February 2024
Contributed by Cora Roelofs, Sc.D., Department of Biomedical Engineering, University of Massachusetts Lowell
Workers, particularly those in physically demanding jobs or occupations with high injury rates, have been more likely to receive opioid prescriptions than the general population and, as a result, have also been hard hit by higher rates of opioid overdose.1, 2 Occupational health providers, state workers’ compensation programs, and the Centers for Disease Control and Prevention (CDC) have developed guidelines for physicians regarding appropriate opioid prescribing. New prescription rates have declined. However, little attention has been paid to the challenges facing injured workers who have years-long opioid dependence.3 In 2016, the Massachusetts Department of Industrial Accidents (DIA), which administers the Massachusetts workers’ compensation program, initiated the Opioid Alternative Treatment Pathway (OATP) (ppt) program to help reduce injured workers’ dependence on opioid pain medications. The OATP supports a mediation process to provide improved pain management and support through dose reductions for injured workers with settled claims who are taking high-dose long-term opioid pain medications.
From 2021-2023, the Massachusetts Department of Public Health provided funding to the Center for the Promotion of Health in the New England Workplace (CPH-NEW) through the CDC’s Opioid Data2Action program to evaluate and improve the DIA’s OATP program. Previously, We had described the many issues related to injured workers and opioids in Opioids and Work: A Formative Research Assessment to Inform Educational Outreach. We explored the themes of this previous report, and the components of the OATP, in a new Formative Evaluation Report. The report describes the views of 24 key informants with experience in a variety of capacities of the program including legal, medical, administrative, and as participants. The interviewees spoke about incentives for participation by injured workers, measures of success, care coordination, medical care for participants, financial issues, education and awareness, and barriers to success. Despite the diversity of the interview participants, they were united in support of the OATP program and their hopes for its expansion.
The interviewees also shared recommendations for program improvement, including educational programs, clinical guidelines for tapering, opening participation to those without settled claims, and more administrative support for program operations. They suggested that basic explanatory information about the OATP, opioids, and tapering that was targeted to injured workers would be useful to help promote the program. Thus, We designed a short Prescription Opioid Pain Medication Tapering Fact Sheet for Injured Workers to explain in plain language the logistics and the value of participating in the OATP and of tapering high-dose, long-term opioids.
We also learned that those providing care for injured workers often struggle with how to reduce their patients’ opioid dependence. Thus, we researched and compiled a best practices guidance document to help primary care providers determine when a taper might be appropriate, engage and assess patients who have been taking opioids for extensive periods, and, how to undertake the taper while centering patients’ pain management, mitigating opioid side effects, and protecting them from unintended consequences. The guidance document: Opioid Medication Tapering Guide for Healthcare Providers Caring for Injured Workers with Chronic Pain and the opioid tapering factsheet described above were reviewed by clinical experts and are freely available on the Department of Industrial Accidents (DIA) website.
Next, We examined filed legal forms related to injured workers’ opioid use during 2017-2022. The Document Review Report describes the insurer/employers’ requests for mediation, the injured workers’ request for mediation, and the mediation agreements themselves. Mediation agreements for employer insurance-paid care coordination for opioid reduction and enhanced pain management for long-time opioid prescription-using injured workers had no standard content and, as a result, varied widely. We recommended the adoption of a best practices checklist to guide the development of OATP mediation agreements. The suggested checklist was adopted by the DIA and is now available to judges and others involved in opioid medication mediation processes.
While the evaluation We conducted was specific to the Massachusetts context, the documents described above can inform and inspire other state and federal initiatives to reduce the toll of opioid-related harms in injured worker populations. More action is needed to reduce inappropriate opioid prescribing for injured workers and to provide more helpful and less dangerous pain management.4, 5 Additionally, of course, We must continue to reduce the toll of work-related injuries in the first place.
References
- ref1Porucznik, C. A., Johnson, E. M., Sauer, B., Crook, J., & Rolfs, R. T. (2011). Studying adverse events related to prescription opioids: the Utah experience. Pain medicine (Malden, Mass.), 12 Suppl 2, S16–S25.
- ref2Hawkins, D., Roelofs, C., Laing, J., & Davis, L. (2019). Opioid-related overdose deaths by industry and occupation-Massachusetts, 2011-2015. American journal of industrial medicine, 62(10), 815–825.
- ref3Franklin, G., Sabel, J., Jones, C. M., Mai, J., Baumgartner, C., Banta-Green, C. J., Neven, D., & Tauben, D. J. (2015). A comprehensive approach to address the prescription opioid epidemic in Washington State: milestones and lessons learned. American journal of public health, 105(3), 463–469.
- ref4Shaw, W. S., Roelofs, C., & Punnett, L. (2020). Work Environment Factors and Prevention of Opioid-Related Deaths. American journal of public health, 110(8), 1235–1241.
- ref5Roelofs, C., Hansen, J., & Hawkins, D. (2023). Letter to the editor: Action needed to reduce opioid prescribing in the mining sector. American journal of industrial medicine, 66(10), 907–908.
Cora Roelofs Sc.D. is a Research Professor in the Department of Biomedical Engineering at the University of Massachusetts Lowell. She is the Principal Investigator of CPH- NEW’s Total Worker Health® Employer Crisis Preparedness research project. She has conducted several studies and generated many resources related to preventing opioid dependence in working populations.
CPH-NEW is a NIOSH Center of Excellence for Total Worker Health. CPH-News & Views is a quarterly blog written by center researchers and guest authors on emerging topics related to healthy workplaces. We welcome your responses and discussions. Please send all comments to CPHNEW@uml.edu.
Total Worker Health® is a registered trademark of the U.S. Department of Health and Human Services (HHS). Participation by CPH-NEW does not imply endorsement by HHS, the Centers for Disease Control and Prevention, or the National Institute for Occupational Safety and Health (NIOSH). This publication was supported by NIOSH Grant Number 1 U19 OH012299. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH or CPH-NEW.