Courtesy of: Alexander Acosta — U.S. Secretary of Labor
WASHINGTON, D.C. -- With National Prescription Take Back Day last week, the Department of Labor released new informationon what we have learned about the opioid crisis and how we are improving our effectiveness in overcoming its challenges.
In 2017, President Donald Trump’s administration declared the opioid epidemic a national public health emergency and directed all executive agencies to use every appropriate emergency authority to minimize the devastation. Since 2017, the U.S. Department of Labor’s Office of Workers’ Compensation Programs’ (OWCP) has dedicated significant resources to stem the abuse, misuse, and proliferation of opioids to protect 2.7 million federal workers from harmful opioid prescription practices.
The use of opioids to treat injured federal workers continued, virtually unchecked, until 2017. The capability to monitor dose level and duration by the department was not even available until operational changes were instituted that year. Since we started this effort, a series of successes can be attributed to the implementation of a four-point strategic plan: (1) effective controls, (2) tailored treatment, (3) impactful communications with employees and providers, and (4) aggressive fraud detection.
The strategic plan’s core is a process where the department continuously gathers information and analyzes data. The results yielded great progress:
• 51% decline in new opioid prescriptions that last more than 30 days;
• 59% decline in claimants prescribed a morphine equivalent dose (MED) of 500 or more;
• 31% decline in claimants prescribed a MED of 90 or more;
• 30% decline in overall opioid use; and
• 24% drop in new opioid prescriptions
A recent study highlights the unique challenges facing a legacy population of injured federal workers who have been prescribed opioids over an extended period of time. Specifically, the study showed that nearly 1 in 4 injured workers in this group had been prescribed a high dose of 90+ morphine equivalent dose. This is important because the higher the opioid dose, the higher the risk for misuse and overdose death. Higher doses, greater than 100 MED, have more than two times the risk relative to lower doses. Additional risk factors, including the use of extended-release opioids and the associated use of certain interacting medications, were also identified.
The legacy challenges needed to be confronted. All federal injured workers with a prescription of 90+ MED underwent extensive individual case reviews. Treating physicians were contacted and, as needed, nurses were assigned. Our goal was to work with the medical provider and injured worker to provide opioid treatment where needed, reduce the opioid risk level, and assist in securing the benefits needed for pain management. These efforts are continuing with second level reviews currently being conducted by a clinical team of pharmacists.
Tapering an addictive drug takes time and there are a host of interacting factors to consider, yet as the statistics prove, the intense focus produced a real difference. This effort is not the federal government deciding what is best for patients. Rather, the federal government is acting as a responsible employer by caring about its workforce and ensuring that employees are getting the treatment and support needed for what can be a challenging recovery.
We are committed to (1) engaging individual employees and (2) analyzing the effects on the employee population as a whole. To win this battle, we must embrace a strategy that pursues accurate information, continuously evaluates that information, and invests the time necessary to find the right, healthy solutions for individuals struggling with opioids.
Alexander Acosta is the 27th U.S. secretary of labor.
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