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Opioid Action Plan

Opioid Policy Four-Point Strategic Plan

OWCP has implemented a four-point strategic plan to combat the opioid epidemic and reduce the potential for opioid misuse and addiction among injured federal workers.

Broad controls set up much-needed boundaries and markers. Because the opioid crisis is a complex problem demanding meticulous attention to a host of different factors, broad controls alone are insufficient. Specific measures that precisely target interrelated variables are necessary. Given its role in processing claims for injured federal workers, OWCP can draw from a broad pool of patient data to identify risk factors and shared characteristics. Opioid duration and dose level, along with specific medical conditions and patient characteristics, will be carefully analyzed. That analysis will equip OWCP with the necessary tools to design and implement impactful controls. This will ultimately lead to successful, long-term solutions for both the individual and the community.

Injured federal workers currently receiving an opioid prescription have unique medical needs based on their injuries and medical histories. Determining the appropriate treatment that successfully manages a patient's pain level and addresses any potential opioid use disorder requires a personalized, human touch. OWCP will work in close collaboration with both the individual and the medical provider to encourage a tailored treatment approach. Such an approach will include exploring other pain treatment methods with the goal of eliminating or reducing the use of opioids. Where misuse of opioids or an opioid disorder is present, removing any barriers to treatment will be the primary focus.

General communications through standard media outlets such as the OWCP website, press releases, and bulletins have and will continue to be utilized. However, because OWCP can communicate directly with every injured federal worker receiving opioids and every provider prescribing opioids to its claimant population, the primary focus will be on targeted communications. These targeted communications are often very specific and individualized. The concern generated by the use of opioids in connection with the existing medical condition is identified, the presence of any potential risk factors discussed, and the historical prescribing patterns, if necessary, are provided. Required actions or possible treatment solutions will also be communicated.

Fraud detection efforts, driven by data analytics and a collaborative team approach with the Department's Office of Inspector General (OIG) (and our agency partners' OIG) are an ongoing, high priority for OWCP. A dedicated team, within the OWCP's Program Integrity Unit, has been tasked with uncovering fraud and quickly setting up controls to prevent any further loss or harm. Our primary focus is on potential provider fraud. Problematic prescriptions involving high volume and/or high dose levels and anomalous billing patterns will be carefully examined.

Opioid Fact Sheet

President Donald J. Trump has mobilized his entire Administration to address the opioid crisis. Central to the President's Opioid Initiative is reducing demand and preventing over-prescribing through education and awareness.

U.S. Secretary of Labor Alexander Acosta, in full support of the President's Initiative, wants every injured federal worker to know the facts about opioid abuse, prevention, and treatment.

  • The Centers for Disease Control (CDC) reported that more than 40% of all U.S. opioid overdose deaths in 2016 involved a prescription opioid. See CDC – Preventing an Opioid Overdose for more information.

  • The National Council on Compensation Insurance (NCCI) data shows that injured workers who were prescribed at least one prescription in 2016 received three times as many opioid prescriptions as the U.S. opioid prescribing rate.

  • While long-term opioid use often begins with the treatment of pain (see CDC - Guidelines for Chronic Pain), a Workers Compensation Research Institute (WCRI) study of workers with low-back injuries shows those who receive longer-term prescriptions for opioid painkillers take significantly longer to return to work than those who are not prescribed opioids.

  • The National Safety Council (NSC) reports that the Washington State Department of Labor and Industries found that receiving more than a one week supply of opioids or two or more opioid prescriptions soon after an injury doubles a worker's risk of disability at one-year post injury, compared with workers who do not receive opioids.

  • Very few studies have been conducted that provide evidence to support the long-term benefits of opioid use for chronic pain. See Agency for Healthcare Research and Quality.

  • Opioid use presents serious risks, including overdose and opioid use disorder. Opioid use disorder is defined as a problematic pattern of opioid use that causes significant impairment or distress. See CDC – Commonly Used Terms.

  • The point of greatest control is before you take the first opioid. Injured workers should be active participants in their care so they can make an informed decision regarding treatment. Know your options.

  • Alternative methods for controlling pain may include non-opioid medications, non-pharmacologic treatments, and pain treatment programs. These alternative treatments are more likely to help reduce disability, facilitate the return to work, and decrease instances of opioid misuse. OWCP's FECA policy on Alternative Pain Management and Treatment for Opioid Use Disorder provides greater detail on options available.
Risk Factors for Opioid Misuse,
Addiction, and Overdose

Prescription opioids such as oxycodone, hydrocodone, morphine, and fentanyl, among others, are powerful medications that have pain-reducing benefits but also may lead to misuse, addiction, overdose, and even death. Various factors will increase an individual's risk of misuse, addiction or overdose while taking opioids. These risk factors include:

Opioid Dose, Duration, and Formulations

  • High Dose. The higher the opioid dose the higher the risk for misuse and overdose death. Higher doses, >100 morphine milligram equivalents (MME), have over two times the risk relative to lower doses. Even low doses (such as 20-50 MME) can present a risk.
  • Prolonged Duration. Prolonged use is associated with significant risk of addiction. Physical dependence and addiction to opioids may occur in as little as a few days. As many as one in four people receiving prescription opioids long term in a primary care setting struggles with opioid addiction.
  • Extended Release and Long Acting Formulations. There are greater risks of overdose and death associated with extended-release and long-acting opioid formulations versus immediate release formulations.

Healthcare Conditions and Individual Characteristics

Individuals with certain healthcare conditions or characteristics may be more sensitive to opioid effects, which may also lead to overdose. These conditions and characteristics include:

  • Older adults (65 years and older)
  • Respiratory conditions (Sleep Apnea, Asthma, or Chronic Obstructive Pulmonary Disease)
  • Wasting syndrome (Cachexia)
  • Impaired energy or strength (Debilitated Patients)

Some individuals with certain healthcare conditions or characteristics are at higher risk of misuse, which may lead to overdose. These include:

  • Younger adults (18-25 years old)
  • Mental Health Disorders (Depression, Anxiety, Post-traumatic Stress Disorder)
  • History of alcohol or substance abuse

As opioids have highly-addictive properties, they pose a substantial risk of addiction and overuse.

Concomitant Use of Other Medications or Other Agents

Unless advised by your health care provider, certain medications should be avoided when taking opioids due to increased risk of severe drowsiness, decreased awareness, breathing problems, coma, or death. These medications include:

  • Benzodiazepines (alprazolam, lorazepam, or diazepam)
  • Sedative/hypnotic agents (zolpidem or eszopiclone)
  • Muscle relaxants (carisoprodol, chlorzoxazone, or methocarbamol)
  • Antipsychotics (haloperidol, quetiapine, or risperidone)
  • Other central nervous system depressants (alcohol or street drugs)

Opioids may interact with other medications that may increase your risk of overdose, arrhythmias, or seizures. It is best to check with your healthcare provider and pharmacist and read information from the Food and Drug Administration (FDA) before taking other medications in conjunction with opioids.

If you have been taking opioids and feel you need help, talk to your doctor. OWCP stands ready to assist its injured federal workers with coordination and authorization of any necessary treatment to reduce the harms and risks of opioids. You may also wish to visit the Substance Abuse and Mental Health Services Administration (SAMSHA) website for additional information regarding treatment, or contact SAMHSA's National Helpline at 1-800-662-HELP.

Additional Resources

Need Help?
If you have been taking opioids and feel you need help, contact the National Helpline at 1-800-662-HELP.