Additional licensure and certifications aren’t unheard of in the world of occupational health. In 2016, the Federal Motor Carrier Safety Administration implemented a new rule that only doctors on their registry can perform DOT Physical Examinations for truckers and other professional drivers. This reduced the number of doctors who can perform those examinations.
When I testified on LB 408, a bill that would have implemented drug formularies for opioids under the Nebraska Workers’ Compensation Act, some doctors were testifying that there was little training in regards to prescribing opioids. Though an opioid prescription registry like the DOT examination registry wasn’t proposed, you could certainly see it proposed as a solution to the opioid problem.
But that article also shared studies that state that pain pill prescriptions are not driving the opioid epidemic. Patients with pre-existing addiction issues are more likely to become addicted to opioids and 75 percent of those who develop opioids start taking opioids in a non-prescribed manner. Furthermore, only 12 to 13 percent of ER patients who are treated for opioid overdoses are chronic pain patients.
The Lincoln Journal Star has run a solid series about the impact of opioid abuse in Nebraska. The series has done a good job describing the challenges of narcotic addiction in regards to mental health, behavioral health and the criminal justice system.
But the series has yet to address the impact that long-term narcotic use can have on physical health. From 11 years of practicing workers’ compensation law, I have found that long-term narcotic use from a work injury can often lead to digestive issues. This is often described as narcotic bowel syndrome or opioid-induced constipation. One of my clients incurred a $50,000 emergency room bill from a bowel obstruction related to taking narcotics prescribed to treat his work injury. These bills should and can be paid by workers’ compensation, but it can be challenging to get them paid, as doctors who treat these injuries may be outside the normal chain of referral for work injuries. They might also be unaware of why a patient is taking narcotics. Both of these factors might make it more difficult for an employee to obtain a medical opinion about the cause of the digestive problems that is sufficient enough to have those bills covered by workers’ compensation.
Very few studies have been done about the economic costs of opoid-induced constipation, but those studies are consistent with my anecdotal experience with my clients. One study showed non-elderly patients with opioid-induced constipation incurred medical costs that were 52 percent higher than non-elderly patients who did not suffer from opioid-induced constipation.
President Obama recently signed legislation designed to curb and treat narcotic abuse. Many other states have passed similar legislation. I hope that when Nebraska crafts legislation in regard to narcotic abuse that it recognizes digestive issues from narcotic use as part of the problem of narcotic addiction.