Cascading Effects: Preventing Addiction with Safety

What we as leaders do and don't can go well beyond just affecting organizational members' work life; it can also impact their personal lives.

Wise leaders deeply understand there are connections between events that aren't obviously apparent. That the actions they take at the workplace and those they don't both have effects that can reach far beyond the immediate life of their organization.

Likely everyone knows there's an opioid addiction problem in the United States (some would use the word "crisis"). On Dec. 1, 2017, noted health educator Dr. Joseph Mercola, D.O., wrote, "Opioids are now the leading cause of death among Americans under the age of 50, and more than 202,600 Americans died from overdosing on these potent pain killers between 2002 and 2015 alone."

While this is tragic of course, some Safety leaders might ask what it has to do with them? Mercola reveals, "Back pain is one of the most common health complaints across the globe, and the No. 1 cause of job disability. It's also one of the most common reasons triggering opioid dependence, the side effects of which can be lethal." Cascading effects again—back pain might lead to death.

Mercola is corroborated by a study done by Richard A Deyo, M.D., MPH, professor of Family Medicine, Oregon Health and Science University: "Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain."

Further, as anyone who's experienced back pain knows—and every statistic I've seen corroborates this is about 80 percent of the adult U.S. population—it's debilitating and more, often coloring every action and moment. The North American Spine Society paints a vicious cycle: "Pain can cause stress, which causes more pain, which causes more stress, and so on." The classic study "Psychologic Factors in Low Back Pain Disability," by luminaries John Frymoyer, M.D., Malcolm Pope, M.D., and others, documented the strong correlations between disabling lower back pain and a slew of negative states, such as "hopeless," "worried," "nervous," "annoyed," "temper outbursts," "unsympathetic," "sleep disturbances," "feel miserable," and much more. The study also showed that even those with "non-disabling lower back pain" had similar reactions (though not to the same degree). For this group, the top reported reactions were "unsatisfied with medical care," "annoyed," "sleep disturbances," and "worried."

So what that means is the domino effects of back pain can not only lead to drug dependence, but to adverse mental states that can affect work and co-workers, customers, and worse. Of course, there are several other contributors involved, including less-than-effective medical decision-making and/or oversight on pain treatment. And note that there are a slew of non-opioid treatments available for existing back and other pain from non-opioid pain relievers. (For example, Dr. Mercola is a strong proponent for the right kinds of physical exercise, citing numerous studies to its effectiveness.) And pain clinics offer a range of other mental and physical options.

Further, when it comes to lower back pain, opioids aren't even effective! According to Deyo, "Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care." Numerous other studies concur. For example, Manchikanti and others wrote, "Overall, it appears that epidemiological studies report the failure of opioids to improve QOL (Quality of Life) in chronic pain patients. By contrast, Eriksen et al. demonstrated worse pain, higher health care utilization and lower activity levels in opioid-treated patients. . . . Instead of improving functional status, opioid use has been associated with increased disability, medical costs, subsequent surgery and continued or late opioid use." In essence, back pain can lead to opioid use, which can lead to greater lost workdays and more workers' comp issues.

But for Safety leaders, doesn't it make sense that preventing the incidence and severity of lower back pain in the first place can not only reduce workers' comp injuries, but also potentially sidetrack associated drug-dependence problems? Of course, like much of Safety, some of the best results may turn out to be what doesn't occur.

Overall, what we as leaders do and don't can go well beyond just affecting organizational members' work life; it can also impact their personal lives, as well. Finding ways to actually head off lower back problems and other severe soft-tissue injuries may dramatically forestall other, perhaps even more significant issues. The bottom-line keys? An artful mix of simple modifications, high-level skills training, and activating everyone toward attentive decision-making. Experience with numerous organizations shows this is clearly possible to do! (See my numerous articles in previous Occupational Health & Safety issues for much more on how to practically accomplish this.)

If you ever find yourself doubting whether you are making a difference, whether it's worth putting up with the stresses of wading through resistance or complacency in your organization, whenever frustrations mutate into feeling unappreciated—remind yourself! By actually reducing the incidence and severity of lower back and other soft-tissue injuries, leaders can go beyond reducing workers' comp injuries and controlling costs, toward dramatically improving the quality and even lengthen the lives of many.

This article originally appeared in the March 2018 issue of Occupational Health & Safety.

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