November 8, 2022

A New Link Between Opioids and Disability

Picture a worker who has an injury so traumatic that he or she is rushed to the emergency room. A doctor prescribes an opioid to ease the pain.

A new working paper adds to the growing evidence that taking opioids, even when necessary, can have serious long-term consequences for workers’ career paths.

Michael Dworsky at RAND found that workers who received prescription opioids after visiting Colorado emergency rooms were far more likely to enroll in Medicare before turning 65 than people who didn’t get a prescription to treat an injury. Starting Medicare before 65 almost always indicates that someone has left the labor force and is receiving benefits from Social Security Disability Insurance, the primary social program for workers with disabilities.

Dworsky reached similar findings in three different analyses, which used Medicare enrollment within four years of an emergency room visit as a rough proxy for whether workers are receiving the federal disability benefits.

People who had taken opioids prior to being injured were the most likely to leave the labor force. After an emergency room visit resulted in a new opioid prescription, more than 2 percent of the previous users wound up on Medicare and disability – a rate that is four times higher than for traumatic-injury patients who had never previously taken opioids.

Dworsky also examined the morphine-equivalent doses that were dispensed to patients over time. The probability of receiving prescription opioids spiked immediately after workers’ injuries and then stabilized at a higher level than before the injuries. …Learn More

November 1, 2022

How Older Workers Adapt to New Disability

One in four workers who are still healthy in their mid-50s will experience a disability in the next few years that will make working more difficult.

Sometimes the disability stems from a sudden medical problem such as a heart attack, but many disabilities are just the accumulated wear and tear on aging bodies or chronic medical conditions that get worse.

Whatever the cause, a new study in the journal Research on Aging finds that late-life disabilities often force older workers into early retirement. Nearly three-fourths of the workers who experienced a new disability in their late 50s or early 60s had left the labor force before their full retirement age. Among the people who didn’t have a disability, only a third had stopped working.

The researchers also looked more closely at those with disabilities who did continue to work. Were they able to transition into a new job or occupation that might accommodate their condition? Do they earn less?

The answer to both questions seems to be yes.

Linking a long-running survey of older Americans with occupational data, the researchers checked in on the workers who did not have a disability at age 55 to see how they were faring at 59, 63 and 67. Occupational changes were fairly common when they remained in the labor force after developing a disability.

This might mean moving from a physically demanding construction job to Uber driver or from school teacher to editor of educational materials. Finding a job in a different occupation potentially creates a bridge that accommodates the older workers’ desire to keep working and delay retirement.

At age 59, for example, two-thirds of the people with disabilities who stayed in the labor force had switched occupations, compared with less than a third of the other workers. Once a disability sets in, “staying in the same occupation is difficult,” the researchers concluded.

The people who develop a disability sometime after their mid-50s also earn perhaps 15 percent less than those who are disability-free at 67. …Learn More

July 1, 2021

An Appreciation of Professional Caregivers

My 85-year-old mother had been up a few times during a night in early June and still wasn’t feeling well in the morning. I called her doctor, who sent a prescription to her pharmacy, and went about my day’s work. But when I checked in that afternoon, mom was in a full-blown medical crisis that she and her 92-year-old male companion did not think was bad enough to tell me about.

I asked her companion to call the EMTs, who immediately dispatched mom to an emergency room a few miles from her Orlando retirement community. These events marked the start of my maiden voyage as my mother’s caregiver from 1,300 miles away in Boston. It was a high-stress affair that challenged all my organizational skills and stamina – an experience I am, no doubt, destined to repeat.

I’ve heard about the stresses of caring for an elderly parent but had only a vague sense of what that would be like. Nearly a week was consumed with keeping tabs on mom’s medical care at the hospital and what she needed, tracking down busy nurses and doctors – in a pandemic! – for updates on her condition (pneumonia) and treatment. Finally, upon mom’s hospital release on a Sunday, I wanted to make sure nothing else would go wrong at home.

The clouds started to lift when I hired three professional caregivers – Rachel, Nadine, and Rosa – to keep an eye on my mother for the first 24 hours at home. I developed a great appreciation for their kindness and efficiency and the unique talents each one brought to the job.

The hiring process wasn’t seamless, however, due to the COVID. My mother and her partner are fully vaccinated. But Florida has a much lower vaccination rate – 62 percent of adults have at least one dose, compared with 81 percent in Massachusetts – and I quickly learned that 35-year-old Rachel, the first caregiver assigned to mom, was among the unvaccinated.

I was about to cancel the contract with the company employing the caregivers when they offered to give Rachel a rapid COVID test. That worked for me. Having made my intentions crystal clear, the company texted me Nadine’s and Rosa’s vaccine cards for the later shifts. …Learn More

May 14, 2020

Opioid Abuse Tied to Where People Live

In 2019, the U.S. Attorney’s Office in northern Oklahoma detained one doctor charged with operating a pill mill that prescribed opioids to addicts for the simple reason that he presented “a danger to our community.”

While mental illness and unemployment are familiar culprits in the opioid crisis sweeping the country, the environment that people live in – including the prevalence of unscrupulous doctors – is actually important as well.

That’s one conclusion in a new study that found that people are more likely to become addicts if they move from an area with a relatively low level of prescription opioid abuse to a high-abuse area.

The research looked at more than 3 million people on federal disability insurance (DI) – a group that uses opioids at much higher rates than the general population. More than half of DI recipients are prescribed opioids in a given year. And since they are covered by Medicare, the researchers had access to the prescription records for Oxycontin, Vicodin, and morphine.

To gauge the impact of moving to a new location, the researchers created an index that estimated the extent of prescription opioid abuse in each U.S. county. The index took into account several factors, including the amount of opioids prescribed to patients and their use of multiple prescribers.

When DI recipients moved from a county at the low end of this index – the 25^th percentile – to the high end – the 75^th percentile – their rate of prescription opioid use increased nearly 5 percent, according to the study conducted for the Retirement and Disability Research Consortium.

People with a prior history of prescription opioid use were at particularly high risk of prescription opioid abuse if they moved to a high-use area. …Learn More