Solution starts with being open-minded about the crisis
By SHERI GASSAWAY
The key factor in battling the opioid crisis in the workforce is understanding that it is a brain disease backed up by science, not a moral deficiency, and the solution to the problem starts with union officials, employers and peers being open-minded about it.
“We know that these drugs rob the prefrontal cortex of your brain,” said Dr. John Gaal, St. Louis-Kansas City Carpenters Regional Council’s director of training and workforce development. “That’s the part of your brain that makes all of your executive decisions. Why would someone continue to use a drug who has lost their house, their family, their children or their car? That’s not logical or rational.”
Gaal was the guest speaker at a program on opioids in the workplace hosted by the Labor & Employer Relations Association (LERA) Gateway Association. He provided an overview of the problem that included some eye-opening statistics, discussed how it started and shared ways that healthcare providers, employers and union leaders can address it.
DRUG OVERDOSE DEATHS RISING
According to the Centers for Disease Control (CDC), more than 72,000 Americans died from drug overdoses in 2017. That’s up from 64,000 from 2016.
“That’s almost 200 people a day we’re losing to drug overdoses,” Gaal said. “The deaths aren’t all from heroin and opioids, but the vast majority of them are.”
In Missouri, opioid-involved overdose deaths have been steadily climbing over the last 17 years with sharp increases in 2016 and 2017, according to the Missouri Department of Health and Senior Services’ Bureau of Vital Statistics. (See related chart.)
MAJORITY OF HEROIN
USE STARTS WITH
Just two years ago, Gaal said, about two-thirds of people who were addicted to heroin reported first misusing prescription opioids. Long-term use of the drugs can lead to a tolerance, meaning people need higher or more frequent doses to achieve the desired effect.
“Today, that same number is up to almost 85 percent,” Gaal said. “This is some scary stuff, and it’s going to bring our nation to its knees if we don’t collectively get involved.”
He noted that that while the United States makes up only of five percent of the world population, it uses 80 percent of the world’s opioid painkillers and 99 percent of the world’s Vicodin.
HOW WE GOT HERE: THE FIFTH VITAL SIGN
Gaal said the opioid crisis began as a solution to pain and everyone is to blame, including the pharmaceutical industry which oversells the drugs and doctors who overprescribe them.
He said lawmakers also played a part in the situation because, after hearing their constituents complain about the widespread problem of under-assessment and under-treatment of pain, they approached the CDC and said, “You have to do something about this.”
“In the late 1990s and in early 2000, the CDC dropped a lot of provisions they had in place for painkillers and said, ‘We have to have a way to measure pain,’ and they created the fifth vital sign,” establishing pain as a recognized vital sign equal to blood pressure, heart rate, respiratory rate and temperature.
The problem, Gaal said, is that pain is subjective, unlike the other four vital signs, which are objective.
“If you went to the emergency room, you had to subjectively tell the nurse where you were on that pain scale,” Gaal said. “And if you’re in pain, you’re sure not going to point to the smiley face on that pain scale because you want some drugs.”
Gaal said the CDC has repealed its directive and instituted a new plan called “Go Low, Go Slow.”
TREATING OPIOID USE DISORDER
Gaal said medication assisted treatment – using methadone, Suboxone or Vivitrol – combined with one-on-one counseling, support groups and cognitive behavioral therapy works best for people with opioid use disorder.
“There are some programs out there that say you’re not going to use one drug to solve another drug, and we’re like, “Really?’” he said. “We know this is a brain disease. Would you do this to me if this was diabetes? You’d hold my medicine back? We know medication-assisted treatment works, and it produces great results.
KEEP AN OPEN MIND, AND KEEP NARCAN ON THE JOBSITE
Gall said one of the most important things employers can do is keep an open mind about the opioid crisis and be sure that Narcan, a nasal spray that can revive someone in the event of an opioid overdose, is readily available at the jobsite or in the workplace.
“The St. Louis community has 11,000 vials of free Narcan available through a federal grant,” Gaal said. “I plead with you to have this on hand and to have more than one dosage because if fentanyl is mixed in with heroin, you’ll need several doses.”
Union officials or employers interested in obtaining the free Narcan should contact the National Council on Alcohol and Drug Abuse (NCADA) at 314-962-3456, or you can stop by the Missouri Network for Opiate Reform and Recovery at 4022 S. Broadway in St. Louis.
PRESCRIPTION DRUG MONITORING PROGRAM
Adding to the opioid crisis, Gaal said, is the fact that Missouri is the only state that does not have a prescription drug monitoring program – an electronic database that tracks controlled substance prescriptions and alerts health authorities if patients are using multiple providers to get the same drugs. Illinois implemented a monitoring program last year.
Fortunately, about 16 counties in Missouri have followed St. Louis County’s lead and implemented countywide drug monitoring programs on their own.
“If you’re part of a Labor-management healthcare fund and have them dig in the data, you’ll be surprised at how many of your members or their spouses or kids have doctor shopped on this very issue,” Gaal said. “I was blown away when I requested the data from our folks.”
Gaal said the best advice for employers and union officials is to be proactive and talk about the problem.
“Reach out to the National Council on Alcohol and Drug Abuse,” he said. “They can do your training on Narcan administration, they can come in and talk to you about the science behind opioid use disorder, and they offer counseling.”
For more information on NCADA or to receive training, visit ncada-stl.org or call 314-962-3456.