is right. There is roughly one opioids prescription written for every adult in the U.S., and the total addiction rate is estimated at 4.6%, which makes it higher than alcoholism and roughly comparable (in the employed population) to diabetes.

Here are five things you need to know:

  1. Opioid abuse has jumped 500% in the last seven years.
  2. The price per milligram of morphine-equivalent paid by employees has declined about 75% in the last 15 years. This is due to more generous coverage (by you!), more use of the formulary and, most distressingly, more pills per prescription. There is virtually no product whose use doesn’t increase as the price falls. And there are very few products whose price falls that much.
  3. The $78 billion all-in cost in the U.S. of opioid use, abuse and treatment works out to about $756 per employee per year. To put that in perspective, that’s about 10 times what you spend on heart attacks and diabetes events (not that those aren’t important, too!).
  4. Workers’ compensation claims costs are 10 times higher when long-acting opioids are involved.
  5. Your ER visit claims coded to opioid issues have probably increased threefold since 2003.

(Yes, we know, that is only five facts. and we promised six. Keep reading…)

How do you solve an opioid problem within your organization?

You can’t look to your wellness vendor to solve this problem. If biometric screens included drug-testing, the employees who need to submit to them wouldn’t. (The legality of the testing would be very questionable anyway.) Asking a health risk assessment question: “Are you addicted to painkillers or heroin?” would generate — at best — the same level of candor wellness vendors observe when they ask about drinking and smoking. You can’t address an addiction that an addict won’t admit to having in the first place.

However, a health literacy vendor – ideally, my firm, Quizzify – can raise awareness of the hazards of opioids in your employee population. Because health literacy quizzes don’t require personal health information, there is no opportunity to lie, no one is being singled out and no one needs to worry that the results aren’t confidential. It’s simply, purely education. The answers are pure facts. (And in our case have passed review by doctors at Harvard Medical School.)

See also: The True Face of Opioid Addiction  

For employees not already using pain meds:

Firstly, employees who are not currently using prescription painkillers need to be made aware of the risks of starting. If there is one health literacy risk worthy of attention — meaning one risk where curing a knowledge deficit (as opposed to trying to change behavior, as with smoking cessation or eating habits) matters — it’s in opioid addiction prevention.

A few facts:

  • It can take as little as three days of use before the first signs of addiction occur. To put this into perspective, even something as minor as prophylactic wisdom teeth removal (not generally recommended by Quizzify anyway) can generate three days of painkiller medication.
  • If you use a 10-day supply as directed, you have a 20% risk of becoming a long-term user.
  • Dose matters. A lot. A high dose for a short duration is 40 times as likely to cause an opioid use disorder as a low dose.
  • Employees’ kids are taking prescription pain meds in numbers far exceeding those of previous generations. This is because they believe them to be safer than street drugs and are easier to get hold of (often from the parents’ medicine cabinets).

For employees already using pain meds:

As mentioned, the percentage of employees using pain meds, 4.6% on average, is roughly the same as the percentage with diabetes. The cost of treating those on pain meds – and their productivity losses (not to mention the possibility to pilferage or other crimes to support the habit) – is much higher than diabetes.

Further, employees are unlikely to seek help on their own. Use of medications designed to treat opioid addiction has grown only about a fifth as fast as opioid use itself. And many employees either don’t know where to turn or are concerned that their EAP conversations are not confidential. Fear of job loss or having a criminal record also impede the likelihood of seeking help. Your health literacy vendor should be able to create the education for you to overcome these natural impediments.

Quizzify’s opioid abuse education includes:

  • Specific contact information for the EAP.
  • “What if I think a coworker is opioid-dependent?”
  • “Are there resources for family members?”
  • “Can I get or renew pain meds from the on-site clinic?”
  • “Is opioid treatment a covered benefit?”
  • “Will human resources find out I am getting opioid treatment?”
  • “What are signs that my children are abusing painkillers?”

What can you do to help?

Your budget allocation for health and wellness should be in proportion to the priorities for health and wellness. As of now, you are likely spending less on educating employees on opioids (not to mention on other health literacy imperatives) than on, for example, weighing employees.

Likewise, employees are probably spending more time figuring out how to cheat on their weigh-ins than on understanding the hazards of opioid use. It’s time to reconfigure these priorities. Teach employees how to avoid, manage and treat opioid addiction before it is too late.

See also: Opioids: Invading the Workplace  

And by “too late” we mean #6 of the facts you need to know:

Far exceeding diabetes and heart attacks, overdoses are the leading cause of death for employees under 50.

We invite you to take Quizzify’s Opioids Awareness Quiz and share it with the top executives, HR administrators and wellness champions within your organization. Your awareness that something needs to be done now will increase. Quizzify offers educational quizzes about opioids for employees. That might be a good place to start.

Is It Time to End Annual Physicals?

A good story with the headline, “Do Annual Physicals Do More Harm Than Good?”, was posted recently on CCN, written by Nadia Kounang. Click here to read the full article.

This is not a new question about annual physicals. Leading physicians have been asking this question for decades. Yet the public and professional wellness vendors persist in having blind and uninformed faith in what is an expensive and potentially harmful ritual.

Dr. Ateev Mehrotra, an associate professor of healthcare policy and medicine at Harvard Medical School, says, “This specialized visit hasn’t proven anything in terms of staying healthful.”

He further says annual physicals “…make sense in theory, but it hasn’t borne out in reality.”

According to the story, “More doctors are saying the annual physical is unnecessary – and can even be harmful.”

Personally, in my career running benefit plans for large corporations, I’ve seen first-hand numerous people seriously harmed by annual physicals, through false positives on unneeded tests that resulted in medical harm to employees. Plus, such false positives cause stunning and unnecessary anxiety, as in “we-said-you-had-cancer-but-oops-my-bad.”

This is a good time to take a hard look at this ritual and consider if precious health dollars could be used better elsewhere.

If your wellness vendor is recommending annual physicals for your employees, you should drop that vendor ASAP. Period.

Carpal Tunnel Syndrome: It’s Time to Explode the Myth

Carpal tunnel syndrome (CTS) has caused a firestorm of controversy in recent years. CTS is a perfect example of how popular beliefs are not supported by medical evidence.

It is time to set the record straight.

Although the popular belief is that keyboard use causes CTS, the science shows otherwise. Nine studies have reviewed this relationship, including ones by the Mayo Clinic, Harvard Medical School and a Swedish study reported in Orthopedics Today. The scientific research shows that keyboards are safe to use and do not cause CTS. Furthermore, keyboard design had no effect on the incidence of CTS. Symptoms may increase with many activities, including the use of keyboards, but keyboards do not cause CTS.

According to the AMA Guides to the Evaluation of Disease and Injury Causation, “85% of patients who meet the National Institute of Occupational Safety and Health (NIOSH) guidelines and requirements for a diagnosis of CTS would not have a true CTS confirmed by nerve conduction testing.”

What complicates the diagnosis and treatment of CTS is that there are multiple causes of the symptoms. These include: diabetes, pregnancy, use of birth control pills, menopause, various vitamin deficiencies, insufficient water consumption, exposure to cold temperatures, incorrect sleeping positions, smoking, knitting, playing musical instruments, recreational sporting activities and other non-work-related activities.

What complicates the diagnosis and treatment of CTS even further is that there are literally dozens of other diseases and conditions that mimic CTS-like symptoms. These include: tendonitis, bursitis, sprains, fractures, dislocations, gout, rheumatoid arthritis, osteoarthritis, thoracic outlet syndrome, myofacial trigger points, as well as an array of neck, shoulder, back and cervical conditions. In fact, there are 59 medical conditions that have been identified to be associated with CTS-like symptoms.

A common error in diagnosis and treatment is the tendency of physicians to treat a case as if there were a single physical site causing all the problems. In fact, it would be extremely rare for only one nerve location to be involved. This means that pain in the wrist may be the result of nerve entrapment in the neck or shoulder. This is referred to as the “whole-nerve syndrome.”

Even the popular name is incorrect. The correct clinical name is Median Nerve Compression Neuropathy. According to the AMA Physicians Guide to Return to Work, “CTS is actually a condition with a known pathology and not a syndrome, but the name ‘carpal tunnel syndrome’ has become so well-known that CTS is used.”

Medical studies have shown that as many as 85% of patients who are told they have CTS are misdiagnosed. The overwhelming number of cases are determined to be work-related–a major problem in the workers' compensation industry for the past two decades–and it has been reported that as many as 70% of those diagnosed go on to receive CTS surgery.

Currently, 250,000 people a year in the U.S. have CTS release surgery. If 85% of those are based on misdiagnoses, that would mean more than 210,000 unnecessary surgeries per year. At a cost of $5,000 to $10,000 per surgery, that's some $1.5 billion a year spent on inappropriate surgery, much of it paid for by workers' comp.

According to a University of Maryland Medical Center study, “CTS surgery does not cure all patients and because it permanently cuts the carpal tunnel ligament some wrist strength is often lost. A number of experts believe that CTS release is performed too often.”

A medical director at a leading insurance company told me, “I recommend that all CTS cases have surgery because that is where all the cases end up anyway.” Needless to say, I will not recommend that insurer to my clients.

The good news is that CTS can be diagnosed accurately. In many cases, it can be treated successfully with conservative treatment in a matter of weeks and is easily prevented.

The bad news is that primary-care physicians more often than not misdiagnose CTS. This results in incorrect treatment and unnecessary surgery, which leads to chronic unresolved conditions, no relief to the patient and staggering costs to U.S. employers and insurers.

Leading medical experts such as Dr. Peter Tsairis, retired chairman of neurology at the Hospital for Special Surgery in New York, said the biggest concern is the automatic assumption that the clinical problem is work-related. “It is a significant problem, since many of these patients do not have CTS,” he added. He has often seen patients already scheduled for surgery whose primary-care physicians did not perform a thorough physical exam or conduct any electrical diagnostic testing to confirm the CTS diagnosis.

Dr. Ron Safko, a New York-based, board-certified chiropractic orthopedist, has also seen many cases of misdiagnosis by primary-care physicians. “It boggles my mind how physicians do not even consider other underlying conditions and do not even examine other areas, such as the neck, back, shoulder or cervical spine,” he said.

Just because it has become a widely accepted urban myth that CTS is caused by keyboarding and, therefore, a work-related injury, should not give treating physicians the liberty to avoid performing a thorough patient history, physical examination and appropriate diagnostic testing based on widely accepted and evidenced-based medical protocols.

Isn’t it about time the workers’ compensation industry got it right?

This article first appeared on Annmarie Communicates Insurance.