TEATER HEALTH SOLUTIONS Pain, opioids, depression, suicide. Workplace issues. Construction Industry Alliance for Suicide Prevention 2/27/18 Don Teater MD, mph TEATER HEALTH SOLUTIONS

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

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

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

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

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

Acute rx leads to long-term use47 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

Efficacy of pain mediations Acute pain26,27,51 TEATER HEALTH SOLUTIONS

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

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

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

TEATER HEALTH SOLUTIONS 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

Teater health solutions 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

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