1. 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

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

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

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

5. 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

6. 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

7. 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 %.
31 days %.
TEATER HEALTH SOLUTIONS

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

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

10. 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

11. 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

12. 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

13. 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

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