Opioid Abuse and the NJ Workers' Compensation Act

The implementation of the recently enacted NJ law concerning substance abuse disorders was the subject of an insightful panel discussion today at the annual meeting of the NJ Workers' Compensation Section.

(Left to right) Jag Desai, MD, Nancy J. Johnson, Esq., Jon L. Gelman, Esq,
Christopher P. Gargano, Esq., Mark B. Zirulnik, Esq., Hon Joanne Downey, Member of the NJ General Assembly
Photo Credit: Margaret Sherlock

The reviewed the implications of the newly enacted NJ law, A3, PL2017, c28, that was enacted on February 15, 2017, and become effective 90 days later. That Act requires health insurance coverage for the treatment of substance abuse disorders. It places certain restrictions on the prescription of opioid and certain other drugs. The law mandates abuse educational programs.

It became obvious during the roundtable program that opioid abuse over the last two or three decades has become an epidemic in nature and the impact to injured workers, employers, and the workers' compensation system has increased enormously.

While the Workers' Compensation Act was not embraced expressly in the text of the legislation, Assemblywoman Downey spoke of her continuing concern and commitment to review the issue further. Ms. Downey told the audience that she would continue to address substance abuse in the workplace going forward and more specifically treatment issues and integration into the NJ workers' compensation system.

Reference Material

The Ethics of Pain Management

The Workers’ Compensation Bench/Bar Conference

May 19, 2017

Round Table Discussion Bibliography

Statutes

P.L.2017, c.28 (Passed) 2017-02-15 S3 Requires health insurance coverage for treatment of substance use disorders; places certain restrictions on the prescription of opioid and certain other drugs; concerns continuing education related thereto.

New Jersey State Sources

Summary: http://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=S3

Text: http://www.njleg.state.nj.us/2016/Bills/S0500/3_I1.HTM
Text:http://www.njleg.state.nj.us/2016/Bills/S0500/3_R1.HTM

Text: http://www.njleg.state.nj.us/2016/Bills/AL17/28_.HTM

Roll Call: http://www.njleg.state.nj.us/bills/BillView.asp

Articles

Rousmaniere, Peter, “We’re beating back Opioids-Now What?, WorkCompCentral (2015) https://www.workcompcentral.com/special-report/special-report/id/2

Paduda, Joseph, “Prescription Drug Management in Workers Compensation,” Workers Compensation Issue 2016 Issues Report, CompPharma (2016)

https://www.ncci.com/Articles/Documents/II_IR2016-Paduda.pdf

Opioid Addiction, 2016 Facts and Figures, American Society of Addiction Medicine

http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

The Opioid Epidemic” By the Numbers, US CDC, June 2016

https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf

Lembke, Anna MD, “Why Doctors Prescribe Opioids to Known Opioid Abusers,” N Engl J Med 2012; 367:1580-1581, October 15, 2012 | DOI 10.1056/NEJMp1208498

http://www.nejm.org/

Alghnam S, Castillo R, “Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey,” Injury Prevention 2017;23:87-92.

http://injuryprevention.bmj.com/content/23/2/87

Stahl, Arthur, IAIABC Policy Guide on Reducing Opioid Abuse Offers Blueprint for Effective Reform, (September 8, 2013) https://www.lexisnexis.com/legalnewsroom/idoctor-health/b/recent-cases-news-trends-developments/archive/2013/09/08/iaiabc-policy-guide-on-reducing-opioid-abuse-offers-blueprint-for-effective-reform.aspx?Redirected=true

Blogs

Domer, Thomas, “Opioid Abuse in Workers’ Compensation,” Wisconsin Workers Compensation Experts Blog, June 17, 2016

https://wisworkcompexperts.com/2013/06/17/opioid-use-in-idoctor-health/

Geaney, John, “What impact will New Jersey’s opioid prescription bill have on workers’ comp?,” NJ Workers’ Compensation Blog, March 9, 2017

http://www.nwcdn.com/state-news/what-impact-will-new-jersey-s-new-opioid-prescription-bill-have-on-workers-comp-nwcdn-new-jersey-mem?A=WebApp&CCID=25405&Page=172&Items=1

Gelman, Jon L., “Doctors, Patients and Opioid Abuse,” Workers’ Compensation Blog, October 24, 2012

http://workerscompensation.blogspot.com/search?q=doctors%2C+patients+and+opioid+abuse

Treatise

Gelman, Jon L., “Medical—Medical and surgical treatment,” 38 N.J. Prac., Workers’ Compensation Law § 12.5 (3 ed.), 2017, Thomson Reuters www.westlaw.com

Zika: The Next Compensable Infectious Disease - Benefit Challenges Begin

Workers' Compensation insures for the consequences of infectious diseases arising out of and in the course of employment. Is the system ready for a potential onslaught of Zika claims?

The line in the sand has been drawn in the State of Florida, where an infected Miami Beach police officer has been denied benefits. The union has actively supporting the municipal employee in an effort to rule the claim compensable.

The NJ Supreme Court in establishing compensability in an occupational disease cited Justice Learned Hand, “Few adults are not diseased … an infection mastered, though latent, is no longer a disease, industrially speaking, until the individual's resistance is again so far lowered that he succumbs.” Bober v. Independent Plating Corp., 28 N.J. 160, 145 A.2d 463 (1958).

Zika virus has been causally linked to Guillain-Barré syndrome according to a new US CDC study.

The US Centers for Disease Control (CDC) has issued an alert about the spread of Zika virus. The graphic above protects the possible scope of disease.

CDC announced that  in Florida Zika is now being spread by mosquitoes in the continental U.S. Travel restrictions have been issued for Miami-Dade County in Florida as Zika spreads to an increased area of Miami- Beach. First responders in Dade County FL (Miami Beach) are demanding workers' compensation benefits after 2 police officers contracted Zika. Local transmission of Zika has been reported in Texas.

A recent study published in "Cell Stem Cell," indicates that Zika can infect adult brain cells, not just fetal cells.

The FDA plans to go forward with the release of millions of genetically modified mosquitos to reduce the entire mosquito population as aerial spraying in not effective.

The National Institutes for Occupational Safety & Health (NIOSH) recommends:

"Employers should protect workers and workers should protect themselves from diseases spread by mosquitoes. Although most people do not become sick after a bite from an infected mosquito, some people have a mild, short-term illness or (rarely) severe or long-term illness. Severe cases of mosquito-borne diseases can cause death."

Employers can take preventative actions including: protecting equipment in the field; removing debris from ditches; filling in areas that collect standing water; remove tires, buckets and items that collect standing water; and placing holes in containers that could collect standing water where mosquitos may breed. Insect repellent safety is yet another issue that should be addressed.

Before the battles enter the courtrooms for litigation over a host issues, including causal relationship, it would be wise to think about how employers, insurance companies and workers can be protected from the virus. Even though Congress delayed in funding prevention and treatment programs, the White House has taken the initiative  in educating the public, and transferring $600Million of unused Ebola funds to the attack on Zika. Eventually Congress enacted the Zika Response and Preparedness Appropriations Act of 2016. In December 2016, the CDC awarded $184Million ton continue the fight against Zika,

Meanwhile, the CDC reports that Candida auris is another emerging viral infection. C. auris is an emerging cause of Candida infections in the United States. Although the cases of C. auris described in the CDC report appear related to isolates from South Asia and South America, available epidemiologic information suggests that most were acquired in the United States.

Hopefully, workers' compensation insurers will participate in the a prevention initiative now that mosquito season has started. Workers' compensation stakeholders can help prevent both an epidemic of illness as well as an epidemic of claims.

Updated: 12/30/16

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New Jersey Workers Are at High Risk for Asthma

The US Centers for Disease Control reported today that workers in various industries and occupations are at risk for work-related asthma. CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System Asthma Call-back Survey and determined that in 21 states among an estimated 74 million adults employed at some time in the 12 months preceding the interview, 7.7% had current asthma.

New Jersey Workers Are at High Risk
Education 9.5% (5.3–13.7)

Education, training, and library 8.9% (3.9–13.9)
Health care and social assistance 9.0 % ( 4.7–13.3) 

Health care practitioners and technical 8.5% (3.6–13.4)
Retail trade 7.7% (3.2–12.2) 

Management 7.5% (3.4–11.7

Occupationally caused asthma has been deemed a compensable condition in NJ for workers' compensation benefits. An electroplater exposed to chronic acid spray and mist was awarded compensation because inhalation of the chrome dust acted as an irritant upon his latent disposition to allergy and was responsible for the resultant allergic bronchial asthma. Bober v. Independent Plating Corporation, 28 N.J. 160, 145 A.2d 463 (1958).

…

Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). 

For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  has been representing injured workers and their families who have suffered occupational accidents and illnesses.

Tobacco an Occupational Hazard: The Case Against Cigarette Sales by Pharmacies

Smoking continues to be a two edged sword in workers' compensation claims. Smokers in the workplace cause serious and sometimes fatal consequences to both themselves (synergistically with other toxic substances in the workplace) and their co-workers (environmental tobacco smoke exposures). On the flip side is the employer's defense that the smoking habit is not work-related and a pre-existing or co-existing disease caused by habit and not compensable. Nevertheless, public opinion continues to trend against permissible smoking and for the sale of cigarettes. Today's post is shared from cdc.com :
Tobacco-free pharmacy policies could help reduce access to tobacco products and exposure to tobacco product advertising, as well as de-normalize tobacco use,” said Corinne Graffunder, Dr.P.H., director of CDC’s Office on Smoking and Health. “By eliminating tobacco sales, pharmacies can also help increase awareness of the health consequences of smoking and better support their customers’ management of tobacco-related diseases.”

Additional Findings:

Those who believe pharmacies should not sell tobacco include:

• 62 percent of men and 70 percent of women
• 65 percent of non-Hispanic blacks, 66 percent of non-Hispanic whites and 67 percent of Hispanics
• 67 percent of adults ages 18 to 24, 64 percent of adults ages 25 to 44, 65 percent of adults ages 45 to 64, and 72 percent of adults 65 and older
• 47 percent of current cigarette smokers, 66 percent of former cigarette smokers, and 72 percent of never cigarette smokers
• 48 percent of current non-cigarette tobacco users, 63 percent of former non-cigarette tobacco users, 71 percent of never non-cigarette tobacco users

The data came from Porter Novelli’s Summer Styles, a nationally representative web-based survey of 4,269 U.S. adults age 18 and older. They were asked, “Do you favor or oppose banning the sale of all tobacco products in retail pharmacy stores?” More than 66 percent said they were strongly or somewhat in favor.

Cigarette smoking is the leading preventable cause of death and disease in the U.S., responsible for 480,000 deaths a year. Tobacco use is an established concern among pharmacists, whose professional obligation is to promote the health of their patients. More than 16 million Americans currently live with a smoking-related illness, and cigarette smoking can complicate chronic disease management. Smokers can call 1-800-QUIT-NOW (1-800-784-8669) or visit http://www.smokefree.gov for help to quit.

….

Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  has been representing injured workers and their families who have suffered occupational accidents and illnesses.

22 million U.S. workers are exposed to hazardous occupational noise

The Centers for Disease Control and Prevention (CDC) released new data regarding injuries, deaths, and illness faced by millions every year in the workplace. This week’s Morbidity and Mortality Weekly Report (MMWR) issue is devoted to occupational health concerns, in acknowledgment of Workers Memorial Day (April 28th).


Work-related fatal injuries remain a serious concern in U.S. workplaces. According to the latest data from the Bureau of Labor Statistics, in 2014 a total of 4679 U.S. workers died from work-related injuries. Unlike injuries, most deaths from work-related illness are not captured by national surveillance systems.

This year’s Workers’ Memorial Day issue reports new estimates of worker hearing impairment from the CDC’s National Institute for Occupational Safety and Health (NIOSH) Occupational Hearing Loss Surveillance Project. About 22 million U.S. workers are exposed to hazardous occupational noise, according to the National Institute for Occupational Safety and Health. Occupational hearing loss, primarily caused by high noise exposure, is the most common U.S. work-related illness. NIOSH works to identify existing health data, such as the audiometric data analyzed in this report that can be used for occupational health surveillance.

This MMWR issue also announces the third Fall Safety Stand-Down campaign.The NIOSH Construction Program, along with partners, will be participating in the Safety Stand Down, which encourages companies across the nation to “stand down” by pausing work on their construction sites and dedicating time toward activities that promote the prevention of injuries and fatalities from falls. According to U.S. Bureau of Labor Statistics, falls are the leading cause of death on the nearly 9.4 million construction sites in the U.S.

This year’s issue will also include a Notes from the Field report from NIOSH’s Health Hazard Evaluation (HHE) program, which investigated an exposure of hospital environmental services staff members to a cleaning product that likely led to respiratory symptoms in thirty employees. The NIOSH HHE team provided the employer and employees with recommendations for preventing future harmful exposures.

For more information about the CDC-NIOSH HHE program see http://www.cdc.gov/niosh/hhe.

Workers’ Memorial Day is observed annually on April 28; it recognizes workers who died or suffered injury due to exposures to hazards at work. As we pay homage to those who have been hurt or killed at work, CDC-NIOSH continues its focus on the future of the workplace and seek solutions vital to reducing risks of injury and illness among the America’s workforce.

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Asbestos Related Deaths in NJ Continue at Record Rates

Source: EWG Fund
asbestosnation.org/

Asbestos related disease, including mesothelioma, continues in New Jersey at epidemic proportions according to an article authored by Environmental Working Group that reviews data of the CDC-WONDER database.

Read more about "mesothelioma" and workers' compensation:

Workers' Compensation: New staging of mesothelioma tumors may ... Feb 9, 2016 ... A recent study indicates that a new physician staging processes by weight and volume of mesothelioma tumors may be helpful in predicting ... idoctor-health.blogspot.com

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