Feeling the pain, employers begin to take on the opioid epidemic

It’s no secret that the opioid crisis has been a burden on society. But employers are finally beginning to realize the impact it’s having on them. From the cost burden of abuse and addiction treatments to absenteeism and lost productivity, abuse, misuse and addiction of the drug is taking its toll. In fact, more than half of employers (60%) say they’ve been affected by at least one case of opioid misuse or abuse, according to a recent survey of 62 large employers by the National Business Group on Health.

All this is leading to a big change: The days of employers viewing the epidemic as purely a societal issue are over, experts say. So what are employers doing to address the issue?

For answers, Employee Benefit News spoke to Brian Marcotte, president and CEO at National Business Group on Health, and Mike Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions. The two industry experts spoke about the need for changes in employers’ education efforts, as well as more pain management alternatives — and how all that might change their benefit plan offerings.

What follows is an edited version of the discussion.

Employee Benefit News: We are seeing how big of a problem opioids are in greater society, and how much it’s also costing the economy. But clearly it’s an issue that’s affecting employers and their workforce — how big of a problem is this for them?

Brian Marcotte: This is a huge problem for employers. I think everyone recognizes it is a big social issue for the country, but people don’t think it’s happening in their backyard. We’re starting to work with employers and are starting to look at employer data going back several years to really dig into this, and we are realizing it’s been a big issue for them.

See also: Employers must step up to address substance abuse

Mike Thompson: Employers initially looked at this [as] a societal issue, not necessarily an employer issue or benefits issue. But our coalition is working to develop an agenda for what employers should do. I think there are multiple parts to the agenda, and part of it is really dealing with the epidemic of addiction and creating an environment that allows people to get the help they need and help get them on a path to recovery. It’s not a simple task at all; it’s probably the fastest-growing epidemic we’ve seen in our generation. It’s one we need to take very seriously, and one where everyone has to do their part.

EBN: What kinds of things should be on the agenda? What are employers beginning to do to address the epidemic?

Marcotte: Employers are doing a number of things: they are working with their health plans and their pharmacy benefit managers to incorporate CDC guidelines — which are very good — [on] how opioids should be dispensed and managed. They’re also working with their health plans to coach, educate and work with providers [regarding their prescription patterns]. And a number of employers have implemented training for managers and peers to identify signs not only of opioid issues, but behavioral health issues, and help steer [employees] to appropriate resources. There are a number of things, but there are still a number of gaps and challenges.

EBN: What have been the barriers to dealing with this issue, and how do you overcome those barriers?

Thompson: Part of it is dealing with this from a cultural perspective, where historically, much like mental health and obesity, there is a sense that people brought this on themselves and they share in the blame for what has happened here. But often people got here by no fault of their own — by treatments from their provider — and when people are affected by this, the pathway out is a very serious one to take. The other part is dealing with delivery of care to try to stem the tide, and that’s starting to turn already. I’m very encouraged by opioid light treatments, for surgery, [which] don’t require as much medication as what was considered standard practice.

EBN: So what are some of the alternatives to opioids and those drugs? How are employers beginning to look at this?

Marcotte: One of the areas we have been exploring is physical therapy as an alternative to pain management, and how effective physical therapy can be as an alternative to opioids. We are beginning to see the emergence of virtual care solutions around physical therapy. There are a number of different companies that can do digital coaching related to physical therapy, which helps break down barriers to access and addresses some stigma issues related to treatment. The convenience factor helps, too. We are beginning to see some changes in provider prescribing patterns when it comes to the number of opioids or alternatives to opioids, but it takes a long time to change behavior and adhere to best practice.

Thompson: What employers are more readily embracing that they should have a point of view on —and should take action on — is pain management. We know past practices have contributed to this epidemic, so educating people on what the risks [of opioids] are, and what are some of the alternatives is key. We need to let people know these are controlled substances for a reason, and we need to treat them as such. It’s a huge issue we’re just getting our hands around, and frankly, employers are playing a big role.

But as we look at alternatives to addictive medications for pain management, we really need to look at our coverage practices for some of these alternatives. Sometimes we may not be covering acupuncture, chiropractor care or other limited approaches to pain management.

EBN: So the opioid epidemic may lead to a big shift in delivery of care and benefits that are covered in plans?

Marcotte: It’s going to have to. We need alternatives. Some of these other solutions, the patient is going to have to be convinced they don’t need opioids and there are alternatives. I think employers will have to take a hard look at their physical therapy benefits and see how they’re structured and ask if they’re an enabler or a barrier to alternatives to opioids.

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EBN: When did the shift start when employers realized this was an issue for them and they need to do something about it?

Marcotte: It’s really gearing up now.

Thompson: I think mental health has been turning for the last decade, but I think for opioids we are in the midst of the turning point. This is something employers, a year ago, in many instances were turning a blind eye. But now they are understanding they have a major role in supporting and helping their workforce and their families. They are starting to rise to the occasion.