The Workplace Safety and Insurance Board (WSIB) takes the opioid crisis in Canada very seriously. Well over a decade ago the WSIB was ahead of the curve in recognizing the problem and deciding to be part of the solution. At that time, we implemented a narcotic strategy focused on limiting maximum doses of opioids, increasing contact between community and WSIB physicians and promoting discussions with health care providers. Ultimately it is up to treating physicians whether to prescribe opioids. The WSIB has an impact by limiting payment for opioids in the hope physicians choose safer alternatives for pain management.
The WSIB’s narcotic strategy has had a significant impact on opioid use. In 2014, the Institute for Work and Health published an analysis titled WSIB Narcotics Strategy Reducing Harm and Spending, which documented an 85% decrease in long-acting narcotic usage within 12 weeks of injury following introduction of the strategy from 2009 to 2014. A further 25% reduction in the number of WSIB drug claims for opioids occurred from 2015 to 2018. Additional research in 2017 demonstrated the strategy also had a sustained impact suggesting individuals were less likely to initiate a long-acting opioid at any point in the year following injury.
At the WSIB, our goal is to help people recover and have safe, timely, and sustained return to work. Ensuring appropriate narcotic use plays a pivotal role in achieving this goal. Our clinical staff engage with the injured/ill person’s health care provider starting as early as four weeks, and not later than eight weeks, to investigate ongoing pain management needs and understand how opioid use supports treatment goals. If pain management or opioid use concerns are identified, the WSIB leverages partnerships with our four Mental Health Specialty Programs across Ontario, including the Centre for Addiction and Mental Health (CAMH), St. Joseph’s Healthcare Hamilton, Homewood Health and University Health Network, to provide expertise in pain management or addiction treatment.
It is not correct to suggest that opioids are useful for masking pain to promote early return to work. Opioids cause impairments in cognition and coordination and are a barrier to return to work. Injured persons, their treating physicians and employers alike should understand that reducing or eliminating opioids not only minimizes risk of dependence, but also promotes early and safe return to work.
The purpose of early and safe return to the work is to promote recovery. This is because delayed return to work results in adverse health effects and the scientific literature demonstrates remaining at, or promptly returning to, some form of productive work improves clinical outcomes. The WSIB works collaboratively with the injured person and the employer to help facilitate safe return to function and work. In the process, we do our best to educate all parties that use of opioids is not an effective or desirable means to facilitate return to work.
Achieving the best possible outcome for people injured at work is the WSIB’s mandate and we are dedicated to helping them get back to the activities that matter most to them.
Dr. Aaron Thompson
Chief Medical Officer, WSIB