Tag Archives: lewis

Dissecting Landmark Decision on Wellness

This is a follow-up to the announcement and “back story” of the Dec. 21 wellness decision in AARP vs. EEOC, a decision that could severely curtail incentives and penalties…and that could, to paraphrase the most memorable G-rated words ever spoken by Bill Clinton, end wellness as we know it.

That’s the bad news. The good news is that this decision may actually be a windfall for employers with wellness programs that use heavy incentives.

Q: What just happened?

AARP just won a very favorable district court ruling against the Equal Employment Opportunity Commission (EEOC), the agency charged with enforcing the Americans with Disabilities Act (ADA) and the Genetic Information Non-Discrimination Act (GINA). The full decision is here.

Q: How is this different from the previous ruling in AARP v. EEOC?

The original ruling, though in favor of AARP, gave EEOC more than three years to amend its rules to redefine “voluntary” to match the dictionary definition. The new ruling gives one year both for the EEOC to write the rules and for employers to implement the rules, and makes clear what is expected of them. Here  is the key to why this decision should stick:

The government can’t define “voluntary” to include fines of $2,000 or more for non-compliance if it also requires a “mandate” — the opposite of a voluntary option — that carries only a $695 penalty for non-compliance. A voluntary option can’t include remotely as high a penalty for non-compliance as a mandatory requirement, especially in the very same law.

See also: A Wellness Program Everyone Can Love  

Q: What will remain as of January 2019 that employers can require subject to forfeitures?

It is still OK to offer medical screenings and HRAs (collectively, “medical exams”) OR dangle incentives or fines (collectively “forfeitures”), just as it is today. The difference is that the programs involving required forfeitures can’t also require medical exams, which both the ADA and GINA say can only be “voluntary.” The court ruled that you can’t force employees to undergo “voluntary” exams by dangling or threatening to withhold large sums of money.

So you can still require employee forfeitures up to 30% (50% for smokers), and you can still offer medical exams. You just can’t combine the two. That’s because, in order for a wellness program to fall under ADA and GINA in the first place, medical exams must be involved. So, for example, requiring employees to either do screening or do Quizzify is still allowed.

Q: Does this cover screenings only, or are programs that combine annual physicals and forfeitures also affected?

A: If the results of the latter are not shared with the employer,  it appears that they may still be require-able. A better question is why an employer would want to require them. First, they lose money.  Second, they don’t appear to benefit employees, either. The New England Journal of Medicine, the Journal of the American Medical Association, Choosing Wisely and Consumer Reports (and also Slate) have all looked at the data and concluded that for most people annual physicals confer no net health benefit, meaning even if they were free they would be worthless. (People who have continuing health issues should, of course, see their doctor regularly. Those would not be considered checkups under this definition.)

Logically and intuitively, this conclusion would appear to be especially true when employees submit to those physicals under duress. Quizzify — and this question, like most Quizzify questions, carries the Harvard Medical School (HMS) shield — recommends two checkups in one’s twenties, three in one’s thirties, four in one’s forties, five in one’s fifties and for most people annually after that. However, this is also Quizzify’s most edited-out Q&A, as some employers nonetheless want even healthy employees to get physicals every year, and Quizzify respects that choice (though a customized question advocating it could not carry the HMS shield).

Q: These Q&As seem very Quizzify-centric.

A: That’s not a question, but I’ll answer it anyway. There are two reasons for that:

  1. We know of no other vendor that solves the problem and guarantees the solution, with EEOC indemnification. Quizzify was both conceived and designed in anticipation that this court decision would happen someday. (I just didn’t expect it to happen four days before Christmas, which meant a lot of my cousins got gift cards instead of ugly sweaters.) All my exposes on the wellness industry led me to conclude that conventional “wellness or else” (as Jon Robison calls it) could never survive a court challenge…and I designed a product specifically to allow employers to address that challenge immediately and completely.
  2. Those of you familiar with my work know I have only three talents in life: wellness outcomes measurement, employee health literacy/consumerism education and self-promotion.

Your vendor, Quizzify or not, should offer something like this right on their website. If they do, you’re safe:

Q: What other analyses should we be looking at?

The best is The Incidental Economist. AARP hasn’t released a formal statement, but its informal back story can be found at the bottom of this posting.

Q: So what should we do about it?

Simply add the option of taking Quizzify quizzes to the option of HRAs/screenings. That one-step fix is guaranteed and indemnified to solve your legal issues. It will also save money both up front (a year of Quizzify costs much less than a single screening) and down the road, because wiser employees make healthier decisions…and healthier decisions save money. Employees also like playing trivia more than they like being browbeaten into promising to eat more broccoli.

If your vendor refuses to add Quizzify via a “single sign on” and you don’t want to add it separately, you can fire the vendor (we can help you do that — if the vendor shows a positive ROI it means their outcomes are fabricated, which we can easily demonstrate) and replace them with one that will, of which there are more to choose from every week.

Q: What happens next?

A: The EEOC needs to rewrite the rules to comply with this decision by making new rules — and needs to do it in 2018 so that they can be adopted and implemented by employers by January 2019. The definition of “voluntary” will be a line-drawing exercise. Likely, gift cards and small incentives will be considered “voluntary.” If your incentive falls within whatever cap they decide upon already, you’re fine, with or without Quizzify.

Q: Is this is last word?

A: No.  First, the final rules have yet to be written. The rules then have to be approved by the district court.

Along with that uncertainty are two others. The EEOC could appeal, because these days it tends to oppose employee rights, rather than support them. However, the DC Appellate Circuit, led by Merrick Garland, would likely not be favorably disposed toward arguments that require, for example, defining “involuntary” as “voluntary,”  especially when the court will know that even award-winning vendors harm employees, vendors flout guidelines and screen the stuffing out of employees and give incorrect advice, creating further harms, and that the industry itself is rife with corruption, starting at the top. (I published my last paper in a medical-legal journal rather than a clinical journal specifically in anticipation that it might be the basis for an amicus curiae brief specifically in a situation like this.)

See also: Should Wellness Carry a Warning Label?  

In an unregulated, employee emptor environment like this, voluntary fines collected by shareholders from employees wanting to protect themselves from the harms above should not exceed fines set as penalties for a mandate, and paid into a pool to create an insurance product. (That the mandate is going away is not relevant — it’s the fact the government has two words with opposite meanings that have inverse fines.)

Alternatively, an Act of Congress could gut GINA. The American Benefits Council could try to convince the legislators their colleagues contribute heavily to, like Virginia Foxx (R-NC5), to push HR1313, for example. HR1313 is arguably the worst bill of any type ever to clear a congressional committee, in that nobody benefits from it (other than DNA collection vendors, for whom it would be a windfall), but the ABC has already demonstrated its disregard for the best interest of its own members by browbeating Rep. Foxx into proposing that bill in the first place. The ABC is down, but not out…and, as this video shows, being down but not out can cloud one’s judgment.

However, because quite literally none of her constituents are helped by this bill and most of them in both parties detest it, Foxx may decide to disappoint her corporate overlords on this one, especially because it’s an election year.

Q: How is HR1313 (or a bill like it) that ABC might propose on behalf of its members (large employers) not in “the best interest of its own members”?

A: Many employers have finally figured out that even their own vendors know wellness loses money, and that incentives generally don’t change behavior because employees revert to their old behaviors once the incentive ends. (Incentives do work for Quizzify-type programs, because, as you’ll see for yourself if you take the quiz, once you pay an employee to know things, she can’t un-know them. Pay an employee to learn that CT scans are full of radiation once, and he will stop demanding unnecessary CT scans forever.)

However, employers are stuck with these huge incentives now, which some employees expect annually. This rewrite of the “voluntary” rules, likely capping incentives in the low three figures, will allow employers to spend much less on incentives…and blame the government. (Obviously, we hope they maintain the incentives and instead just offer the Quizzify alternative. This will also save money due to Quizzify’s low price and a much-reduced number of employees having to follow up on false positives.)

If ABC were to be successful in gutting GINA and allowing financially coercive wellness programs to continue unabated, employers would still have to fork over large incentives.

2017 Deplorables Awards — Runners Up

It’s time for the 2017 Deplorables Awards, lovingly bestowed on those vendors who do the best job making other vendors look good. 

The good news is that you don’t have to actually win the Deplorables Award to sue me.  Runners-up are eligible, too. Here is my address for hand-service delivery most of the year:

890 Winter Street #208, Waltham MA 02451

In case you decide to sue me between June 22 and Aug. 8, use:

8 Paddock Circle, Chilmark, MA 02535

And don’t leave out my attorney:

Josh Gardner, GARDNER & ROSENBERG P.C.33 Mount Vernon St., Boston, MA 02108

I don’t know how much more I can do for you, other than lick the envelope. So go for it. Don’t make me beg.

But, remember, unlike with your usual business model, in court you are required to actually tell the truth (I would be happy to explain to you how that works), meaning there is no chance of your winning — or likely even avoiding summary judgment, because none of the evidence is in dispute. It’s all your own writings. Oh, and I do my own cross, which means you won’t be able to find an expert witness. Anyone who knows enough about wellness to be an expert witness also knows enough about wellness to know that attempting to defend you would be a humiliating, on-the-record experience.

And there is always the chance that some annoying jerk might blog about it…

The 2017 Runners-Up

Springbuk and Fitbit

As many of you recall, earlier in the year we analyzed the study done by Springbuk that was secretly financed by Fitbit. Or maybe I need new glasses, because I just couldn’t find the disclosure in the Springbuk report that this paean to Fitbit was financed by Fitbit, much as Nero used to have the judges award him Olympic medals.

Coincidentally, the study showed Fitbit saving gobs of money because employees taking more than 100 steps a day spend less money than those taking fewer. However, a simple tally of one’s own footsteps shows that it is impossible not to take 100 steps a day unless you are both:

  1. in a hospital bed; and also
  2. on dialysis.

This 100 steps-a-day threshold was repeated many times in the study, with no explanation of how that number came to be. However, it turns out we owe these two outfits an apology. Fitbit and Springbuk have told a number of people privately (not publicly, to avoid an embarrassing news cycle) that they didn’t really mean to say that 100 steps a day constituted activity. They meant to say that taking 100 steps a day implied you had your Fitbit on. My apologies for failing to read their minds that their conclusions were based on reading people’s minds to determine whether they wore the Fitbit deliberately, or simply forgot/remembered/cared to put their Fitbit on.

Springbuk and Fitbit never did explain — privately or publicly or to anyone — how employees who took an average number of steps during the baseline year could show huge savings by taking an average number of steps in the study year, too.

They also never explained how these two statements didn’t completely contradict each other, even though I specifically asked them to in a personal letter, excerpted here:

Third, can you reconcile this statement…:

“The materials in this document represent the opinion of the authors and not representative of the views of Springbuk, Inc. Springbuk does not certify the information, nor does it guarantee the accuracy and completeness of such information.”

…with this statement:

“This demonstration of impact achieved by integrating Fitbit technology into an employee wellness program reinforces our belief in the power of health data and measurement in demonstrating ROI,” said Rod Reasen, co-founder and CEO of Springbuk. 

National Business Group on Health

Next up is the National Business Group on Health. Last year, they made the list for criticizing the U.S. Preventive Services Task Force for not demanding enough screenings, in a country that is drowning in them. Not content to rest on those laurels, this year they earned an Honorable Mention for inviting Dr. Oz to keynote on the role of quackery in corporate wellness, and perhaps tell us about his latest lose-weight-by-eating-chocolate miracle diet.

See also: How Advisers Can Save Healthcare  

Health Enhancement Research Organization

HERO, of course, also earns a runner-up award. 2017 will be remembered as the year they finally came to grips with the realization that a business model based on fabricating outcomes requires that perpetrators possess that critical third IQ digit. Without that extra “1”, an organization trafficking in math that can at best be considered fuzzy is going to be outed.

This year’s set of lies?  By way of background, their 2016 poison-pen letter insisted they had fabricated that data set showing that wellness loses money without disclosing that it was fabricated — and also never reviewed their fabricated data before publication. Early in the year, I had the insight that, wow, this “fabricated” chapter in their guidebook is so much better than the other chapters that something is amiss. No one at HERO can analyze data competently…and yet, here it was, a competent data analysis.

I did something I had never thought to do before, which was look up the actual author of that chapter. It was Iver Juster, MD. He was a great analyst even before he read all my books, took all my courses and achieved all my certifications in Critical Outcomes Report Analysis.

So I called Iver. Here’s what I learned:

  1. Whereas Paul Terry and Ron Goetzel had insisted that Iver fabricated the data, Iver said that, of course he didn’t — whatever made me think that?  (“If it wasn’t real, I would have disclosed that,” he observed. Of course, he would have. Iver has tremendous integrity.)
  2. The board discussed and reviewed his chapter at length and made helpful suggestions, for which he was quite grateful. This review process required “countless hours,” just as the HERO document says:

The number of  transparent lies HERO tells could make a president blush. In the immortal words of the great philosopher LL Cool J, they lied about the lies they lied about.

Even though 2017 was an off-year for them in terms of the number of lies, they still told enough to be named a runner-up.

Wellness Corporate Solutions

Next is Wellness Corporate Solutions, famous for its crash-dieting contests. WCS now offers a water-drinking contest. The idea is to set up a “challenge” for your team to drink more water than other teams. They call this a “healthy competition.” I guess they didn’t get the memo that forcing yourself to drink when you don’t want to drink, just to make more money, is anything but healthy. Here is a novel idea: Drink when you are thirsty.  Evolution 1, WCS 0.

Perhaps as an encore, WCS, Dr. Oz and the National Business Group on Health could team up to offer a chocolate-eating contest.

I looked into this outfit to see where they get their ideas. The CEO previously ran something called the Washington Document Service. That qualifies her to run a wellness company. As Star Wellness says, to run a wellness company successfully, your background needs to be in sales, or “municipality administration.” After all, what is more central to administering a municipality than documents?

Wellsteps

What fun would a list of runners-up be without Wellsteps, the  proud recipient of the 2016 Deplorables Award? While their streams of consciousness weren’t as memorable in 2017 as in 2016 (“It’s fun to get fat. It’s fun to be lazy“), they get credit for trying. Their 2017 weight-loss campaign was headlined: “This campaign is not really about weight loss, it is about helping you apply the behavioral secrets of those who have lost weight.”

So if your kids ever want you to teach them how to ride a bike, say: “It’s not really about riding a bike. It’s about helping you apply the secrets of people who have ridden bikes.”

And what secrets are we talking about? What person who has lost weight doesn’t brag to everyone or even write a book?  If there is a secret to weight loss, like eating chocolate, Wellsteps owes it to the country to tell them. Don’t make us beg.

See also: Should Wellness Carry a Warning Label?  

Odds and Ends

No Koop Award winner this year, but an honorable mention to past winners and runners up for their commitment to wellness:

Sounds like in 2018 the logical winners would be Philip Morris, or maybe the Asbestos Corporation of America.

Veering briefly into the public sector, kudos to Rep. Virginia Foxx, (R-NC5) for introducing the Required Employee DNA Disclosure Act. Even HERO thought it was a dumb idea…and their threshold for thinking something that increases wellness industry revenue is a dumb idea is quite high, having all rallied behind the Johnson & Johnson fat tax, in which companies would be required to disclose the weight of their employees.

Next up…the winner of the 2017 Deplorables Award

Stents Provide a Lesson on Healthcare

Intuitively, stents make sense. If you’ve got occasional chest pain due to reduced blood flow to your heart, having a stent—a thin mesh tube inserted into a coronary artery to hold it open—is a seemingly logical solution. Half a million of these procedures, called angioplasties, are performed every year, at a cost of roughly $20,000 apiece.

Alas, sometimes hard data trumps intuition.

Recently, a landmark “sham surgery” study showed these procedures don’t make a difference in people with stable angina and a single narrow coronary artery. Stents are inserted using a catheter. In this study, 200 people with chest pain who had single vessel disease had the catheter inserted. Half of them got a stent, and half did not (that’s the sham arm of the study).

And the envelope please…

Six weeks after the procedure, there was no real difference in the patients, either in chest pain or performance on treadmill tests. In other words, the placebo surgery did just as well as the real thing.

While these results were described as “unbelievable” by some cardiologists, they are not much of a stretch from what we already knew about stenting. Even five years ago, the New York Times reported on research that found No Extra Benefits Are Seen in Stents for Coronary Artery Disease in patients with stable angina. That article also reported there was an “insignificant difference” between people who have had stents inserted and those who didn’t. A cardiologist and professor of medicine at Yale told the New York Times, “When people are making decisions, it’s important to disclose to them that this procedure [stenting]—outside of an emergency—is not known to be life-saving or to prevent heart attacks,” adding, “the vast majority of people who have this procedure have the expectation that it will help them live longer. That belief is out of alignment with the evidence.”

See also: Global Trend Map No. 4: Industry Health  

The good news is that we know that there are more conservative measures that can slow or reverse heart disease, include quitting smoking, exercising more, improving your diet and losing weight if possible. There are a range of safe and effective drugs that can help reduce chest pain as well as your risk of a heart attack.

Although rare, there are some serious risks with angioplasty, such as bleeding from the site of the incision used to insert the catheter, damage to the blood vessel itself, irregular heartbeats and damage to the kidneys caused by the dye used. The risks of complications are low, but why would you take any risk, endure an uncomfortable recovery and pay a substantial co-pay or deductible, if there is no evidence of benefit?

Like many medical procedures, the amount of unneeded and unnecessary stenting is a byproduct of the healthcare system’s financial structure that rewards doing more procedures, when doing less is often wiser and certainly cheaper.

Sometimes the best procedure is none at all.

Should Wellness Carry a Warning Label?

You know those “three biggest lie” jokes? The third biggest lie would be: “I’m from Interactive Health, and I’m here to help you.”

Hilarious… unless you are one of those unfortunate souls who are:

  1. paying their bills;
  2. believing their outcomes; or
  3. taking their advice.

The first and third are closely related in the sense that one would think, with their fees – which rank among the wellness industry’s highest due to their industry-leading embrace of hyperdiagnosis — they could afford to train their employees in wellness.

See also: Healthcare: Need for Transparency  

However, because they apparently forgot to check that box, I’ll do it for them. I owe them this favor, having recently made unflattering observations regarding their botched cover-up of their invalid outcomes reporting.

First the good news

No one can accuse Interactive Health of wasting money on excessively silly, excessively gimmicky, excessively readable user interfaces. Here is the advice they give to employees, all 1,350 words of it, starting with Page 1:

But wait…there’s more. Page 2:

And for all those employees who simply have too much free time on their hands at work, Page 3:

More good news. They do tell this employee, after informing her that she has metabolic syndrome, to “avoid sugar.” Credit the law of averages with that — if you write 1,350 words, it is likely that two of them —  0.14% — will be correct. These two words are in the middle of the second page, so I’m sure she saw them. Who wouldn’t?

Next, the bad news

To prevent that metabolic syndrome from progressing to diabetes, the letter also recommends “lowfat or nonfat dairy” in the diet. However, according to the the journal Circulationpeople with the most dairy fat in their diets had a 50% lower risk of diabetes. Likewise, a study of 18,000 women showed lower obesity among those who consumed full-fat dairy. Journal articles are likely beyond Interactive Health’s grade level, so here are two lay summaries and two lay books:

  1. The Skim Milk Scam: Words of Wisdom from a Doctor Dairy Farmer
  2. Lowfat Dairy: Zombie Guidance
  3. The Big Fat Surprise
  4. The Bad Food Bible

It’s not just dairy fat, where the science, though perhaps not definitive, is settled enough that even the dumbest wellness vendor should know not to tell diabetics to switch to skim milk. It’s also saturated fat in general, where the change in scientific understanding over the last 10 years has caught many wellness vendors by surprise, and they haven’t had time to react.

If consumed in large quantities, perhaps saturated fat may be a heart disease risk factor nonetheless.  Who are we to say? However, if it were a culprit of any significance — like trans fats or cigarettes or family history — that conclusion would be definitive by now, given the massive amount of research that’s been thrown at this question.  Even if saturated fat were a minor risk factor, there is still one overriding reason that Interactive Health shouldn’t be telling people with metabolic syndrome to eat less fat: What the he** do they think people will eat instead? There is a whole body of literature on how telling people to eat less fat helped create the obesity epidemic.

In all fairness to Interactive Health, they recommend eating only less dairy and other saturated fat, not less total fat. However, that is a subtlety that can get lost in those 1,350 words brimming with all sorts of random advice. For instance, on the subject of abnormal thyroid function, the letter says: “Talk with your healthcare provider about possible treatment options for this condition.” Sound advice indeed — if in fact the person in question had abnormal thyroid function, but according to this report (bottom of Page 2), her “thyroid was normal.”

More bad news

Even though this person does not have high blood pressure, the letter also recommends eating less salt. For people without high blood pressure and especially people like her who have other diabetes and cardiac risk factors, avoiding salt is likely a bad idea.

Other than the answer being different for different people and different ethnicities (subtleties overlooked by almost all wellness vendors, which prefer to give blanket advice), the science is unsettled. It does, however, increasingly point to the importance of salt — something humans have been consuming in large quantities ever since way before the Roman empire paid its soldiers in salt — in the diet. This is especially the case for people with, or at risk for, diabetes or heart disease (which this person is). In particular, for people without hypertension, reducing salt intake to a level much below the U.S. average:

Among other limitations,  most of these studies are correlative, not causative, and rely on self-reporting rather than controlled environments.  So we can’t conclude with certainty that avoiding salt is a bad idea. Nonetheless, my suspicion is that companies paying Interactive Health millions of dollars — and basically forcing their employees to choose between submitting to them or losing money — have assumed that the advice they are giving employees is settled and likely correct, rather than controversial and likely incorrect.

Other studies, generally older ones, recommend low-salt diets to prevent high blood pressure, so it is still at least arguably fair to say salt science is conflicted. But the overriding reason for Interactive Health to stop telling employees at risk for diabetes to eat less salt and less saturated fat is, what the he** do you think they are going to eat instead? Because most proteins come with saturated fat (and salt), there is only one thing left to eat: carbohydrates.

The bottom line is that anyone who actually takes Interactive Health’s advice on how to avoid diabetes is likely to increase their odds of getting diabetes.

See also: Wellness Isn’t the Only Scam in Healthcare 

Fortunately, most employees will have the good sense to ignore their advice, if for no other reason than it is quite a Herculean task to plow through it all. How do I know this? By definition, any employee reading this blog is more health-conscious than average. And yet the particular employee who, after reading my blog post on them, sent me this letter originally sent me only the first and third pages. She hadn’t even realized there was a second page, because Interactive Health printed it on the back of the first page.

Ironically, that was the page where it said “avoid sugar.”

The “coaching” call

In addition to the letter, this employee did receive a coaching call, described as follows:

When they called to offer me advice, they simply said, “ Do you know you have high cholesterol?” I said, “Yes.” Then she proceeded to ask me what I was going to do about it. I said: “I thought you would tell me what to do.” She had nothing to say. Then I received another call a few weeks later as a follow-up, and I wanted nothing to do with them as they had already discredited themselves with the first call.  

In yet another installment (which will have to wait until 2018 because December is devoted to highlighting the best-in-shows of the wellness industry and, of course, the Deplorables Awards) we’ll explain how Interactive Health translates ignorance of clinical guidelines, bad dietary advice and massive hyperdiagnosis into quite literally the most inflated savings in the wellness industry this side of Wellsteps.

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.