A few weeks ago, we asked whether the Association should include the nation's opioid crisis in its program of work. In addition to members discussing with us its impact on their personal lives, we were reading a stream of troubling stories. One in the Washington Post described the residents of a halfway house finding two people in the building dead from drug overdoses. Both were the institution's drug counselors. Another in The Economist observed that "billboards in some American towns do not advertise fast-food chains or home insurance. Instead, they tell people what to do in case of a drug overdose." But the catalytic event may have been the lawsuit filed by the Republican attorney general of the State of Ohio against several drug companies, accusing them of misleading marketing campaigns.
The Washington Post editorialized in favor of the litigation, saying "We have an opioid crisis in large part because gatekeepers at every level…either could not or would not prevent it. These institutions have awakened to the mistakes they made in the past, and have set about correcting them, in some cases as zealously as they once promoted opioids." The editorial went on to say regarding this and similar lawsuits being filed around the country, "Whether these uphill legal battles actually succeed or not, we hope litigation pressures everyone in the prescription opioid supply chain to reveal more clearly what they knew, and when they knew it…" Two questions. How broad is the term "everyone," and who's the next target of a lawsuit? While the Ohio lawsuit could be criticized for singling out only one aspect of the problem, the clear message is that anyone involved in people receiving opioids should be aware of changing attitudes.
In view of the above, we were very pleased that your response was yes, the Association needs to begin a discussion of how the opioid crisis might be collectively addressed.
In reviewing the comments received, there was acknowledgment that heroin and opioid abuse is a profound public health problem, but many CHROs were not certain about the extent of its reach into their company. One example, "I for one have no idea what impact the epidemic is having on my organization, but am absolutely certain there is one, and it may be significant. [A]mong the many significant problems the U.S. faces, this has got to be in the top 5."
Pam Kimmet of Cardinal Health verified the figures we initially quoted and added that while the U.S. represents 5 percent of the world's population, 90 percent of all opioid drugs made in the world come to and are sold in the States. Quest Diagnostics, one of the largest workplace-testing labs in the nation, released new data showing that more U.S. workers are testing positive for illicit drugs than at any time in the last 12 years.
David Rodriguez HR Head of The Americas for Marriott summed up the sentiment well, saying that "by all accounts this is a huge and growing issue in the United States which is clearly impacting everyone directly or indirectly including employers." Rodriguez reports that Marriott is working with its PBM and health plans on a number of actions related to prevention, identification and treatment of opioid addiction.
We were pleased to receive several descriptions like Marriott's about what companies are already doing. Susan Peters of GE described its $15 million investment in both addiction medicine and programs to address the crisis using a four stage process—prevention, harm reduction, treatment and recovery. One fascinating GE initiative is an opioid hack-a-thon which resulted in four innovations which are close to clinical deployment.
Regarding specific steps CHROs can take within their own companies, one recommended the following. First, the highest priority should be reducing the stigma of abuse. The need for that was articulated in a recent article in The New Yorker, "The Addicts Next Door," which, among other things, talks about the funerals of young opioid victims having "a peculiar aspect…The parents didn't want anyone to know how it happened, and they tried to keep the friends out." The author drives home the point that for the problem to be dealt with, it must be acknowledged. Next, confirming appropriate resources are available to both employees and families is recommended, making sure the behavioral health network is adequate and well equipped to address the issue and that its usage is being monitored through all channels, including the medical plan and EAP. Specifically, the carrier and PBM should work closely together to identify and reach out to those prescribed opioids over a certain period, such as 60 days, because the longer the use, the greater the potential for addiction. "And if the member and/or prescriber don't engage with the medical carrier, then companies may have to demand the PBM trigger their controls," she counsels.
Finally, we turned to our colleague, Henry C. Eickelberg, who was a vice president of HR and shared services at one of our member companies for several years. He put together an excellent paper on how HR leaders can assess the extent to which their organization may have an opioid crisis in the workplace. He suggests marshaling available data sources to assess the impact in the areas of employee productivity, health care expenditures, and covered dependents. On productivity, he recommends listening to what employee relations professionals are saying. Are there higher than expected unexcused absences? Changes in drug testing results? Regarding medical costs, does your PBM have programs in place to identify abuse? Does your third party administrator screen for abuse? Are you able to document increases in opioid-related abuse problems? As The New Yorker story describes, most addicts need medication-assisted treatment for a long time, if not the rest of their lives. Finally, opioid addiction may mean that grandparents, aunts and uncles, and other relatives have taken custody of an addict's children, resulting in guardianships or adoptions. Do you see evidence of this within your benefits administration function and from employees struggling with these new responsibilities? And how are you being of help to those experiencing these unanticipated challenges?
Pam Kimmet cut to the chase, saying that something must be done to stop the availability of these illegal drugs. "All of this comes down to two core issues that have to be addressed. Doctors need to change their prescribing habits." Further, "once people use this class of drugs and then become addicted, the cost of these meds is such that they are shifting more and more to heroin because it is cheaper and readily available. The strength of the types of heroin available is so lethal that it is contributing to the tragically high death rate. More steps have to be taken to stop the availability of this supply."
The topic of what specifically our organization can and should do to address the opioid crisis is on the agenda for this week's American Health Policy Institute Governors meeting. We plan to begin discussions there and continue them at future membership meetings. In the meantime, please continue to send us your thoughts at firstname.lastname@example.org.