In a Globe and Mail investigation, reporter Kathy Tomlinson has explored how workers’ comp fanned the flames of an opioid crisis that leaves addiction, overdose and death in its wake. Her examination of appeal decisions and the experiences of injured workers reveals ‘deeply entrenched flaws’ in Canadian workers’ compensation systems with policies that facilitate addiction.
When the system – if not their doctor – deems them ready to return
Pain specialists and workers’ advocates point to a workers’ compensation system focused on early return to work (as outlined in Ontario Workplace Safety and Insurance Board (WSIB) document Better At Work). Critiqued by the Ontario Network of Injured Workers Groups (ONIWG) in a 2016 letter to the Premier, this policy leaves many injured workers with severe or permanent impairment without adequate time to heal and prematurely forced back to work, retraining or job search. Injured workers have long called for workers’ compensation boards to respect their treating doctor’s opinion on when and how they should return to work, and made it a key demand of the Workers’ Comp Is A Right campaign.
As illustrated in the article by heartbreaking personal accounts of the devastation caused, too many workers are loading up on painkillers to cope with WCB demands, risking addiction and reinjury rather than lose compensation benefits or their job.
The drive to keep workers on the job has saved compensation boards millions of dollars
In commenting on The Globe investigation, University of Waterloo professor Ellen MacEachen notes little has changed since her research findings on WSIB return-to-work and opioid use. Injured workers were blamed for taking drugs and accused of not wanting to work, yet it was fear of losing their jobs that pushed them into addiction: “It was financially convenient for the WCBs and the employers. The sooner these employees got back to work, the better it was for them financially … They (the workers’ compensation board) become like the drug pusher. They revert back to putting it all on the worker and making it about their choices.”
For their part, workers’ compensation boards say that in face of concerns over an opioid addiction crisis and rising drug costs, they have tried to steer workers away by limiting narcotics coverage, most up to 12 weeks – changes the WSIB introduced in its 2010 strategy to “reduce harm and spending”. Doctors interviewed for The Globe article point out that most WCBs pay for injured workers’ opioid prescriptions long enough for them to get hooked – and then cut them off. Left to struggle with injury now worsened by opioid dependence, some turn to street drugs that can prove deadly.
What help do injured workers get for addiction?
Data is lacking. Canadian workers’ compensation boards don’t track who turns to them for help with opioid disorders (though the WSIB says it monitors for signs of addiction) or the number of opioid deaths. In reviewing nearly 300 appeal decisions from 2019, the investigation found that of those seeking compensation from the Board for enabling their dependence, 70% were successful. But with appeal system wait times of up to 10 years, this is a recourse too slow for many: in Ontario five of the claimants in the review died before their appeal was concluded.
In a response to the June 18 article, Ontario Minister of Health Christine Elliott referred injured workers to access the public health system through the province’s new Roadmap to Wellness initiative for mental health and addiction …
What alternative treatment is offered injured workers?
“… I don’t think I have seen a case where, after opioids have been cut off, I have seen other options for treatments.” (Peter Bird, workers’ compensation lawyer)
Specialists and advocates want early intervention for all injured workers with complications, medical rehabilitation that ensures access to good diagnostics and a range of non-opioid treatments. As chronic pain consultant Dr Mandy Manak notes, this multidisciplinary approach takes money. In Ontario, as IAVGO Community Legal Clinic’s 2017 Bad Medicine report documented, workers’ health benefits have fallen victim to the WSIB’s cost-cutting drive.
While injured workers and their families pay the most dearly for the lack of well-rounded long-term care, employer advocates also point to frustrations with medicated workers pushed back to work too soon – the challenges of creating meaningful modified work, and potential of increased premiums (under WBCs’ experience rating systems) due to re-injury.
The bottom line?
The faster a worker gets back on the job, the less of a financial burden they are on workers’ compensation boards. The vast majority of injured workers are able to make a relatively straight-forward timely return to work – the system should be there also for as long as the disability lasts for those with complex or severe conditions.
They are basically just insurance companies. They are not run like government systems … But they should be again. There is supposed to be a system in Canada to make sure injured workers get proper care, and they’re not. To me, this is a violation of a sacred trust.
– Gaylord Wardell, chronic-pain specialist
- Tomlinson, Kathy. 2020 Jun. 19. “Ontario’s new program to help people with opioid addictions, Health Minister says.” Globe and Mail
- Tomlinson, Kathy. 2020 Jun. 18. “How workers’ comp fanned the flames of the opioid crisis.” Globe and Mail
- Lancaster, John & Tarranum Kamlani. 2018 Jul.12. “Ontario injured workers shut out of medical pot coverage — told to take opioids instead.” CBC News
- Michael G. DeGroote National Pain Centre. 2017. Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. McMaster University
- MacEachen, Ellen et al. 2009 Jun. 17. “If You Don’t Pick Up, You’re Cut Off”: Pain and Medication Use During Return to Work. (Presentation to CAMH)