The opioid epidemic has been one of the most disruptive conditions in the American healthcare system in decades. Statistics show more than 50,000 Americans died from drug overdoses last year, topping the number of motor vehicle-related fatalities as well as gun deaths. Many of the overdose deaths were attributed to opioids that were prescribed for chronic pain.

The workers’ compensation system has been at the forefront of efforts to combat the opioid epidemic for the last several years and reported some positive, albeit small results. Efforts by various stakeholders have slowed the increase in opioid misuse, abuse and diversion among injured workers. However, the problem still demands our undivided attention as we have a long way to go.

“As an employer, one of the best things you can do to combat this epidemic is to find an occupational health provider that uses early intervention therapy, which is seen as one of the best alternatives to bed rest and opioid prescriptions,” according to the American Physical Therapy Association. “This approach uses immediate physical therapy to increase mobility and reduce healing times. By focusing on functional recovery, patients are less likely to develop chronic pain that requires prescription opioid pain medication.”

The push for early intervention of PT is part of a campaign the ATPA initiated to encourage the use of PT as a safer — and more effective — alternative to opioids for chronic pain. With the launch, the PT community joins the multitudes of recent efforts to address the opioid epidemic.

Government involvement

The national opioid epidemic attracted the interests of the Federal government last year on a couple of fronts. The Food and Drug Administration issued a statement mandating opioid prescriptions to carry a ‘black box’ warning about the risks of abuse, addiction, overdose and death. Additionally, the Centers for Disease Control and Prevention released guidelines to help guide medical providers who prescribe opioids for chronic pain. The idea is for them to try other methods to treat pain before opioids.

Even more action on the opioid epidemic is happening on the state level. Some states have recently placed limits on the number of days for which opioids can be prescribed; several have imposed 7 day limits, while New Jersey is imposing a 5-day maximum. Experts expect that trend to continue. Other states are looking at helping to wean injured workers off opioids. New York recently rolled out a new hearing process to address workers’ compensation claims that involve problematic drug taking.

One of the major trends underway within the workers’ compensation community is the adoption of drug formularies. What began in the group health space as a tool to help reduce costs is becoming prevalent in workers’ compensation, but with a different focus. In group health, the presence of co-pays and other out-of-pocket expenses is a reason to direct patient care to the least expensive medication. Workers’ compensation, which typically does not include out-of-pocket expenses, has formularies designed to identify the medication that will result in the best outcome for the injured worker and get him back to function and work.

Formularies in workers’ compensation are generally lists of pre-approved medications and others that require preauthorization, such as opioids. The idea is not to prevent patients from getting opioids or other medications if they truly need them, but to encourage the use of other remedies first.

Right now, about 20 states either have, or are considering drug formularies in their workers’ compensation systems. California, for example, is being closely watched as regulators are under a legislative mandate to implement a formulary this summer.

The Role of PT

Experts are pushing the idea of taking a holistic approach to help people in pain. Massage therapy, chiropractic sessions, cognitive behavioral therapy, acupuncture and mindfulness training are among them. But one of the most effective alternatives to opioids to treat pain is PT.

One reason is its cost effectiveness. Where 10 PT sessions might cost $1,000, payments for an injured worker taking opioids indefinitely can run into the hundreds of thousands of dollars.

Even more important than potential cost differences is the fact that PT can reduce or eliminate the need for opioids by improving physical function and decreasing pain. Physical therapists these days are highly educated and trained in musculoskeletal injuries — the cause of most chronic pain among injured workers — whether it is low back pain, knee ailments or shoulder injuries.

Physical therapists focus on function and increasing range of motion — not just masking the pain for a few hours with a drug. Those of us with a deep understanding of pain biology, biomechanics and ergonomics can target the cause of overuse issues.

Research from Canada confirmed this. A study at the University of Alberta found that patients who were not prescribed opioids benefited more from physical therapy in terms of rebuilding their physical ability and were able to function quicker.

It is, of course, important to focus on each injured worker’s individual issues. By working with one-on-one with injured workers, the physical therapist can understand the comorbid conditions and other unique challenges of each person. By doing so, physical therapists can help injured workers understand how to move without fear or pain.

Physical therapists with companies such as PhysNet work one-on-one with only one injured worker for an hour in the person’s place of business, making them well suited to address a worker’s painful conditions typically without the need for opioids. In our next blog, we will continue to explore various ways the workers’ compensation system is reducing or eliminating the unnecessary use of opioids among injured workers.