Injured workers can develop painkiller dependency. A Philadelphia firm that handles workers' compensation claims tries to ensure opioids are not overprescribed.

Share story

For many, the path from opioid use to heroin addiction begins at work when an injury sustained on the job is treated, or rather, over-treated, with painkillers such as Oxycontin or Vicodin.

“So, the original injury might have been a back, a knee, a shoulder that obviously you would hope could be treated, and (the worker) healed and returned to employment,” explained Peter C. Madeja, 57, chief executive and president of Genex Services LLC in suburban Philadelphia.

Genex handles workers’ compensation claims for businesses as they try to keep medical costs down and return employees to work.

In March, at a time of increased public attention to the issue, Genex introduced a new service, Medication Safety 2.0, to monitor and prevent opioid addiction.

Q: What happens to the injured workers?

A: If there were too many narcotics prescribed, in many situations an addiction developed as a secondary issue. And that became even more damning than the original injury. We’re often brought in where there is a related issue of addiction or abuse.

Q: Because you monitor the workers’ compensation claims, you get to see all patients’ prescription histories. What does Genex’s new service do with that information?

A: We make sure that in the treatment of that individual, the medical community is using evidentiary medical guidelines. You show them the medical guidelines to indicate why you might not want to prescribe (an opioid) for a patient with these circumstances, diagnoses, symptoms and medical conditions.

Q: How do you communicate this to doctors?

A: Between our nursing staff and our physician advisers, we’ll work proactively with the physician to try to create a better solution. We’ll actually accompany the injured worker to appointments.

Q: Any other strategy?

A: If we see the patient is treating with a number of physicians, there’s where one of the issues has come in. Physicians don’t always know that, and all of a sudden (the patient is) getting prescriptions from three physicians. The benefit of our involvement is we’re able to spot that.

Q: You read about companies forcing injured employees back to work too quickly, or firing them when they get hurt. What do you see?

A: You’re dealing with a pretty big system, so when it goes wrong, it can (still) be a pretty large number. Often overlooked is that most employers we see and deal with are really interested in the welfare of the individuals. They want to make sure that they get the right care and are treated right.

Q: At first, you and some partners owned Genex. Then you sold it to a large public company. Next, it was owned by a series of three more public companies. Finally, in 2007, you, your team, and private equity investors repurchased Genex, which was recapitalized with new investors in 2014. Through that, how did you maintain Genex’s culture?

A: You have to decide where you put a stake in the ground as to what’s really important to the integrity of your company, your culture, and your ability to serve your customers well, versus meeting the interests of that new owner/investor, who obviously has bought the company and should have a right to do as they see appropriate. As a leader, you’re trying to balance that.

Q: You’ve survived as a leader through many changes. Any advice on managing up?

A: Communicate when things are going well, but equally, communicate when there’s a problem. (Investors) like it when they feel like they have a sense for what’s going on in the business. Try to put yourself on the other side of that equation. They’ve made a significant investment in your business. They’re responsible to people who have given them money to invest on their behalf.

(Interview questions and answers have been edited.)