Murthy's Law

At the National Rx Drug Abuse & Heroin Summit being held in Atlanta, GA, the nation's relatively new Surgeon General, Vice Admiral Vivek Murthy, made some poignant observations about the nation's issues with opioids, and of course observations that bleed into workers' compensation.

Murthy first observed that, like many issues in work comp itself, the public health problem that is prescription drug addiction arrived here with good intentions, but went astray because, for the most part, we as a society, as professionals, as consumers, didn't really understand what we were getting into.

Now, of course, there are more than 2 million Americans becoming addicted to prescriptive opioids every year and when those folks are denied their opiates they turn to the black market, eventually driving heroin use, and worse.

Surgeon General Vivek Murthy

Murthy said that over 250 million prescriptions are issued for opioids every single year - nearly enough for every single individual in America. But the overall level of pain reported by Americans has not changed.

There are five key components that need addressing, Murthy said:

1) Change the prescribing practices of health professionals to ensure they are treating safely and effectively;

2) Increase access to Buprenorphine, an opiate uptake inhibitor that helps with the detox process;

3) Ensure that medication is combined with counseling services and that the combination is available to all with addiction profiles;

4) Expand public education so people understand the risks of opiates and how to properly manage them; and

5) Change how this country sees addiction to remove the stigma - it is a disease says Murthy (and many of the folks here) not unlike any other disease such as diabetes.

The workers' compensation institution helped create this opioid issue two ways: by denying or strictly limiting access to conservative care (physical therapy, chiropractic treatment, acupuncture, etc.) and failing to account for the "whole person" in providing medical care.

The only remedy left for physicians, then, became pills. More pills. Stronger pills. Get that patient out of the office quickly because he or she is costing valuable practice time, ergo, billings.

Certainly the constriction of conservative care wasn't without good intention. Abuses were rampant. Certain chiropractors, physical therapists and other conservative care providers determined that unrestricted care meant a constant, recurring revenue stream well beyond any beneficial care plateau. 

That abusive, selfish mentality made some people mad. Mad enough that laws and regulations were implemented to constrain the abusers, which of course punished the vast majority that had no intention of abuse, and the spiral down to a national crisis began.

So now we're left with trying to correct a problem of our own making, and Murthy's steps 1 and 3 can be directly affected by this industry: changing prescribing habits requires education and resources (i.e. use common sense in managing care rather than wholesale constrictions), and treating the whole person (yes, that means psychological care and treating the comorbidities along with the industrial diagnosis).

There were two very important philosophical points that Murthy made, though, that if we hold them close to our professional commitment, will not only increase the dialogue about drugs, but also about the efficacy of workers' compensation as the work injury protection program it is intended to be.

One - Murthy wants the country to know that addiction is not a moral failure, and in this regard WE should tell the country that workers' compensation itself is not a moral failure. If we look at work comp in the manner for which it was intended - not a line of insurance but as a mode of social obligation - this changes how we look at it, and how others look at it (so make your Comp Laude nomination now!).

Two - It is a fundamental American value that we are responsible for each other.

We forget that the children of our workers are our children too - that those people are our people. There is no economy without our people, and the children of our people. One need only look at areas that have been particularly hard hit by the opioid epidemic, such as rural Kentucky, to realize that the social burden from ignoring the problem is far greater than the cost of the remedy.

We are responsible for each other.

How often do we forget that?