I already know what you're thinking. "Again, with the opioids? Hasn't everybody and his brother in workers' comp already talked about this issue ad nauseum? Aren't we seeing reports suggesting the problem is getting better? Aren't we doing everything we possibly can to address this issue?"

Yes, yes, yes ... and no. We're on the right track, but we are NOT yet doing all we can. Several recent developments point out that we cannot become complacent about recent efforts. In fact, we need to double down our endeavors.

One reason: heroin. This nasty drug is making an unwelcome comeback and much of the blame points to opioids.

The head of the Centers for Disease Control and Prevention says much of the new heroin "crisis" in this country is growing out of prescription drug abuse, especially opioid painkillers. A recent CDC study showed that people who abuse painkillers are 40 times more likely to abuse or be dependent on heroin. Those most at risk include non-Hispanic white males between the ages of 18 and 25.

Dr. Tom Frieden says it's a one-two punch; the use of opioids has primed people for heroin addiction because the drugs have essentially the same active ingredient. Also, heroin's "increasingly available." That doesn't bode well for injured workers who become addicted to the opioids they've been prescribed for their injuries and are subsequently cut off from their supply.

While Frieden was commenting following the release of the CDC's report, President Obama recently announced that $5 million of a new $13.4 million anti-drug trafficking initiative will go directly to fight heroin. Half of that amount will focus on places with a "severe heroin threat," including Appalachia, New England, Philadelphia/Camden, New York/New Jersey, and Washington/Baltimore.

There's another reason to refocus the efforts to combat the opioid issue: courts throughout the country are forcing workers' comp payers to foot the bill for injured workers who become addicted to, or die from opioid overdoses. The National Safety Council recently published a sobering report on the financial liability risk from opioid abuse.

The report looked at some two dozen cases from 2008 to March of this year in which payers were ordered to pay for detox and medical-assisted treatment services, as well as death benefits to surviving families.

What was somewhat striking was that the cases were compensable "even when the medication is not taken as prescribed, taken with alcohol or inappropriately prescribed."

Experts say opioids CAN be effective for helping SOME people deal with their pain for a SHORT period of time -- like right after surgery. But there are a plethora of studies showing long-term use doesn't do much, if any, good -- especially for people with noncancer pain; i.e., injured workers.

The trick is to make sure injured workers who are prescribed opioids are the right candidates in the first place and are taken off the medications when appropriate, like when they reach meaningful functional recovery. Injured workers who have become addicted to opioids need to be treated and properly weaned off their meds.

So what more can we do? Well, the main thing is to work with others, both within the workers' comp system and outside of it. Here are some additional suggestions:

• Require providers to use opioid prescribing guidelines. The American College of Occupational and Environmental Medicine, for example, recommends taking thorough patient histories with more detailed screening if the treatment is to continue beyond two weeks; use urine drug monitoring; avoid co-prescribing opioids with benzodiazepines; and prescribe the lowest effective dose and only the quantity needed for each patient.
• Require use of each state's prescription drug-monitoring program to the greatest extent possible. Except for Missouri, all states have them. At the very least, make sure providers look at them before prescribing opioids. The PDMP should be timely and easy to use so providers can make informed decisions before they prescribe opioids. If it is not, it may be a good idea to work with a state's Legislature.
• Screen injured workers for depression, mental health conditions and current or prior substance use.
• Require that all pharmaceuticals be purchased and managed by a pharmacy benefit manager.
• Educate workers! Don't assume they understand the hazards associated with prescription pain medications. They don't. They are in pain and looking for relief. Period.
• Educate supervisors focusing on identifying impaired workers.
• Work with carriers to identify inappropriate opioid prescribing and adopt procedures to manage a worker's opioid use.
• Evaluate employee assistance programs and make sure they include access to treatment.