Nationwide efforts to address the opioid epidemic have resulted in a reduction in the number of opioids prescribed to patients and the length of time a physician can prescribe such medication to a patient without extenuating circumstances.
But a June 6 report by the U.S. Postal Service’s Office of Inspector General found that the number of postal workers who receive opioid prescriptions under the Federal Employees’ Compensation Act program has not seen a similar reduction.
“Specifically, although the cost of opioid prescriptions for the Postal Service employee FECA population declined from 2016 to 2018, the rate of decline was substantially less than that for other federal agencies,” the report said.
“We also found that between 2014 and 2017, the average number of prescriptions per Postal Service employee under FECA increased from about 6.2 to about 6.8. The [Centers for Disease Control] reported the number of opioid prescriptions per patient nationwide decreased from about 3.7 per patient in 2014 to about 3.4 in 2017. An increasing number of prescriptions per employee could indicate an increased risk of opioid misuse.”
According to 2018 Department of Labor statistics, the U.S. Postal Service employs one of the largest groups of federal employees at 610,528 workers. That is second only to the Department of Defense, which employs over 700,000.
Such employees occupy arguably some of the most dangerous jobs in the federal government.
Despite making up approximately 21.6 percent of the federal workforce, Postal Service employees account for over 50 percent of reported workplace injuries and illnesses and 56 percent of fatalities, according to Occupational Safety and Health Administration statistics.
In 2018, seven percent of the Postal Service workforce reported an injury or illness.
That high rate of injury can cause a high rate of opioid prescriptions.
According to the OIG report, nearly three percent of the Postal Service workforce received an opioid prescription in 2018 and accounted for 48 percent of the opioid prescription costs under the federal employee FECA program.
Those prescriptions cost the FECA program nearly $22 million in 2018, according to the report.
“The risk of misuse is increased because employees can get additional opioid prescriptions outside of the FECA program,” the report said.
Due to the addictive nature of opioids, the CDC has issued guidance that opioids be prescribed for no more than three days, except in cases of medical necessity, and 25 states have set that same limit at one week or less.
The Department of Labor, however, allows physicians to prescribe opioids to new users under the FECA program for up to 60 days without a letter of medical necessity.
That difference is significant, as CDC research has proven that over 13 percent of patients prescribed opioids for eight days or more were still taking them a year later. That rate jumps to 30 percent if the patient has been taking opioids for a month or more.
OIG investigators found that Postal Service officials haven’t properly tracked the statistics available from the DOL, which would give them better insight into where there could be potential opioid abuse problems in their workforce.
“When the Postal Service does not use data analysis, it cannot assess and anticipate any associated workforce issues and take targeted action to help protect its employees and customers from the dangers of prescription drug addiction,” the report said.
Compounding this issue, investigators determined that the Postal Service had not developed a sufficient drug policy and drug education plan, with insufficient data to determine how many of its employees were reached by current education measures.
The report recommended that the Postal Service develop a quarterly data analysis plan for opioid use, request that the DOL reduce the prescription length allowed under FECA, update supervisory policy to ensure supervisors understand the impact opioid use could have on mental or physical abilities and develop a comprehensive, ongoing educational plan.
Postal Service management agreed with the first two recommendations but disagreed that they needed to update supervisor policies or educational plans.
“It is important to note that the Postal Service has no involvement with the prescriptions that its employees receive from their doctors. That includes employees who are covered by the Federal Employee Compensation Act, and thus receive prescriptions that the Office of Workers Compensation Program approves and covers from a payment standpoint. The Department of Labor is primarily responsible for the administration of FECA and any meaningful changes to how DOL manages prescription opioids cannot be implemented unilaterally by the Postal Service,” a USPS spokesperson told Federal Times.
"For the same reason, the Postal Service has concerns with the report’s reliance on statistics regarding the Postal Service’s rate of decline in opioid prescriptions as compared to other federal agencies. Any difference between the Postal Service’s opioid costs as compared to other government agencies is more likely attributable to the nature and types of work activities performed by Postal Service employees, which due to their physical nature, are more likely to lead to injuries that may require opioid prescriptions as compared to injuries sustained by employees of other agencies. It is similarly misleading to compare the Postal Service to the private sector because the private sector is better positioned to implement best practices to control the circumstances under which opioid medications are prescribed to their employees along with the associated costs that are incurred as a result of these prescriptions.”
This article has bee updated to include comments from USPS.
Jessie Bur covers federal IT and management.