In order to curb the opioid epidemic among employees, companies need to begin by identifying who is at risk, according to a session presented on Wednesday during the Pharmacy Quality Alliance (PQA) 2020 Annual Meeting.

“In the midst of the COVID-19 crisis, opioid addiction is especially deadly,” said Jamie Jenkins, PhD, senior program manager with Cotiviti, during the session.

Although managing multiple epidemics can present major challenges, the opioid crisis should not be forgotten, Jenkins said. She gave a case study in order to illustrate the steps a company should take.

In the case study, a fictional travel company experienced a bus crash, which was carrying 62 passengers. In the aftermath, police found opioids among the driver’s possessions, leading to a company-wide effort to identify and manage opioid dependence and addiction.

The first step, Jenkins said, should be to identify the employees at risk. In the case study company, 5% of employees had a diagnosis of opioid abuse or dependence. Those employees were mostly males, direct employees (not spouses or dependents), and averaged 44 years of age. Furthermore, the company found that those struggling with addiction or dependence were mostly vehicle transporters and maintenance crews.

Identifying outside influences of opioid addiction and dependence is also important, Jenkins said. In the fictional example, employees in California, North Carolina, New York, and Kentucky were estimated to cost between 6 and 7 times the average cost of another employee, and costs were predicted to rise an average of 40% if nothing changed.

Jenkins said the most common conditions for which opioids were prescribed included back or neck pain, osteoarthritis, unspecified pain, miscellaneous skin diseases, and musculoskeletal disorders. Identifying employees with these conditions could also help narrow down which employees need opioid management plans.

Finally, Jenkins said the most common prescriptions in the example were oxycontin and oxycodone. She added that identifying and targeting the high-volume prescribers would be a vital step to managing opioid dependence and addiction.

For all companies, there are several prescribing patterns to look for in order to identify employees at increased risk of opioid use disorder, overdose, or death, said Jennifer Ach, PT, MHA, director of clinical metrics and compliance at Cotiviti.

The PQA opioid core measure set includes:
  • Concurrent use of opioids and benzodiazepines
  • Use of opioids at high dosage
  • Use of opioids from multiple providers
  • Use of opioids at high dosage and from multiple providers
  • Initial opioid prescribing at high dosage
  • Initial opioid prescribing for a long duration
  • Initial opioid prescribing for long-acting or extended-release opioids
Finally, Jenkins recommended calculating a relative risk score, or the measure of resources used compared with a benchmark. For example, whereas an average individual in the fictional company may have a score of 1, an individual with a score of 2 would be predicted to be twice as risky or costly as the average person. Businesses that are managing and stratifying their employee populations will want to “normalize” these scores, Jenkins said.

REFERENCE
Jenkins, J and Ach, J. The Aftermath: How One Employer is Using Data to Address the Opioid Crisis Among its Employees. Presented at PQA 2020 Annual Meeting, May 13, 2020.