Pain opioids depression suicide Workplace issues Construction Industry

Pain, opioids, depression, suicide. Workplace issues. Construction Industry Alliance for Suicide Prevention 2/27/18 DON TEATER MD, MPH TEATER HEALTH SOLUTIONS 1

Opioids and your employees: • Increase costs • Impairing • Addicting • Increase depression • Increase the risk of suicide TEATER HEALTH SOLUTIONS 2

Illegitimate use • Impairing • Probably a sign of opioid use disorder TEATER HEALTH SOLUTIONS 3

Legitimate use • Impairing • Addicting • Increases risk of future disability • Delays recovery • Increases medical costs • Less effective than alternatives TEATER HEALTH SOLUTIONS 4

Depression-pain-opioids • Those with depression suffer from more pain. • Almost half of people with chronic pain have depression compared to 16% in the general population. (Ohayon) • Following a workplace injury, the greatest risk factor for developing chronic pain is the mental status (depression and/or anxiety) of the individual prior to the injury. • Work satisfaction is the second greatest risk factor. • The use of opioids to treat pain is also a major factor. • If opioids are used to treat chronic pain, it increases the risk of developing depression by 50%. • If they are already depressed, it worsens the depression. TEATER HEALTH SOLUTIONS 5

Depression-pain-opioids • The risk of suicide is increased in those with chronic pain. • The risk of suicide is increased in those on chronic opioids for chronic pain. • 42, 000 people died in 2016 from opioid overdose. We simply do not know how many of those were intentional. TEATER HEALTH SOLUTIONS 6

Acute rx leads to long-term use 47 Duration of acute use: 1 day - 6% chance of still using that drug a year later. 8 days - 13. 5%. 31 days - 29. 9%. TEATER HEALTH SOLUTIONS 7

Efficacy of pain mediations Acute pain 26, 27, 51 Percent with 50% pain relief 62 40 37 37 28 21 Ibuprofen 200 mg Acetaminophen 500 mg Ibuprofen 400 mg Oxycodone 15 mg Oxy 10 + acet 1000 Ibu 200 + acet 500 TEATER HEALTH SOLUTIONS 8

Chronic long-term opioid use • Impairing • Probably NEVER appropriate in the workplace • Increases pain • Increases depression • Increases risk of suicide TEATER HEALTH SOLUTIONS 9

Drug Free Workplace Policies • Historically have been used to detect illegal behavior in workers • Now should be used as a safety/health tool for workers TEATER HEALTH SOLUTIONS 10

Workplace actions • Protect employees by directing occ. med. providers to reduce opioid prescribing • Update DFWP policy to: • Do random UDS on employees in safetysensitive positions • Refer positive tests to an EAP that can evaluate and treat OUD • Educate employees about the dangers of opioids TEATER HEALTH SOLUTIONS 11

Jim’s story (time permitting) Workplace interventions that could have saved his life: • Limited opioids after injury (3 days or less). • No opioids in safety-sensitive positions. • EAP referral for repeated oxycodone positive UDS. TEATER HEALTH SOLUTIONS 12

Common quote: “Opioids are the most potent medications we have for treatment of pain. ” ASAM Principles of Addiction Medicine – Fifth edition. Chapter 97. TEATER HEALTH SOLUTIONS 13

Don Teater MD, MPH Teater Health Solutions teaterhs. com don@teaterhs. com TEATER HEALTH SOLUTIONS 14