Doctors Are Prescribing Less Painkillers: Progress on Our Opioid Problem?

(TFC) – Let me paint you a picture. You are a construction worker, building up American highways. Every day, you shovel asphalt, press concrete and drive trucks up and down the shoulder of the interstate. You wear reflective vests against traffic, and a hard hat to avoid workplace injuries. However, one day, when stepping down from your truck, you miss the step and land on your ankle. Your bone breaks, and you are off work for the next month or two while you recover.

Your health insurance covers the medical costs, but the pain in your ankle is unbearable without prescription painkillers. You don’t like the idea of taking pills, but your insurance won’t pay for expensive physical therapy sessions or other methods to help recovery and mitigate the pain. Plus, your trusted doctor wrote you the prescription. You’ve heard rumors of how addictive the opioid painkillers can be, but without the personal savings to pay for alternate methods, you suck it up and take the pills.

In due time your ankle heals, and you can resume work. However, you find it difficult trying to focus and complete your job without the painkillers. Unfortunately, following your follow-up, your doctor noted your ankle had almost completely healed and discontinued your prescription. Without the order, your only option is to buy your pills from other sources, at a significant markup.

Given your time off employment, you can’t afford these prices and turn to cheap opioid street drugs — heroin, in particular — for your fix. In the course of a few months, you have become addicted to one of the most dangerous and addictive drugs on the planet. But where did you misstep?

The Opioid Crisis

This story is not purely rhetorical. The most significant roadblock facing the reduction of modern opioid addiction in the working class is its inevitability. A worker injured at his or her job — particularly a job requiring physical exertion — is very likely to be prescribed painkillers. Assuming the injury — and related pain — is severe enough, the prescription will be a highly-addictive painkiller like oxycodone. This is not a possibility, but rather a likelihood.

It is easy to write this story because there are hundreds of thousands of these accounts every year, in every major city and rural region across the US. While Appalachia, rural New England, and the Midwest are the hardest-hit, the epidemic has spread to every corner of America and will continue to grow in its severity. In 2015, overdose was the leading cause of accidental death, with heroin overdose responsible for over 20,000 cases on its own.

Steven R. Ryan, Esq., a Certified Workers’ Compensation Specialist at Frommer D’Amico Anderson, explains the difficult situation for workers:

Injured workers face a catch-22 as it relates to the opioid epidemic. On the one hand, they are taking addictive medications prescribed by their physician, in that physician’s best judgment, to address pain. The national conversation is driving state legislatures to address the epidemic in some fashion, and many are seeking to pass legislation limiting access to opioid pain medications. Many legislators are using this conversation to try and pass legislation that could hurt injured workers. On the other hand, insurance companies often refuse to pay for alternatives to opioids, and legislatures rarely address this part of the problem. This often leaves injured workers forgotten and in pain.”

The Choice

A considerable number of heroin addicts never have a choice when it comes to addiction. Injuries occur at workplaces every day, sometimes from the fault of the work environment, and sometimes from personal mistakes. Whatever the case, the go-to solution for doctors during the majority of these cases includes prescribing painkillers in varying degrees of potency, depending on the severity of pain and injury.

For the worker, there is no real choice: they can refuse doctor-ordered medication that should aid their recovery and prevent significant, work-impairing pain, or they can take the pills and go back to work. Any logical person would take the pills, mainly if their job depends on physical, pain-free labor. Without any established framework for preventing addiction during injuries, this scenario is not a possibility, but an inevitability.

All of this said, most doctors are aware of the crisis and its source, and recently slowed down their rates of prescription. With fewer actively-prescribed narcotics, the rates of addiction nationwide will surely fall. In the long-term, this move away from immediate prescription during worker’s comp cases seems more optimistic.

The Solution?

From here, the culprit of the opioid epidemic is clear: a prescription-based culture in health care services. The way forward is not nearly as simple. There are, however, a few areas we can begin focusing on.

Namely, the wildly negligent prescription of potent painkillers. It is easy to blame the doctors for this, but at the end of the day, their hands are tied, and many are doing the best they can. As mentioned before, the rate of opioid prescriptions is dropping. Unfortunately, the system of health care itself — most workers rely on health insurance for treatment of their injuries — lacks proper funding for personalized alternate methods for dealing with pain and injury.

The opioid epidemic is the worst in the lower-middle class, those most likely to be hurt doing physical labor, and those least able to afford more holistic methods. Health processes not covered by health care or insurance are not realistic options for many of these workers. A return to the Reagan-era War on Drugs that President Trump seems to be suggesting is almost certainly not the answer. With fewer prescriptions written, the future could be brighter. However, real systemic changes in health care will be necessary.