An Issue of Epidemic Proportions

The United States is suffering from an epidemic of opioid use and abuse. The President has gone as far as declare a state of emergency on the opioid epidemic sweeping our country. The opioid crisis has garnered much attention from the media regarding the ever-increasing death toll due to overdoses. Still , little has been done to curb the use of opioid medications. In fact, within the last couple of years newer, stronger opioid medications have been released to the market. 

Medication and OSHA

EHS professionals at sites subject to OSHA regulation know too well what an opioid prescription means for an injured employee. In the best scenario, the case is recordable. In the worst case, it could become a lost time injury. The OSHA standard leaves very little wiggle room for what counts as medical treatment beyond first aid. Below is an excerpt from 29 CFR 1904 regarding medication as an example.

 1904.7(b)(5)(ii)(A) Using a non-prescription medication at nonprescription strength (for medications available in both prescription and non-prescription form, a recommendation by a physician or other licensed health care professional to use a non-prescription medication at prescription strength is considered medical treatment for recordkeeping purposes)”

Over the last several years, EHS professionals have seen injuries that could have remained first aid, elevated by well meaning medical staff. Opioid medication has been marketed as the supreme pain reliever for so long that it seems to have become the default medication prescribed for pain in in a medical setting. In my experience, it is the first thing I look for in medical paperwork received for a work-related injury.

About the Study

A recently released study on the effect of opioid vs. non-opioid medications in patients with chronic pain has found that opioid treatment is not superior to treatment with non-opioid medications. The study was conducted on 240 Veterans Administration patients in primary care clinics for a period of 12 months. The strategy was to aim for improved pain and function in the patients. The opioid group was treated with morphine, oxycodone, and hydrocodone/acetaminophen. The non-opioid group was treated with acetaminophen or NSAIDs. There was a significant improvement in pain related function in the non-opioid group over the opioid group, while there were more adverse reactions noted in the opioid group. The study concluded that not only do non-opioids work better than opioids at treating pain, but also that the results do not support the initiation of opioid therapy in moderate to severe chronic pain for the conditions observed. You can read the study HERE.

OSHA rules on OTC and Injections

There are some key things here for the EHS professional to keep in mind. In the study, the medicines administered were in injected form. Any injected medication is considered medical treatment beyond first aid and is recordable (tetanus immunization is the only injection that passes). A medication may be available OTC but prescribed in prescription doses. A non-prescription medication prescribed by a medical professional in a dosage that requires a prescription is medical treatment beyond first aid (even if the employee can take 6 OTC ibuprofen for the same effect).

Is Change on the Horizon?

This is only one clinical trial, there are many more needed before it becomes a medical fact. Other types of chronic pain will need to be studied, different methods explored, and other focus groups observed. Some medical professionals are already beginning to distance themselves from opioid medications and insurance companies are implementing new rules on coverage for opioids. Perhaps soon the opioid epidemic will be a thing of the past.

I’d like to thank National Public Radio (NPR) for giving me the idea for today’s article. You can listen to or read what inspired today’s article HERE


Dave Knight is the founder of Orient Safety, an EHS consulting firm in Goshen, Indiana. To learn more about the services Orient Safety provides, visit us HERE. As an offering to potential customers, Orient Safety provides a free incident reporting app for your business HERE. Connect with Orient Safety on Facebook and LinkedIn.