The Pandemic-Era Opioid Crisis: Where Are We Now? How Can We Break the Cycle?

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Presentation, Wednesdays with Woodward (registered trademark), Webinar Series. Travelers logo. Video feed. Text, Joan Woodward.

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Hello. Good afternoon, and thank you all for joining us. I'm Joan Woodward, and I'm honored to lead the Travelers Institute, which is the public policy and educational arm of Travelers. Welcome to Wednesdays with Woodward, a webinar series where we convene leading experts for discussions about some of today's hottest topics and biggest challenges.

We tackle business, leadership, insurance, and so much more. Today's program, we're going to take a look at the opioid crisis in America. As always, we want you to be part of this conversation so please submit your questions throughout the program in the Q&A function at the bottom of your screen.

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Slide, Wednesdays with Woodward Webinar Series. Submit Live Questions, Use the Q and A Feature, LinkedIn Connect, Joan Kois Woodward, Watch Replays, travelers institute dot org, Take our survey, Link in chat, Join our email list, link in chat or institute@travelers.com, hashtag Wednesdays with Woodward.

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And I'm delighted today to unveil and announce our winter programming, including upcoming webinars, one, my in-depth conversation with CNBC's Sue Herera, reflecting on her 30 years and career there. Next, we have an encore cyber webinar, featuring six steps you can take to protect your business from cyber thieves. This is a follow-up to the very successful one we had a few weeks ago.

And, next, we have the chief economist at Goldman Sachs joining me to talk about his forecast for 2022. So we've put the registration link in the Chat feature right now so please go ahead and register for those upcoming webinars. We're listing all the ways you can keep in touch with us as well in the Zoom chat, so join our mailing list, connect with me directly on LinkedIn, or watch past replays of our webinars.

So you'll also get an email with the replay of this webinar on opioids in a few days. So take the survey, too, and let us know how we're doing. Before I get started, I'd like to share a disclaimer about today's program.

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Slide, About Travelers Institute Webinars. The Wednesdays with Woodward educational webinar series is presented by The Travelers Institute, the public policy division of Travelers. This program is offered for informational and educational purposes only. You should consult with your financial, legal, insurance or other advisors about any practices suggested by this program. Please note that this session is being recorded and may be used as Travelers deems appropriate. Information contained herein is not intended as, nor does it constitute, legal or professional advice, nor is it an endorsement of any source cited or information provided. Any examples or discussions of claim handling or processes are for illustrative purposes only. Every claim is unique and must be evaluated on its own merits. Claim professionals should exercise their professional judgement in the management of claims in accordance with all Travelers guidelines and or procedures. This presentation does not amend or otherwise affect the provisions or coverages of any insurance policy or bond issued by Travelers nor is it a representation that coverage does or does not exist for any particular claim or loss under any such policy or bond. Coverage depends on the facts and circumstances involved in the claim or loss, all applicable policy or bond provisions, and any applicable law. In no event will Travelers or any of its subsidiaries and affiliates be liable in contract or in tort to anyone who has access to this presentation for the accuracy or completeness of the information relied upon in the preparation of this presentation or for the completeness of any recommendations from cited sources. Participants should consult source material for more detail.

Recording, Downloading or any Reproduction, is strictly prohibited without the consent of Travelers.

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So I also want to thank our partners for today's program, including the American Property Casualty Insurance Association and the MetroHartford Alliance. Thanks for being with us and welcome to your members.

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Slide, The Pandemic Era Opioid Crisis. Where are we now? How can we break the cycle? Logos, American Property Casualty Insurance Association, Insuring America, a.p.c.i dot org, Travelers Institute, MetroHartford Alliance.

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OK. Let's get started. Today, we're taking a look at the Pandemic-Era Opioid Crisis. Last year, more than 81,000-- and by some estimates, even more-- Americans lost their lives due to the opioid overdoses, the highest number of overdose deaths in any 12-month period. Sadly, the isolation of the pandemic seems to have made what was an already acute crisis even worse.

This is an epidemic that has been indiscriminate in its destructive path over the past decades. It has impacted every demographic and every corner of our country. It's broken families, and it's destroyed lives. It has resulted in lost jobs, increased crime, and lost productivity.

Opioid-related risks increase with each legal opioid prescription written. This means addiction is a real risk when opioids are used long-term to treat such symptoms as chronic pain. Chronic pain is defined by the American Chronic Pain Association as ongoing or recurrent pain that lasts beyond the normal healing time, more than three to six months, and impacts individuals' well-being.

More Americans, 100 million of us, suffer from chronic pain from cancer, heart disease, diabetes combined. And according to the CDC, one in six American workers live with chronic pain. And at Travelers, we've seen the data in our own workers' compensation claims. The number of employees who suffer from chronic pain brought on by a serious workplace injury has increased significantly over this past decade, and we see this every day in our data.

When opioids are prescribed for chronic pain, they temporarily block that pain. They do not get rid of the underlying causes of pain, as we all know. Instead, opioids contribute to delayed recovery from pain, as well as increased medical costs, disability, and overall cost. This means that workers prescribed opioids have significantly higher workers' compensation claims.

Most tragically, in too many cases, an opioid legally prescribed as a painkiller leads to opioid use disorder. What can employers do to help employees better prevent and manage chronic pain so they never begin with an opioid? What can insurers do to help those businesses keep their employees safe and healthy on the job?

What can agents and brokers do to be part of the solution here because we're all in this together, right?

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Slide, Speakers. Images, Three Profile Pictures.

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So we need some innovative solutions, and I'm really thrilled today to have two experts here to discuss these questions for us. So, first, joining us from the renowned Milken Institute is Sabrina Spitaletta, Senior Director at Milken Center for Public Health.

Sabrina is charged with leading the center's efforts, focusing on mental health and addiction, specifically the role of employers and strategic collaborations over sectors and over stakeholders. She also serves as the program operations for the center's strategic priorities for mental health, health equity, and prevention. She's leading efforts to help employers of all sizes, small and large, access platforms, tools, evidence-based holistic approaches to combat addiction and mental health broadly.

Before joining the institute, Sabrina was at Children's Health Fund, a national organization focused on equity and access to quality care, which is such an important issue during the pandemic and even before. Prior to that, she spent 15 years at the pharmaceutical company Sanofi in corporate affairs, social responsibility. She's on the Dean's Strategic Advisory Council at Brown University School of Public Health and is also on the advisory board for the nonprofit, Creating Healthier Communities, focused on bringing communities and businesses together around a shared commitment for better health and well-being. Welcome, Sabrina. That's quite a resume.

And joining us from Travelers is my friend and colleague, Rich Ives. Rich is Vice President for Business Insurance Claim. Rich leads Travelers' Workers' Compensation Claim, Travelers Medical Center of Excellence, and is the Claim Business lead for Small Commercial National Accounts and Constitution State Services.

For the past five years, Rich and his team have been leading the way in the industry on innovative solutions to reduce opioid dependency by those injured in the workplace. So these programs have had remarkable success as you're going to hear about from Rich today. So now I'm going to turn the Zoom floor over to you Rich Ives.

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Slide, Breaking the Pain Cycle. Travelers Medical Advantage (registered trademark), Rich Ives, Vice President, Business Insurance Claim.

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Thank you, Joan, and thank you to all of you for attending and for the invitation to speak on this important topic. Traveler's Insurance is the largest workers' compensation insurer in the US. We work with customers who are business employers in the handling of over a quarter of a million new employee workplace injuries each and every year, and that comprised associated three and 1/2 million medical bills each year.

Now our interest is specifically in the health and wellness of our customers and employees and to promote workplace safety. The opioid epidemic, as Joan has already described, is a very sad and unfortunate situation, and we believe here that education and regulatory attention to the prescribing of opioids has helped. But we believe that many of the underlying factors that have led to the rise in opioid-related deaths still need to be managed very thoughtfully. Therefore, it is not surprising that we have seen broadly in our communities a resurgence of the opioid issue during the COVID pandemic.

Now

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Slide, Influencing Factors. Diagram.

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what you see here on this picture in front of you are some of what we believe those primary factors are, five specifically that have contributed to the opioid crisis. The first one is a pain-free expectation. The medical community advanced the notion that pain was the fifth vital sign and should be addressed and treated as an indicator of overall recovery.

Now to that end, greater attention was paid to the alleviation of pain during the treatment and the recovery process. That was accomplished in part by the introduction of questions asking patients how well their medical treatment helped manage their pain. And this motivated the treating of the symptom rather than the underlying cause. Patients, too, themselves often expect complete resolution of pain, a goal that is often unrealistic.

The second factor is more environmental issues broadly, such as the broad accepted use of a prescription opioid to alleviate the symptom of pain. Additionally, we have seen an increase in the prevalence of complicating factors, such as anxiety and depression, the lack of family support and connectedness. Third, we've seen a rise in the frequency of chronic pain, as Joan stated at the beginning of our webinar.

Now chronic pain, as she stated, is long-term pain that lasts beyond the acute phase of the injury and becomes an issue many months later. Chronic pain is caused not by-- and this is key-- the mere physical injury alone, but it's the combination of the social, the physical, and the psychological challenges that an individual may be dealing with. Examples of social would be engagement or relationships with others, either at home or at work. Examples of psychological that we're referring to would be catastrophic thinking, such as, I may never get back to where I was prior to my injury, or there may be issues of coping skills and being able to cope with challenges or an unhealthy fear.

The fourth issue is a drug dependency. As a society, we tend to medicate rather than change behavior to alleviate a desired result-- to achieve a desired result. Additionally, while we have medical guidelines for the treatment of chronic pain, we see a lack of adherence to those guidelines, often resulting in more drugs being prescribed to address the symptom rather than address the root cause of that symptom.

And then, lastly, fifth, long-term opioid use, the long-term use societally of an opioid which has no curative ability and needs to be increased in dosage over time, in order to have the same level of effect and result and can result in issues of addiction and abuse. In fact, used long-term-- this surprises many-- used long-term, the same drug used to alleviate pain can actually cause the pain symptom, and you think about how that can be a dangerous situation.

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Slide, Addressing the issue. Cogs, Early Severity Predictor (registered trademark), Injured Employee Centric Approach, Pharmacy Management.

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Now all of this creates a complicated and revolving cycle, that if not broken can end catastrophically.

Our experience in workers' compensation has been that it's very difficult to address this issue the longer the cycle continues. And the question that we asked ourselves was, how can we get ahead of this and change this course in a favorable direction?

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Slide, Early Severity Predictor. Returns to previous slide, Addressing the issue.

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So moving on, one of the things that-- let me back one slide-- one of the things that makes Travelers and specifically the team that I'm part of special is that we are passionate about delivering value to our customers and agents, and we deploy our creativity and innovation investments toward solving problems.

Our approach to address this issue is three-dimensional. Take any one of these three things away, and we don't think our approach is as successful. But we take first an injured employee centric approach in the way that we engage, in the way that we understand what that injured employee is dealing with, and we take a holistic approach to their care and their circumstance, placing them really in the center of everything that we do, creating our process and our care around them.

Second, we build a predictive model to identify injured employees who are likely to decompensate into chronic pain within the first few weeks of an injury, rather than many months later after it is diagnosed. And, additionally, we invest in a more granular pharmaceutical knowledge, data, and vendor partnerships. Now you might ask, how difficult is it to find injuries that turn into chronic pain. And it's much more difficult than you would think, and that's because those injuries don't often start out as serious.

And to make this point, we took a look at our chronic pain claims over a long period of time and then looked backward and said, where did they start out. What were the injuries initially from? And they were from strains, sprains, dislocations, and fractures 80% of the time.

80% of them were caused by lifting, pushing, pulling, slips and falls, or repetitive motion. And 60% of those were injuries to shoulders, backs, and knees. Another way of putting it, they're the everyday injuries that we see all around us.

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Slide, Early Severity Predictor. Flow chart of seven circles in two rows, three in the first, four in the second. Each contains a description.

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Now moving on, we therefore needed to use our data to determine which early known variables, early in the life of that injury cycle, had the greatest predictive value in determining the likelihood of an injured employee developing into chronic pain. We're not talking about a flagging system that indicates to us as something bad is happening. We're talking about a predictive model that tells us the likelihood that something bad is going to happen.

Now to do this, we use a combination of statistical techniques, such as logistic regression, machine learning, coupled with text mining. We use both structured and unstructured data as the claim develops and the injury recovery progresses. Our model is always running in the background, as new information develops.

The variables that we use in this model can be grouped into three primary categories. The first, injured employee characteristics, such as age, gender, prior injuries, chronic conditions, such as diabetes, obesity, heart disease, and other demographics. The second would be injury characteristics, such as how the injury happened, the current diagnosis, or keywords or phrases used to describe the injury. And then, third, the medical treatment characteristics, such as the initial treatment, the diagnostics, the types of medical services being referred, and obviously medications that are prescribed.

Our Early Severity Predictor, , produces an outcome score and a confidence value. If the value is within our target range that we've set, then an alert is integrated right into the fabric of our claim system and goes directly to the managing claim professional and dedicated nurse. Now I do want to say that we're very proud of our team of over 500 Travelers nurses here.

To know something bad is likely to happen is one thing. The power is in the expertise in the approach of our nurses to then influence a change in that course. Our nurse asks the injured employee a series of detailed questions to help them understand how the injury happened and how the injured employee is coping with the injury, to determine if the current treatment plan is helping them effectively progress in their recovery and to consider other psychological aspects as part of their holistic approach.

So, for example, the nurse will ask questions like this. Is the treatment that you are receiving helping you to function better? Or are you feeling anxious or discouraged because of your injury? Or how much pain relief have you received from the medications that you are currently taking for your injury?

Now from there, our team of medical professionals engaged with the injured employee in an intentional way. And we work directly with their primary care physician to assist the physician in their development of a personal treatment plan unique for the issue specific to that injured person. We also carefully consider other complicating factors that could hinder their recovery, such as co-morbidities or their coping skills, like I mentioned prior.

It's our approach to combining both the science and the talent expertise that makes all of the difference. With our assistance, the physician is able to develop an aggressive sports medicine-like treatment regimen. This often includes using physical therapy and other options to keep acute pain from becoming chronic. And we escalate and monitor and evaluate the drugs being prescribed for those injured employees.

Now moving on, what results have we seen?

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Slide, Outcomes. Graph, A line decreases gradually from 2015 to 2021.

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So we believe our progress has been significant. We've been able to reduce opioid use by roughly 80% since 2015. Now no doubt, part of this reduction has been achieved through the environmental efforts and the attention given to addressing the opioid epidemic. However, we believe a significant portion of this reduction can be directly tied to our Travelers approach, given that we've continued to see a reduction throughout the pandemic rather than a resurgence, which we think is a real credit to our continued work here.

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Slide, outcomes. Early severity predictor, Analytics plus injured employee centric. Early severity predictor predicts an injured employee's likelihood of developing chronic pain. Our claim and medical professionals work with the treating physician to develop a personalized level of care and helps avoid opioid addiction.

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Additionally, moving on, regarding chronic pain, the outcomes that we have seen have been terrific as well. We have improved recovery time in chronic paint-type claims by 10%. We've also experienced a 25% reduction in the need for surgery, which lessens the needs for opioids because surgery is almost always followed by an opioid prescription.

All of these things have helped reduce loss cost of chronic pain claims up to 50% for these types of injuries. More importantly, we know that we've helped avoid an unfortunate outcome for so many. We are also helping to address a real issue in our communities in which we serve. And we're helping to return productive employees to the workforce. Our work is far from done here, but our progress has been terrific.

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Slide, Working together. Insurance Providers, Public Policy Initiatives, Healthcare providers, employers. Analytics, population trends, wellness, quality of care, employee engagement, disease management, education.

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Now the last point here moving on is just simply that, if what we have said is accurate, that this issue is multifaceted and it's complicated and it's not just about the drugs, then we can know that it will take a continued partnership between all of us to overcome it. We each have a role to play, which is why we love working with partners like Sabrina and the Milken Institute, who are passionate about addressing issues like this. And now I'll turn it over to Sabrina.

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Text, Sabrina Spitaletta. Slide, Milken Institute, Center for Public Health.

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Thank you, Rich. That was very interesting. You continue to advance your work. I know that I've seen it over the course of a number of years, so thank you for sharing that.

And thank you for Joan and the entire team for having me here today. Before we get started, I just wanted to recognize the grave situation, as Joan outlined in her opening comments, in terms of the statistics, and those statistics are people we all know. Just by the number of years, this has been going on in terms of friends, family members, colleagues, and just recognizing that it continues to impact all of us in various ways and hoping and planning that the continued work and collaboration from all of us will help fill that gap, will help accelerate change, and improve the health outcomes and larger effort that could help protect our communities where we live and operate, so thank you for that.

There are so many roles. As Rich said, there's so many roles that we can all play. And the role that we're looking at or that lens is the role of employers in that broader public health community.

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Slide, Broader Community and Public Health. Pie chart divided into six equal parts.

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So you'll see here how there's different aspects that we all play.

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Circles Employers and Business portion of pie chart.

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And if we're zooming in first on that employer, businesses for profit, non-profit, government, starting there people get a point of fulfillment from work hopefully.

There's structure. There's organization. There's connectivity. There's resources. 50% of the US have benefits through their employer.

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Slide, Employer Impact, Mental Health, S.U.D. and Prevention. A circle labeled Trust with three phrases that touch its borders, Comprehensive Healthcare, Organizational Culture, Internal Wellness and Community. Numerous key terms appear under each phrase.

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And so with that, yes, coverage but it's that connectivity, too, that those community roles or that employer role reaches all those other aspects of the community. And so when you look at the employers that we are working with and continue to, yes, it's comprehensive benefits. It's internal wellness and community and organizational culture.

And then you'll see the build of all these different themes that come up through that work and the connectivity, whether it's employee assistance programs, tech resources, and internal policies, when we talk about workplace or employment policies. So you get the picture that they're all working on a number of things. But the piece here is it's that comprehensive view.

It's the physical health. It's the mental health, and it's also the financial health. And the point here is showing that employers are recognizing that pain is larger, that the impact on our own mental health is larger.

It's just not one aspect, and it's all interconnected. And so when we take that whole person approach and understand what is needed, there's better health outcomes, right? There's more connectivity within that workplace community as well.

So what's happening within the work that we're doing and what we're seeing with employers, whether they're small employers, medium size, larger, and as I mentioned across sector, some are working comprehensively across all these areas. Some are focusing, say, starting with stigma, right, and understanding what does that mean. And how does it connect back to access to resources, accessing these resources? Or say they have a caregiver, right, so it's not just someone receiving it themselves. So it's understanding the roles people play in terms of receiving these benefits, too.

Other starting points are proper disposal, right? So you have the connection of the medical piece. But then it's also, OK, we have these prescriptions that we didn't use all of them. What do we do with them now? So organizations are focused on educating in terms of properly disposing of those medications.

I also want to talk about health literacy or flag these pieces. I won't go one by one, but it's important to talk about health literacy because understanding the science of addiction that it's a disease of the brain. It's understanding what prevention means or what does proper disposal. So there's a general approach to health literacy, also with stigma, stigmatizing language that organizations are actually bringing into, whether their employee orientation or their management training, their leadership training, their everyday communication, leadership messages, and personal stories. You'll see it come through, or we're seeing it come through all these different ways, and that's creating this more comprehensive approach and response.

There's also putting a little bit more control for that individual. There's resources, like patient checklists before surgery and then after surgery, what to look for, what to do, that's helping people feel more prepared going into something versus just the unknown. And while we can't give answers to everything that's happening, it helps create a trusted source for where they're getting their evidence-based resources and understanding what's happening in their environment.

At the center of this all, as you can see, is trust. With all these resources, if trust isn't continually built in the organizations and our communities, we won't necessarily have folks access it. So how do we build trust?

Well, it's the consistency. It's the transparency. It's all of those pieces when we talk about organizational culture.

So depending on your organization, these could be bucketed in different ways. Some are more obvious than others, but they're all interconnected. And the idea is organizations that know their employees by talking to them, serving them, connecting with them, meeting them where they are, build stronger prevention framework and scaffolding to be able to help them one-to-one or in a group be able to respond to what they're experiencing.

Just reflecting back on some of what Rich said in terms of when an individual is going through, say, they had a surgery. That doesn't mean all these other things in their lives aren't happening as well. So when Rich mentioned this holistic approach, it really resonates with me because you're seeing the whole person. And that's what we're talking about here, in terms of there's other things happening, too.

So the responses that employers are providing are comprehensive in that way but also provide resources to navigate it one-to-one and realizing it could be overwhelming receiving all this at once. And so it's how you get what you need when you need it through that journey. So this is when we're talking about mental health, substance use disorder, when you have something properly prescribed to you, right? How we innovatively respond to the opioid crisis, and, larger, we also have a pandemic in terms of hitting the entire world.

There's different themes that I've touched upon in the past, and we see that their employers' trust being at the center. Collaboration, that collaboration happens within organizations. It could happen with community partners for those organizations with philanthropic strategies. What does that look like to be able to close gaps to accelerate action?

Data, looking at the data, looking at the facts, there's a story behind it. It's unveiling it a little bit. It's digging into it to understand what story is being told and what are the needs and anticipating those needs.

And looking back on past-- I should say-- sessions that we've done, one thing that I'd want to emphasize even more is not just responding to the now. What we're seeing employers also doing is anticipating what's needed in the future. We have five generations in the workforce right now, five generations with different needs, different life experiences, different journeys. And understanding what's happening with one's own organization helps us better meet people where they are when it comes to whether it's the medical benefits; whether it's comprehensive mind and body; when it comes to the wellness programs, how they complement that; when it comes to the culture and how that's reinforced; and builds that trust around there.

So with that, there's also other things happening in our community when it comes to opioids.

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Slide, Document. Title, Public Safety Alert.

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It's the end of September. There was a public safety alert that was sent out by the Drug Enforcement Administration.

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Highlights date, September 27 2021.

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I want to mention that there hadn't been an alert in six years.

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Highlights two paragraphs.

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This alert was to all of us in our communities, showing the use of synthetic opioids from an illicit perspective, that there was, "If these drugs are not prescribed to you directly, you don't take them." There was people are dying of fentanyl, right? We'll send this around in terms of this link and understanding the broader awareness.

And employers, there's a unique position that they have in terms of educating and, going back to the health literacy, making their employees more aware of what's happening in that broader community when we see things like this, the safety, the accessibility of certain things that could harm, right? It may not be-- it may not be something that's directly maybe happening. It could be happening to their families. We just don't know, but the idea is to be more informed.

And there's ways-- the DEA, Drug Enforcement Administration, actually has a community outreach effort. It was called DEA 360. Now it's called Operation Engage because it's continually responding and working across partners within the government SAMHSA, CDC, and intersecting public health and public safety to better reach our communities.

And there's a workplace component, where they're reaching out to be able to share their information from that law enforcement perspective, so employers are able to bring and educate their employees better in terms of what's happening in that community. How do we continue to have unlikely collaborations, right, in these intersections that better inform us all? And so this was an example-- a timely one as well-- in terms of how it connects back to the workplace.

And so when we talk about innovation, it's not just technologies and how we work together. It's how we not just transfer knowledge, but it's how we see where there's gaps and be able to reach out to each other and bring them together across sector. And so from the position of an opportunity of working at the Milken Institute, we continue to try to weave that together, find those opportunities, and we see employers doing more of that and looking holistically and helping each other.

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Logo, Milken Institute, Center for Public Health.

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And so if we create that space for each other, we see these evidence-based approaches, whether it's from primary prevention, secondary and tertiary around the whole life cycle, if you will, we can continue-- we continue to persevere, right? We don't want to stop. We'll be able to start closing those gaps. Get ahead of it.

But the last piece I want to mention is we're responding or emphasize we're responding to the now, but we also need to plan for the future and anticipate the needs of the workforce, the needs of our communities to create these protective layers and prevention and understand what people need. And through forums like this, through the collaborations across sectors and understanding what's new, what's different, we can continue to do that together. So thank you again for this opportunity and the unique lens through the employers in reaching more people.

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The three speakers all on one screen.

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Rich, Sabrina, that was just terrific. And I know we're just getting started here. We have a lot to get into and dig into. And so, first of all, though, to our audience members, we're going to turn the tables on you and ask you a few questions about this topic.

And these questions are all anonymous. We don't save any data. This is just to get a feel for the audience and what you're seeing in your lives. So the first question, this poll is going to pop up right on your screen.

And

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Joan puts on her glasses.

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you're going to see this question and just answer as you wish. So which of these common prescription drugs contain an opiate, Vicodin, Percocet, Opana, Tylenol with Codeine's out there, Fentanyl, of course? Which of these contain an opiate in your view? And I'll give it a minute to come in, and we'll tell you what the answers are here.

OK. So we have a kind of a mixed bag, 20% Vicodin, 20% Percocet. Opana is a version of oxycodone, I believe. Tylenol with Codeine and Fentanyl, people say 20%. Those of you who answered "all of the above" are correct.

All of these are opiates. So there's lots of warnings out there. We all don't know-- if you're not around this every day, you don't realize that every one of these is an opioid.

OK. Second polling question and the last one for you. So all of these prescription drugs that we just mentioned, any one of them, how many of you have this in your home right now? How many have any of these drugs in your medicine cabinet, in your pantry, in your bedrooms?

You may have been prescribed this for a knee injury or a back injury or a surgery, and you're keeping them around the house. So let's see on this question. How many of you have this in your home right now?

OK. So it looks like the answers coming in, about 29% of us have this in our homes right now. We're either using them for chronic pain or we're saving them maybe after a knee surgery, thinking we might need it later for some reason. So I'm going to ask my panelists to comment on this, especially kind of the last one there. Sabrina, what do you make of these answers here?

It brings it back to the health literacy, right? Not all of us know what certain things are, and you're feeling better. You leave it in the cabinet. It's not intentional all the time, right?

And so the "I don't know" could even be higher. I think any segment of that, especially if you've gone through a surgery or someone in your family, it's getting and creating new habits of, even if it's just that one time, the proper disposal. I think that's a key piece of prevention, right, and thinking of that.

And so I can't help but go to that's really informative, right? Any piece of the population, especially in this poll, giving us insight in terms of, it matters to keep saying, this is what can be what's in your cabinet and what can be disposed of. These are the steps you can take and why.

And, Sabrina, what is the best way to dispose of these? So say we have it in our cabinet. We just had knee surgery, and we forgot.

We saved it. Maybe we thought-- I don't know where. Do I just throw it in my garbage can? What do we do?

So there's definitely direction online through our federal government. But there's proper disposal. You can take them-- you can actually go online and look where you can actually deposit them at your local pharmacy because some pharmacies do it, police departments.

And two times a year, the DEA actually has a take-back day for free. You just bring it, no questions asked, and they properly dispose of it. So that is also easier for people versus looking something up and figuring out how to mix it or do I do this. Do I do that?

And also some companies are actually giving proper disposal packets that they're able to deconstruct the chemical components and not worry about harming the environment as well where it does all of that. And then they can dispose of it at home. So there's a number of options there.

OK, thank you for that.

And affordable.

Let's move on in our discussion here, and I really want to talk about how-- and, Sabrina, this is to you and then to Rich-- how has the pandemic exacerbated addiction to opioids and the mental health crisis? And has it? Has the pandemic really exacerbated from the data you've seen?

From the data we've seen and from the experts we get to work with, yes, right? People have been isolated from each other. Whether someone is suffering from substance use disorder, is a caregiver, or any spectrum or mental health condition or maybe you didn't even realize and then you are, everybody has been impacted in some way.

So overdoses have gone up. Deaths by suicide have gone up. There's been very troubling, alarming numbers. Overdoses have gone up. We've talked about that.

So, yes, it has impacted people. The pandemic, when we talk about isolating, there's also been changes that were made during the pandemic for access to care. Those experts, though, quickly responded, and we actually-- so this is the light, the positive part.

There's a number of innovators that we can highlight to show that actually have been able to pivot, to be able to help with access to care or reaching more people, and taking down-- leveraging technology to be able to bring people together but also receive their treatment or the social support that they need. So a number of things, disease of despair, right, anxiety, depression, they've all gone up. And the idea is not to create more alarm through this discussion but raise that awareness that it's all connected. And that the more that we learn about how it's connected, we could actually get in front of this, right, together, the right evidence-based resources, earlier interventions, and recognizing effect.

OK. Thank you for that. Rich, I want to bring you back in here. So have we at Travelers seen a change in our workers' comp claims during the pandemic?

And I know your terrific chart there, just the number of just coming down dramatically since in 2015 when you implemented your Early Severity Predictor. That number was just so wonderful to see. But tell us what you're seeing now and workers' comp claims.

Yeah, and so I'll step back and go a little bit more broadly away from opioids and chronic pain that we've been pretty deep in. The COVID illness itself is something that we have been-- both we and our customers, employers-- have been working on and sorting out which of those illnesses, where somebody has contracted COVID, came out of the course and scope of work. And we obviously insure some customers in health care or public sectors in some of those areas where they were definitely in a position of greater risk was real, so that's something that we've seen.

We've also seen, while minor, an increase in work from home injuries, given that the big increase in workers working more remotely. We've broadly seen a decrease in workers' compensation injuries for our customers overall due to the lack of business travel and limited hiring practices over the last-- for at least in the initial first year of the pandemic. We do anticipate that one will change with the increase in open jobs and hiring activity going on currently.

OK, OK. So staying on the theme of the pandemic and the remote workforce, Sabrina, how can employers recognize problems if their workers are working from home? I mean, is that-- are you running into this? Is this a real issue that employers are grappling with?

I think many employers, yes, and employers are evolving and adapting to that. Now if people have the opportunity to have a role and be able to work from home, there's ways-- so I want to be able to respond to those that aren't able to work from home-- but they're able to still have attendance in terms of people showing up to meetings or how they're showing up to meetings. The workplace is a critical place to understand someone's wellness in terms of how they engage.

But it's also old school. Reach out to them. Ask them how they're doing. You could still connect via phone. It doesn't always have to be video.

Because if you haven't met, if someone was hired during that so you don't know certain things, you have to take a different step. So that's the evolution of our training as managers of people and leaders of people. And we see organizations making those changes, right?

So we have to continue to grow and understand what's happening, and they're doing that. At first, we went from in-person to virtual for those that have that opportunity. But yet then we went to that next level of, well, how do we engage. How do we know something's happening?

So absent-- you still look at absenteeism. You still look how they're connecting. And is it something wrong or maybe people haven't gotten used to that adjustment yet? So understanding-- and, Rich, you mentioned this earlier on-- root causes.

Root causes could also be, help me have the skills to be able to do x, y and z, to express myself the way I did in person, right? And so this way there's not this fear of getting negatively impacted if you're not doing it the same way. It's that adjustment and still what's that final outcome. Help people do their jobs well.

But to your direct question as well, Joan, it's, yes, there's ways by leveraging technology but also reaching out and connecting. It takes more effort. But you're able to really then help your employees and create that social network as well and protective layer.

Terrific, terrific, thank you, Sabrina. So, Rich, back to you. How does this opioid epidemic really impact businesses? So you see-- again, you see this workers' comp claim data coming in. How are the employers really impacted by people who are addicted to this?

Sure. And so I would say loss of productivity, loss of knowledge, the increase in the cost of a workplace injury, and the increase in health care costs more broadly. I mean, this is an issue that's pretty significant in the impact if you think about the broader impact. So from loss of productivity, absenteeism, longer disability duration, ineffective recovery techniques and treatment, and then loss of knowledge. It's not just about the person's loss of productivity. But when somebody is not back in the workplace, their expertise, their knowledge, their mentoring, their coaching, their training, I mean, those are big impacts to our customers of this issue.

And why do you think, Rich, that we've seen such an increase in chronic pain among workers? What's the phenomenon? What are you seeing in your data?

Yeah. And if I could, I'll give you a little bit of some thoughts on this one, too. Some might be a little bit more personal, but I'm close and passionate about the issue. So I'd love to take your question and turn it just a little bit and turn it around and say, how can we achieve a reduction in chronic pain.

And I think-- I believe success for us more broadly is going to be found in the increase in the level of holistic wellness. I think we've seen a decrease in holistic wellness. I think when you hear Sabrina talk, she talks very eloquently on this topic. We've got to be holistic in our approach.

And I believe wellness is really four-dimensional. Sabrina gave you some dimensions. I'll give you four, four-dimensional being, it's physical so nutrition, exercise, change in behavior, so it's physical.

It's emotional, investing in personal connection. Relationships are investment in others, so it's emotional. I think it's mental, being a continuous learner, naturally curious, a balance around entertainment versus other things that we can do to invest in others and in our communities. And I do think lastly but certainly not least, it's spiritual, investment in spiritual well-being. Those four dimensions, I think, that are more holistic, I think if we could invest more as a community and a society around that, we'll gain a number of benefits and not just the decrease in chronic pain.

I love that actually, Rich.

Can I jump in from that one, too, just to continue that line of thinking because, Rich, I love the cycle, though, as well because then you have from the employer perspective, you have those looking out for the whatever leadership is doing that, right? They're looking out. They're trying to implement. Who is also looking out for them?

How do we create this whole cycle of everyone has someone that's looking out for them in that holistic way, right? When we talk about the doctors and nurses and all the technicians from a health care perspective, taking care of that caregiver, also at home, who is the main caregiver? And we are in the pandemic, the life cycle of that.

People had over 20 months to change and pivot, right, in terms of how to then optimize at work or work through pain. And now because nothing is static, it'll change again. So people have to go through that.

Well, they have lives at home, as Rich is saying. Maybe they're caring for parents and children at different stages, children that may have some extra needs or not. And so it's understanding the whole person and all of these levers.

It takes time. But our workplace is transforming, and this helps us move to a better place in terms of what work means and the fulfillment and the connectivity. And hopefully also for those that don't have the opportunity to work from home, right, what more can we do there as well because that pain as well, showing up, having to-- if they have physical pain, emotional pain, still having to show up to be able to hold that job.

Excellent, that's really excellent. I like-- I love the holistic approach in your comments. So, Sabrina, you touched on the stigma. I want to get back to this for a second. How much of a factor is the stigma connected with substance use disorders, or SUDs, when it comes to identifying and helping those employees in the workplace?

Some of our experts say it's the number-one access issue to resources, at seeking help or accessing it or understanding it further because there's so much-- when we say stigma, it's important to deconstruct that as well and look across your organization of what can it look like. Shatterproof came up with an index, right? So there's resources that we'll be able to post as well, to be able to show what does stigma look like.

It's the words that we use. And there's language in there right now we could all start using and continue, even as individuals, but it's also at the organizational level. But getting better at that and recognizing it will help in terms of the access to these resources, talking about it more, following up and the whole recovery journey for all that are impacted.

All right. So let's get right to that, solutions, resources, for our audience today. Tell us-- Sabrina, tell us a success story, right, of interesting prevention, progress that some employees are doing out there and the work that you're working on.

Yeah, so one employer, so you may have seen in the news. Leidos had in 2017 started the CEO Pledge against the opioid crisis and brought hundreds of organizations along with them. And now they've started an action group of cross-sector working together, whether some have comprehensive approaches like they do-- and there's detail, whether health safety, physical, or emotional safety, the intersection. They're looking at everything to be able to then cross-pollinate and share with each other, to be able to then have recommendations to share more broadly, to start making those changes.

That's a success story because they're not just doing it for themselves. They're working with many others to move it forward. And how do we continue to create those collaborations for profit, non-profit, government? Learn from each other's ways, understand what works in our organization as well, right, different cultures, but still find that way in that holistic way, build it one piece at a time, and have a long-term plan. So I've seen that.

Then you have organizations like Work at Health that are focusing on partnering with, using their technology, and building workplace wellness from a substance use disorder, evidence-based component, right? They're really changing the way it's approached to create a whole different culture around it. And then there's platforms out there that we've seen that are helping to remove social isolation, the reduction of that. Wisdo is working that. I think they have a million people that are accessing that.

So there's things out there. There's organizations out there that are doing a lot all in one, and then there's pieces of it that are coming together. And it's the sharing of the information, so I want to be able to emphasize that. It's those organizations that not just do for themselves but are sharing with others to connect across industries and sectors to help our broader communities. That's what's really powerful, seeing that, hearing that, and also all of us learning from that.

That's great. Rich, the same question to you, tell us a success story about the Travelers program. And actually what do agents and brokers need to know about the Travelers program in this space?

Sure, and I'll come back--

We're going to put up a slide, too, with some resources that we've collected from both the organizations while you're speaking, Rich.

Perfect,

(DESCRIPTION)
Slide, Further Resources for Employers. National Safety Council, nsc.org/pages/prescription dash drug dash employer dash kit. Operation Prevention in the workplace, operationprevention.com/workplace. Center for Disease Control CDC, blogs.cdc.gov/niosh dash science dash blog/2015/12/21/opioid dash overdose, cdc.gov/niosh/topics/opioids/resources.html, DEA Operation Engage, dea.gov/operation dash engage.

(SPEECH)
and I'll come back to your second one last. We love sharing the success stories because, you know, they're just-- where we've made a difference makes us proud. But as I mentioned earlier, one of the key components to our program is developing personal connection and understanding with the injured employee.

And so in this example, we had a claim that involved a gentleman who had a back injury. They slipped and fell at work, and the injury was serious enough to require a complicated low back surgery for them. After the surgery, the injured employee began taking opioid medications for pain.

As the medication use continued, we recognize through our program that the injured employee may be experiencing a delayed recovery. And we developed a plan, along with them and their family, to really help prevent an outcome of delayed recovery. Our nurse contacted the injured employee. And during the course of their conversation, asked, do you think your treatment is helping you?

And the injured employee said this, that they did not think that the current treatment program for them was helping them at all. Now that intentional engagement resulted in us working with the injured employee to transfer his care to a different physician, to develop a more holistic treatment plan and focus less on medication usage. The injured employee started a course of non-medication therapy, which resulted in significant pain relief for them.

The injured worker reported an almost 80% reduction in their pain. And eventually they were able to reduce their medication by almost 50%. Now we don't know what the outcome in that most current example would have been if the injured worker had not changed positions and taken a different course. However, we're really pleased that we were able to work with the injured employee, find him a physician to help with his pain management, and really reduce the opioid issue, potentially avoiding a potential chronic pain as well claim for them. Now I'll come back to your other question.

Agents and brokers.

What's important for agents and brokers to know, and we talked about this a lot. Our approach is holistic. You definitely need a partner who is going to take a holistic approach.

And for us, even though we're doing a number of different things around transformation inside our organization, our workers' compensation vision is really that perfect blend of personal connection, expertise, and technology, the blending of all three of those as we go forward. We think if you drop any one of the three, we're probably not successful long-term. But we're proud of the additional advancements we're making.

Great, great. All right. We're going to open up to audience questions now. We've got a bunch coming in through the Q&A feature so drop one in if you're interested in asking a question. So first one comes from Rebecca Carts of Marsh.

How do we work with law enforcement for prevention strategies and methods? I know, Sabrina, you mentioned the DEA and that safety alert, which is really alarming about the synthetic fentanyl being put out in the marketplace where people are getting these fake drugs. Sadly, lots of overdoses we saw during that period of time. But what are the strategies for working with law enforcement?

A number of them-- thank you for the question as well-- I mentioned the DEA Operation Engage, which is an active community outreach. Now they are in 11 different locations across the US. So whether it's virtually or if you're looking for in your community, look for proper disposal to start, if they do something locally, whether it's DEA or local law enforcement in terms of take-back days.

Understand public safety, many have meetings, right, where they're inviting people in. Also go through public safety-- your public health meetings that are happening. Whether you live in a smaller town or a larger town, it's happening there behind the scenes. But also I want to mention the Operation Engage.

There's a workplace module, where this is law enforcement resources working with public health. Through Discovery Education, they've made them free, open access to be able to bring it to your workplace. So it's that bringing in that public safety and that knowledge from law enforcement, so there's greater awareness, right, so you know where to access the right information.

And they also have tools on their website, too, that are helpful. I hope that answers the question. So locally how to be able to reach out, I would start with proper disposal, take-back days, and different community meetings that happen at that local level, even larger cities.

At the rural level, you may want to look at a geographic component, too, if you're coming more from a rural, and it's harder transportation wise, and you'll want to see something online for your own access, if that's possible, too. And then, as I mentioned, on the DEA website, too, you'll be able to see where actively they have community outreach programs working with public health and the broader employer community and youth programs.

OK, great. Question coming in from Carolyn McGratten. She says, she had ankle surgery a couple of weeks ago. She took opioids for three days, but she was written a prescription for 30 pills.

And so is there an education program for doctors prescribing these, maybe just give someone five pills. And then they'll have to come back for a refill or have to-- is there, you know-- what is the medical community engagement here? Rich, I don't know if you have a thought on that or?

Let me just start, Sabrina, and then--

OK.

Yeah, sure. G ahead.

And this one's different state by state, several states have passed laws on exactly this issue. How much drugs can you actually prescribe within those initial first seven days, which I think has really helped? Now the other thing we see inside certain states is the ability to monitor adherence to some of those rules, being able to get data on prescribing trends by doctors and such to help really crack down on the issue. So I will say we're a long way from consistency across what we see in the United States. But there are efforts underway to address specifically this issue.

OK, very good.

Yeah, while that's happening and, as Rich mentioned, state by state, there's also something hopefully most of us can do. If we're on the receiving end of those prescribed opioids, properly dispose of them.

OK.

As these policies continue to evolve, there's still something we're able to do, but thank you for recognizing it, right?

Right. Question coming in, says her daughter has been suffering with chronic pain since she was 15. Now she's 21 years old, and doctors arranged for her to get a medical marijuana, I believe, the CBD or THC. Would you ever consider making life a little bit better and the chronic pain has been eased a bit? Is there any-- and maybe this is for you, Sabrina-- a way to think about instead of opioid use, more medical marijuana use.

Well, I can speak about alternatives, right? So I'd look at, one, you want to look to what's evidence-based? What's evidence-based, meaning from NIH, right, through that. A recent JAMA article, so this is not directly answering it, focus on PT, physical therapy, right, and physical therapy before and after surgery. I know this is a little different, but there's alternatives in terms of that are evidence-based, showing an alternative to opioids in that sense.

Now I would encourage the individual to talk to their doctor, talk holistically, the experts at their own work or where they receive their benefits, to figure out the best course of action for them and what works in their state and broadly speaking. But there are evidence-based alternatives that one can look to to be able to get the best solution. So indirect answer, but I would reference that JAMA article, looking at the PT piece. And then, Rich, I don't know if you have any other pieces.

Well, Rich, in our workers' comp insurance, right, we cover PT, right?

We absolutely cover physical therapy. As a matter of fact-- and this is actually a less known fact-- it's actually cheaper in the beginning to just pay for opioid prescriptions than it is to actually pursue a sports regimen medical treatment, which would include aggressive physical therapy. But the long-term impact is so much better and less cost in the long run. But we absolutely will pay for that.

And I was very curious to hear Sabrina's response on the medical marijuana because we get asked this question often. And she and I haven't talked about this one. But I completely agree with what she is saying.

And I will throw this out for folks to think about because this is often touted. Is medical marijuana a safe alternative to opioids? Now if you think about everything that we've talked about over this past hour, many of the same issues that we discussed with opioids really still remain with marijuana.

Primarily, that it is another drug treating a symptom rather than addressing the cause of pain. So I wholeheartedly agree with Sabrina around making sure that we're getting a doctor or treating physician who is really trying to look at and help address the root cause. Additionally, there is a lack of medical science to support the medical benefits of medical marijuana currently, and we do not have medical guidelines right now to ensure the effective and safe use of marijuana, such as quantity and duration.

And so we think that these are very important questions that need to be addressed proactively before we end up in another terrible situation.

Right, right, I couldn't agree more. We are out of time, but I want to thank you so much. This has just been fascinating. I think we're just scratching the surface.

So we'll invite you back next year and have an update. And hopefully those numbers go down in terms of fatalities we've seen in the country as we emerge from the pandemic. So, Rich, Sabrina, thank you so much for your thoughts today, and I want to get back to our audience and give you just a heads-up on our winter programming.

(DESCRIPTION)
Slide, Upcoming Webinars. Register travelersinstitute.org

(SPEECH)
Please also fill out the survey. So in the Chat box, we have a survey on today's program. Give us your feedback. Let us know what other topics you want to hear from, what other speakers.

You know, I'm doing these almost every Wednesday, and we're going to continue throughout the winter and spring. So let us know what topics you want us to focus on in these webinars. In the meantime, join us on November 17, again, Running with the Bulls: a Conversation with CNBC's Sue Herera on her 30 years there anchoring the news desk. December 1st, a Cybersecurity Playbook and six steps your customers and you could do to protect yourself. On December 8th, the chief economist at Goldman Sachs talking about the outlook for 2022.

Also connect with me on LinkedIn. I put a lot of our replays there. You will get an email with a replay of this session today. So one last time, I want to thank our speakers, Rich, Sabrina, really appreciate you coming on today.

Thank you.

Thanks. Great to be here.

All right, terrific. Stay safe, my friends. Get your vaccines, and we'll see you in a couple of weeks.