When studying the CDC guide, employers can recognize the importance of both treating pain as well as screening, recognizing, and intervening when risky and/or problematic drug use exists.
In 2016, the Centers for Disease Control & Prevention (CDC) developed the Guideline for Prescribing Opioids for Chronic Pain. Born out of America's opioid epidemic and struggle with pain, the CDC analyzed research on opioid prescribing and pain treatment to ultimately develop the guide.
The guide was meant to apply to patients and providers in particular settings where opioids might be considered or used for treating pain. Though, as an unintended consequence of the CDC guide, some governmental bodies, insurers, health systems, and prescribers adopted changes beyond the scope and intent of the guide. This resulted in harm to patients. Recently, the CDC guide was updated and is currently in draft form for public comment.
When considering the CDC guide, employers should first acknowledge that pain is a universal part of the human experience. At some point, all employees will have pain, and the CDC wants those who experience pain to receive effective and safe treatment. As noted in the CDC guide, treatment options can include opioid and nonopioid medications, physical therapy, Cognitive Behavioral Therapy (CBT), and complementary and alternative approaches like chiropractic and acupuncture care. Health care providers must always balance the risks and benefits of treating pain with these available modalities, with special attention to opioids.
In contrast to the initial CDC guide, the proposed update is more complete and connects the relationship between pain and opioid addiction. Specifically, the update provides a synopsis of the available evidence and a discussion on opioid addiction and medications that are FDA approved for Opioid Use Disorder (OUD) treatment (see Rec. #12). In particular, the update provides information on Buprenorphine as it relates to both pain and OUD treatment.
All employees need, and deserve, access to evidence-based treatments that are effective and safe. This applies to treating pain and opioid addiction – just like we strive to treat hypertension and diabetes. The CDC guide in its updated version makes a call for providers to make use of buprenorphine and other OUD treatments. While this recommendation is certain to yield positive outcomes such as decreased overdoses and increased return to work, we are still missing the mark.
Consider that alcohol and drug use often begin in adolescence, and while many teenagers ultimately do not go on to manifest addiction, there exists a large opportunity for prevention efforts in this population. Further, consider that by the time an employee manifests his or her drug addiction, there will likely be more severe and detrimental consequences stemming from the drug use. What if someone opened the conversation and helped bridge the gap between prevention and intervention efforts and employees? Employers have the opportunity here to do just that.
When studying the CDC guide, employers can recognize the importance of both treating pain as well as screening, recognizing, and intervening when risky and/or problematic drug use exists. To tackle these issues, employers must offer a comprehensive set of health care benefits to employees. On one hand, this includes a primary care home with easy access to providers who can treat pain with effective and safe modalities as noted in the guide.
On the other hand, employers must also ensure employees have access to the full complement of addiction treatment services. Let's make proper use of the guide and provide excellent health care to employees who deserve the best services. Regardless of the past, we are now armed with a base of evidence that, if used correctly, will help sufferers of both pain and addiction. This will also prove beneficial to families, communities, and the workplace environment. Employers, this is your call to action. Will you answer?
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