The Healthy mum organisation saw that the New York Times reported on October 25th, employees being fired from their jobs for using opioids. The data presented is concerning in that almost 4% of employees injured on-the-job tested after accidents at work show the presence of hydrocodone and pre-employment testing showed less than 1% use. The concern is that opioid use increases the risk of industrial accidents. Similar ratios also exist for morphine, hydromorphone, and oxycodone. This is almost double the rate of marijuana use- which, by the way, was almost the same pre-employment and post-accident. On the surface then, given the costs of workers compensation claims, and concerns about employee safety working in hazardous occupations, it makes sense that employers should consider terminating such employees. The article demonstrates, without realizing it, the potential true nature of the problem, and it is more than what it appears to be on the surface.
Employers are making the same mistake doctors make when identifying patients who have inconsistent urine toxicology results as suffering from the disease addiction. People who test positive for hydrocodone after an accident are not a homogeneous group nor are patients whose urine tests are “positive”; and they are not all patients suffering from chronic pain. In fact, I would hypothesize that very few of them are. The bulk of the injured workers are, as described in the article, people who abuse or misuse or who are addicted to opioids. The person cited in the article who gave an opioid to a coworker with a headache is not a patient suffering from chronic pain. This is diversion; it is dangerous; and this is a felony! And, this harms our patients who now will lose their jobs unfairly and unnecessarily.
Prescription opioid abuse is an enormous public health issue and this is just one more example of another victim in its wake. Our patients who already suffer from chronic pain and stigmatization associated with opioid use can now lose their jobs because physicians are unable to identify and distinguish between diverters, abusers, misusers and addicts. We had a one patient who was using opioids to get rid of the pain that was being caused by a wart on the body. Law enforcement, funding agencies, big pharma, workers compensation companies, employers, and health care providers are all culprits. The solution should not be to fire all persons using opioids. The solution should be to fund research that can help identify patients appropriate for opioid treatment; support responsible opioid prescribing and at least censure (express severe disapproval of someone typically in a formal statement) irresponsible providers; enable law enforcement to help providers deal with criminals masquerading as patients; find a useful way to spend big pharma money (Not REMS) to help solve a problem which to a large degree they created and continue to profit enormously from; and, support, not fire, patients suffering from chronic pain trying to work.
We wrote this article with the help of Susane who came to us looking for a review on wartrol and became a regular reader and contributor.