New Connecticut partnership aims to 'make a difference' in opioid crisis

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"Addiction and mental health have only gotten worse over the last two years with the COVID situation," The Hartford CEO and Chairman Christopher Swift said in an interview. "We're launching this pilot to see if we can make a difference."

The Hartford has donated $150,000 to support the pilot being run by the Yale Program in Addiction Medicine. The first phase includes the development of training modules and a compendium of "clinically relevant" resources. In a second phase set to run from January to June, the training will be delivered to a preliminary group of 50 to 100 Connecticut medical professionals, who treat workers with acute pain, chronic pain and/or a substance-use disorder. In the final phase expected to run in the third quarter of 2022, the modules will be updated based on medical providers' feedback.

Dr. David Fiellin, director of the Program in Addiction Medicine, and Dr. Jeanette Tetrault, the program's associate director for education and training, are leading the pilot.

"When we realized that The Hartford was interested in this area, we were very enthusiastic about thinking about ways that we could use the work we've developed over the last 20 to 30 years and apply it in a novel place, the workplace," Fiellin said in an interview. "It's common that both acute and chronic pain are seen the workplace, and we need to be able to, when possible, improve functional status and address pain with both medication and behavioral treatments, avoid trajectories that lead to patients developing an addiction and address the stigma that's associated with these conditions."

Recent data highlight the prevalence of stigma toward those struggling with addiction. Some 65 percent of health care workers reported that substance-use disorder was not a chronic medical illness, according to a new study published by the Norwalk-based nonprofit Shatterproof, with support from The Hartford.

Fiellin described that finding from the study as "shocking, but not surprising."

"We know that nationally only 30 percent of patients who are prescribed opioids receive what's called guideline-concordant care - care that is based on consensus and evidence to maximize benefit and avoid risk," Fiellin said. "I don't believe that injured workers are any different in the extent to which there are opportunities, from a system standpoint, to improve processes of care and avoid addiction when possible."

While the pilot is focused on Connecticut, officials at The Hartford, Yale and Shatterproof said the insights gleaned from the program could eventually be applied nationwide.

Further advances in pain management and addiction treatment are needed as the opioid epidemic continues to devastate the country. Estimated overdose deaths from opioids increased from 50,963 in 2019 to 69,710 in 2020, according to the Centers for Disease Control and Prevention.

"There is a clear need in the field for this kind of training," Matthew Stefanko, vice president of Shatterproof's National Stigma Index, said in an interview. "Presuming the results are as good as what I think they'll be, this could be the national model for improving addiction care and providing compassionate training that addresses stigma and provides better outcomes for people with substance-use disorder."

The Hartford was a founding partner of the National Stigma Index, which was founded in 2019.

A number of elected officials also lauded the partnership.

"The Hartford and Yale School of Medicine have created a forward-thinking collaboration which will improve the lives of many, and address a crisis that has consumed the state of Connecticut," U.S. Rep. Jahana Hayes, D-Connecticut, who spoke in June at a virtual conference sponsored by The Hartford that focused on mental health and addiction, said in a statement. "I am thrilled to see community leaders working together to help address substance disorders, from the lenses of prevention training in higher education institutions to response approaches in the field. This partnership will benefit the community, students, faculty, and healthcare providers for years to come."

Sen. Richard Blumenthal, D-Connecticut, said in a statement that The Hartford and the Yale School of Medicine were "leading the way in providing internationally-recognized innovative training to help curb the opioid epidemic, which has a corrosive grip on communities here in Connecticut and across the country,"

The Hartford's longstanding interest in tackling the opioid crisis reflects its status as one of the largest providers of workers' compensation. In 2020, the No. 142 firm on this year's Fortune 500 list recorded about $3 billion in workers' compensation premiums, according to data from S&P Global Market Intelligence. Its market share of nearly 6 percent ranked No. 2, after Travelers, among insurers issuing workers' compensation in the U.S.

The Hartford pays for treatment of substance-use disorder if the condition is tied to the injury in a workers' compensation claim, according to company officials. For example, if a construction worker were to sustain a back injury at a job site, and medication prescribed to treat pain resulting from the injury later resulted in overuse, the company would consider treatment.

"We're… a very interested bystander to sort of say,' What is really happening here?' because obviously we're paying the bills," Swift said.

While addiction stigma persists, numerous initiatives across the country in recent years have increased health care providers' understanding of prescription opioids' risk of addiction. Reflecting those efforts, opioid prescribing rates have fallen significantly in the past few years.

"This is a very complicated scenario that is oftentimes between the clinician and patient. We support shared decision-making on these issues," Fiellin said. "Our goal is to allow for effective treatment - irrespective of whether it's opioid or behavioral (treatment), or a combination - and improved patient function."

The torrent of litigation unleashed by the opioid crisis has also raised public awareness of the dangers of overprescribing and misusing pain drugs. Stamford-based Purdue Pharma, the maker of OxyContin, filed for bankruptcy in September 2019 after local and state governments filed several thousand lawsuits alleging the company fueled the epidemic with deceptive marketing of OxyContin, its top-selling product.

Despite denying those allegations, Purdue sought in the following two years to secure a bankruptcy judge's approval of its settlement plan. It gained that endorsement in September, but Connecticut is one of a handful of states appealing the approval.

"We cannot allow our bankruptcy laws to be abused and misused as a loophole for the rich and powerful to avoid justice and accountability," Connecticut Attorney General William Tong said last month. "When I speak to the parents who have lost their children, the people who will spend the rest of their lifetimes in recovery fighting addiction, they do not tell me to settle. They tell me to continue fighting for justice, and that's what I have promised to do."

[email protected]; twitter: @paulschott

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