#PewPerspectives - Week of May 7

Following are the stories that I posted on LinkedIn during this week in case you missed them. View counts are as of 10:00am ET on May 12.

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Subcommittee on Workforce Protections (2,300 views)

Best wishes to Joe Paduda and Ramona Tanabe as they testify today (May 8) at 10am in DC to the U.S. House Subcommittee on Workforce Protections about "The Opioid Epidemic: Implications for the Federal Employees’ Compensation Act." Important information to leaders that can make a difference. Hopefully Congress listened to not just Joe and Ramona but also other well-informed people on how to have a balanced approach to managing the opioid issue. I haven't seen Joe publish his thoughts yet on the questions, the answers, and the next steps from his perspective, but I'm sure that will be coming soon.

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More U.S. Workers Test Positive for Certain Illicit Drugs (680 views)

Interesting data from an analysis of more than 10M urine drug tests conducted by employers:

• A 17% decline in positive tests for opioids
• An increase in positive tests for marijuana where it's legal (including a 43% increase in Nevada)
• Illicit drugs stayed the same at 4.3%
• A surge in methamphetamines, especially in the Midwest, South and parts of the Northeast
• A surge in cocaine in Nebraska and Idaho

"In all, 2.6% of workers Quest tested in the general workforce showed positive results for marijuana, although the company said fewer customers are requesting the marijuana test." That's the same feedback I've been hearing - employers are starting to remove marijuana from their drug testing panels (or not do drug testing at all). U.S. employers are dealing with an impaired workforce, from a variety of substances. Pretending like it's not there is not an option. It's all about risk management that is evolving (and in some ways becoming increasingly difficult). How does an employer manage an impaired workforce? From what I've heard in direct discussions with many, there are as many plans as there are employers. Working in one community / state is different than multiple states. Receiving federal dollars adds mandatory constraints. Safety sensitive jobs have different expectations (and potentially testing) than other jobs. Ultimately, being able to fill job openings (and keep them filled) is a challenging prospect. Integration of H/R, risk management and legal with the "C-Suite" and supervisors is paramount in making the best decision for each company.

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Menu labeling provides transparency for our guests (1,089 views)

Posting calories in restaurants with more than 20 locations is a good thing - and was effective yesterday (May 7). An educated consumer does in fact (usually, hopefully) make better choices. And better nutrition choices (e.g. eating anti-inflammatory foods, ingesting less sodium & sugar, burning more calories than you eat) can help in the management of pain. Do you make different (maybe better) choices when you see the calories on a menu? If you don't, yet, now's the time to pay attention. One commenter noted that pizza restaurants haven't been very supportive of calories on menus. I'm sure being somewhat precise in counting calories is complicated for restaurants with all of the variables (the primary pizza argument) but having an idea of the "cost" for what you're about to eat will help decision making. That "cost" could be long-term health or extra minutes at the gym, but at least everyone will know what they're doing.

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Suicide: A Silent Contributor to Opioid-Overdose Deaths (483 views)

An important conversation to have - the intersection of suicide and opioids. This includes prevention (adequate screening) and treatment (mental/behavioral health). But it also includes compassion. If Rx opioids are being tapered/eliminated because the risks now exceed the benefits, it MUST be done in a thoughtful and careful manner and it MUST include the addition of alternative forms of managing the pain that remains. Finding a different treatment plan (if needed) is complex and must be individualized. It takes time, money and active engagement by all stakeholders (patient, provider, payer) to determine the best combination of treatment options (Rx and non-Rx) to optimize daily function. We can't get this wrong! With heightened government, business and personal awareness of the opioid epidemic there is also a heightened desire to address it. But that means poor decisions can be made in regards to that ... for example, prescribers being so averse to prescribing opioids that they drop their chronic pain patients without any thought as to a proper tapering process or how that pain will be managed. Every life matters, before the first script and with the 100th script. The overuse of opioids has created dialogue that could have never been contemplated in advance.

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Abuse of Opioid Alternative Gabapentin Is on the Rise (1,291 views)

Gabapentin pills can "enhance the euphoric effects of heroin and when taken alone in high doses can produce a marijuana-like high". In addition, the combo of opioids & gabapentin increase the potential of overdose death. We continue to have an #opioid epidemic. We have had a #benzodiazepine epidemic. Are we about to have another Rx drug that can be abused in epidemic scale? It just goes to show the abuse of Rx opioids was a symptom of bigger issues that will just migrate to other methods if we don't deal with the root cause. For more context on gabapentin check out "#PewPerspectives - Week of Apr 2" where I included this: "According to an active-practice physician (treating addicts) I've corresponded with, gabapentin does not create euphoria (since it does not affect the ventral tegmental or nucleus acumben areas of the brain) and is not abused (in his experience)." But it is still apparently being abused in increasing measure. There was some good dialogue in the comments on this particular post that I thought would be helpful additional context here:

• And yet gabapentin, is prescribed as MAT throughout the country in drug rehabs as a “treatment” for opioid addiction. Very vulnerable people who are taught they are “powerless” and are desperate enough to pay for “recovery” are unknowingly being sucked into this scam. MP: Certainly not all "drug rehabs" are created equally in regards to their standard of practice. As with any issue, there are profiteers emerging to take advantage of others (I've noticed articles specifically in Florida and in California that address it). Exchanging one drug for another is the answer for some but not for all (and may not be the best option for many).
• Just read an article on this topic.. "Is Gaba The Newest Prescription Drug Killer?" this specific article refutes the idea that claim. MP: Thanks for providing some balance. There is legitimate use of gabapentin that provides legitimate clinical value, which Snopes points out. And those that derive benefit, especially for on-label uses to treat epilepsy and neuropathic pain, should not be stigmatized by continued use. It's the abuse factor that is concerning, even if just as an adjunct to other drugs to increase euphoria. The viral Facebook post that Snope quoted as saying gabapentin is the "newest killer prescription" that is "killing thousands" is overly dramatic and may be as erroneous as they point out, but it still bears watching (which is what Ohio and Kentucky are doing).

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Opioid distributors flooded communities with painkillers. Now they deny responsibility. (283 views)

So which opinion is accurate? Are drug distributors not culpable in the #opioid epidemic because they have a process in place and ultimately they're not responsible for how Rx drugs are used because it's the doctor's fault ("Don’t blame pharmaceutical distributors for opioid crisis")? Or did they turn a blind eye to an egregious number of pills and, whether by lack of action or silence, are complicit in what happened ("Opioid distributors flooded communities with painkillers. Now they deny responsibility.")? The answers to that question will play out in legislative sessions and courtrooms, and is as much about not letting something like this happen again as being punitive for any mistakes that were made.

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Walmart Introduces Additional Measures to Help Curb Opioid Abuse and Misuse

Posted originally by Kelly Zuppke, I offered the following comment: "Between the free DisposeRx to now the 7-day supply (initial, acute, not addressing chronic pain/use) and 50mg MED cap, Walmart is certainly leading on two primary issues that can result in Rx opioids being used non-medically (stolen out of medicine cabinets and/or sold on the street). But don't overlook their 2020 requirement of e-prescribing of all controlled substances. Not only does that reduce errors (legibility, typos) and fraud (a Rx script or full pad is easy to abuse) but it better integrates into EMR systems for better tracking that can lead to more informed choices. Honestly, I can't think of a reason why EVERY state doesn't require e-prescribing. Walmart's efforts may help make that a reality."

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In addition, I published three blogposts:

• "#PewPerspectives - Week of Apr 16" on May 7
• "#PewPerspectives - Week of Apr 23" on May 10
• "#PewPerspectives - Week of Apr 30" on May 11

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#CleanUpTheMess