The Role of the Employer in the Fight Against Opioid Abuse

By Gus Crothers
November 6, 2017

In light of the President recently declaring a national health emergency due to opioid addiction, it can’t be overstated that an ounce of prevention is worth a pound of cure.

As an addiction specialist, I often hear heartbreaking stories about the moment when a patient’s life took a dark turn. Too often it begins in a doctor’s office, on the seemingly innocent day they received a prescription for opioids. As our country searches for sensible behavior around pain and addiction, it’s critical we turn our attention toward physician quality.

One particular patient’s journey stands out as an example from my years in practice. He worked at a large company with a health plan that afforded him the opportunity to access quality medical care. He thought he was on the road to a healthier life, but then his primary care physician (PCP) prescribed him opioids for chronic lower back pain—despite him having multiple risk factors for addiction that should have been red flags. The story gets worse:

  • His PCP and surgeon both failed to review the state prescription monitoring program where they could have learned they were both prescribing opioids to this patient.
  • His surgeon escalated the opioid doses beyond what’s recommended outside of a pain-specialty setting.
  • He did not receive effective care for his psychosocial problems, turning instead to self-medication with addictive substances.
  • When the doctors became suspicious of opioid misuse, they “cut him off” rather than providing him with referrals to appropriate addiction treatment resources.
  • When he finally sought addiction treatment on his own, he sought various forms of low-quality, short-term treatments without pursuing evidence-based maintenance treatment for his chronic disease.
  • From the onset of his addiction, it took the patient four years to receive effective, life-saving treatment (sadly, on the bright side, that’s six years faster than the national average for substance use disorders.)

I was lucky to be able to help this patient achieve sobriety, return to the workforce, and find stability at home. But his journey of low-quality care actually inspired me to leave traditional practice and pursue a career path where I could help employers navigate toward high-quality health care within their coverage network for their large workforces. The number of patients each day that I could keep away from unnecessary medications and procedures was far greater this way than the impact I could have in traditional practice.

For instance, there’s a new data analysis that assesses the pattern of irresponsible pain medication prescribing for patients with headaches. The analysis shows physicians whose overall quality rates in the bottom 10% of our rankings are prescribing opioids at nearly double and triple the rates of their highest quality peers. Similarly, this bottom decile is prescribing barbiturates (another addictive class) to headache patients four to five times more often than the top decile.

Guiding patients away from irresponsible prescribers and towards high-quality, effective physicians can drastically change the trajectory of opioid addiction in America. Our nation’s largest employers can play a vital role in moving our country away from a perpetual cycle of low-quality, high-volume health care that is fueling the opioid crisis.

Over the past weeks, companies like CVS and Cigna have made moves that underscore the role of pharmacies and payers in patients taking opioids. While I’m encouraged by this step, I feel we are still missing out on a critical audience. Corporate executives (who, realistically, are more responsible for their employee’s health than almost anyone else) have a major opportunity to impact our country’s opioid crisis.

Of course, opioid addiction is just one potent example of the impact of low-quality care—there is so much more work to do. But for today, with a greater focus on opioid addiction, our country can turn to tools and technology that already exist to prevent personal tragedy at the hands of health care, and move the needle on a national emergency.

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Gus Crothers

Gus Crothers

Dr. Crothers joined Grand Rounds after completing his Medical School and Family Medicine residency training at Tufts University School of Medicine and Cambridge Health Alliance in Boston, MA. While in his residency, Dr. Crothers designed an area of concentration for his training that focused on primary care leadership and innovation. In this work, he participated in local and regional primary care improvement and research initiatives, culminating in a research fellowship at the Robert Graham Center of the American Academy of Family Physicians, where he studied participation rates of primary care physicians in addiction medicine. In addition to his passion for broad-spectrum primary care, Dr. Crothers has a special interest in substance-use-disorders and maintains an active primary care and addiction medicine practice.