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How Employers Can Help Prevent and Reduce Addiction in the Workplace

Wednesday, December 5, 2018

With the help of our partners at the talent development firm Maher & Maher, IMPAQ International’s policy researchers have been studying the plight of communities and identifying some of the most effective solutions to combat the opioid crisis. This is the final installment of a four-part blog series.

Introduction

This blog series has explored the policy intervention of using employment training services to support those in recovery from opioid use disorder (OUD) and how expanding access to outpatient medication-assisted treatment (MAT) can allow people in treatment to continue to work.

There are also steps that employers can take to prevent addiction from developing in their workplace, initiate early interventions, and successfully hire and retain workers in recovery. The final post in this series discusses some practices that employers may consider implementing in their organizations to fill open positions, retain employees, increase safety, and furthermore help to disrupt the opioid epidemic in their local communities. 

The White House Council of Economic Advisors reported that the cost of the opioid crisis in 2015 was $504 billion,1 with a separate analysis estimating that 79 percent of the cost can be attributed to lost productivity.2 Unexcused absences, tardiness, quitting or being fired within a year, and elevated compensation claims are all consequences that opioid misuse can have on a business.2

Constant turnover and open positions drain money from businesses. Hiring in the United States costs an average of $4,000 for each employee and it generally takes 52 days to fill a position.3 Furthermore, new employees take eight to 26 weeks to achieve full productivity. With 7 million job openings as of September 2018, many businesses are struggling to find qualified candidates.4 A high percentage of pre-employment drug tests (between 25 and 50 percent) are being failed and a Princeton survey from 2016 found that 31 percent of men not in the workforce take prescription pain medication daily.5,6 OUD is a serious issue for the unemployed population.

Given the magnitude of this disruption, employers are no longer able to ignore the opioid crisis.

“Not in my House”

Considering 75 percent of people with substance use disorder are employed, it is reasonable to consider that addiction may be present in your workplace. If you work in construction, mining, or the entertainment, recreation, and food service industry, then the likelihood is even higher.7

In Massachusetts, workers in the construction industry died from overdoses at a rate six times higher than the average rate for all workers. They accounted for 26 percent of opioid-related deaths from 2011 to 2015.8 The Mapi Foundation found that 10.1 percent of manufacturing-centered counties in 2016 were experiencing the highest opioid overdose rates, up from only 1.7 percent in 2011.9

Roughly 40 percent of employers have experienced an employee using prescription pain relievers at work, 29 percent have noticed impaired or decreased employee job performance, 29 percent have had a family member impacted by prescription drug usage, and 14 percent have had employees borrow or sell prescription drugs at work.10 Overall, seven in ten of the employers surveyed by the National Safety Council in 2016 have had some type of negative interaction with prescription drug usage.10

Workers are even overdosing while on the job. There were at least 217 overdose deaths in the workplace in 2016, marking a 32 percent increase from the year before. However, this does not paint an accurate picture of people overdosing at work, as this statistic does not account for employees who were revived with Narcan by a Good Samaritan.11

Though it is evident that opioids are present and impacting the workplace, many employers are overlooking the severity of this issue. More employers were concerned about the aging workforce than the misuse of prescription drugs (30 percent compared to 23 percent, respectively). Only 24 percent of employers viewed opioids as a problem for their workforce.10

It can be difficult to take a critical look at one’s own circumstances. To prevent addiction from developing and to secure access to treatment for employees who need it, employers should reevaluate their workplace culture and policies to address the growing influence of opioids.

Changes to Make Today

Considering the extent of this issue, it can be overwhelming to decide where to begin when strengthening a workplace against the opioid epidemic. Though this epidemic is a newer issue for employers, 70 percent of them have shown interest in helping employees who misuse prescription drugs to return to their positions after completing treatment.10 Listed below are interventions that employers may consider implementing in their workplaces.

  1. Train managers to identify and intervene with employees who are suspected of misusing painkillers in a non-confrontational manner.12 They should learn to monitor employees returning from injury and identify early warning signs, such as absenteeism after a payday.13

  1. Educate workers on the risk of OUD, pain management alternatives, and safe storage and disposal methods.

  • The National Safety Council has developed a free Employer Kit containing tools to examine business’s drug free workplace and employee benefits program, fact sheets and handouts, five-minute safety talks, and a poster series focused on home safety and disposal.

  1. Have naloxone, the opioid overdose reversal drug, available at work and train employees on how to administer it.

  1. Offer low safety risk positions for those in recovery or those legally taking prescription painkillers.14 These positions may also be used for employees who had a positive drug test and are pursuing treatment. 

  1. Foster an environment of open communication that may consist of an anonymous reporting process for employees to notify the management team with concerns about their colleagues, employees feeling comfortable seeking treatment services without risking their position at the organization,15 and employees alerting their managers when beginning an opioid prescription. Managers may elect to temporarily move an employee using a legal prescription or who is recently in recovery to a low risk position and will be in a better position for an early intervention if necessary.

Institutional Policies to Consider

Additionally, there are some larger scope modifications that organizations may consider to mitigate the effects of opioids in their workplace.  

  1. Review the organization’s workplace drug policy for compliance with the Americans with Disabilities Act (ADA). The ADA protects people who are legally prescribed opioids, unless they are a safety risk.16 Thus, automatic termination or disqualification from a position due to a positive drug test can leave a business open to an ADA lawsuit.
  1. Implement paid sick leave to prevent addiction from developing.14 Workers are sometimes forced to rely on prescription painkillers to return to work before their injuries are fully healed.
  1. Provide access to an Employee Assistance Program (EAP) that offers counseling services.
  1. Review the health care providers and prescription drug coverage aspects of the employer-sponsored health insurance plans. A comprehensive insurance plan will address the following:
  • Opioid utilization management, such as requiring prior authorizations for larger quantity limits or having dispensing quantity limits;17
  • Pharmacy and prescriber “lock-ins” for high opioid users, which would require employees to use a single pharmacy or a single doctor for their opioid prescriptions;17
  • Coverage for alternative pain management therapies, such as physical therapy.18,19 Research shows that over-the-counter ibuprofen is more effective at treating pain than opioids, without the dangerous potential side effects;20 and
  • Monitoring doctors for risky opioid prescribing behaviors.
  1. Create or promote a local prescription disposal program. It is estimated that half of abused prescription painkillers are obtained from a friend or family member.21 One study of a community “take-back” program found that roughly two thirds of pills from an opioid prescription are not consumed. Additionally, nearly half of individuals with an opioid prescription did not receive information on how to safely dispose or store their medications.22
  1. Amend zero-tolerance drug policies that mandate automatic termination after the first positive drug test. Employers may consider requiring counseling, treatment, probation, and/or future drug tests to support their employees after a positive drug test. One carpenter union decided to allow employees to return to work before the end of their 30-day probation period if they followed a treatment plan.23

Conclusion

Employers can be part of the solution to the opioid crisis. They have direct ties to communities in ways that other OUD recovery service groups struggle to develop.

However, businesses do not have to face this fight alone. Government programs should be leveraged to support employers that wish to retain and hire people overcoming opioid addiction. Afterall, employers’ decisions and policies support the governmental goals of having a strong economy and healthy population.

For example, a two-year pilot program in Ohio reimburses employers for pre-employment and random drug testing, training, and employee support if the business hires people in recovery.24 Additional efforts should be made in communities that are struggling to hire and experiencing high rates of positive drug tests.

This blog series has explored the intersection between employment and opioids, while highlighting the promising steps being taken to address the crisis. Though progress has been made, the expansion and evaluation of programs should be prioritized to reach those in need and educate future efforts.

IMPAQ International recognizes the value of supporting access to employment for people in recovery from opioid addiction, and we aim to assist in the effort to end the opioid crisis in the United States.

References
  1. Council of Economic Advisers Report: The Underestimated Cost of the Opioid Crisis. (2017). Retrieved from https://www.whitehouse.gov/briefings-statements/cea-report-underestimated-cost-opioid-crisis/
  2. Hansen, R., Oster, G., Edelsberg, J., Woody, G. & Sullivan, S. (2011). Economic costs of nonmedical use of prescription opioids. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21178601
  3. Zivkovic, M. (2018). The True Cost of Hiring an Employee in 2018. Retrieved from https://hundred5.com/blog/cost-of-hiring-an-employee
  4. Job Openings and Labor Turnover Summary. (2018). Retrieved from https://www.bls.gov/news.release/jolts.nr0.htm
  5. Bolden-Barrett, V. (2017). Opioid crisis remains the latest barrier to hiring. Retrieved from https://www.hrdive.com/news/opioid-crisis-remains-the-latest-barrier-to-hiring/448309/
  6. Krueger, A. (2018). Where Have All the Workers Gone? An Inquiry into the Decline of the U.S. Labor Force Participation Rate. In BPEA Conference Draft. Brookings. Retrieved from https://www.brookings.edu/wp-content/uploads/2017/09/1_krueger.pdf
  7. A Substance Use Cost Calculator for Employers - Methodology. Retrieved from https://www.shatterproof.org/sites/default/files/2017-03/A-Substance-Use-Cost-Calculator-For-Employers-Methodology_0.pdf
  8. Department of Public Health taking steps to keep job-related injuries from leading to opioid misuse. (2018). Retrieved from https://www.mass.gov/news/department-of-public-health-taking-steps-to-keep-job-related-injuries-from-leading-to-opioid
  9. Callaway, J. & Shi, Y. (2018). Ignorance Isn’t Bliss. The Impact of Opioids on Manufacturing. Retrieved from https://mapifoundation.org/economic/2018/2/22/ignorance-isnt-bliss-the-impact-of-opioids-on-manufacturing
  10. National Employer Survey: Prescription Drugs and the US Workforce. (2017). Retrieved from https://www.nsc.org/Portals/0/Documents/NewsDocuments/2017/National-Employer-Addiction-Survey-Methodology.pdf?ver=2018-07-05-105114-883
  11. Gold, J. (2018). Workers Overdose on the Job, and Employers Struggle to Respond. Retrieved from https://www.nytimes.com/2018/09/21/business/economy/opioid-overdose-workplace.html
  12. Vance, T. & Foulke, E. (2017). America's opioid epidemic and the workplace: 3 lessons for employers. Retrieved from https://www.bizjournals.com/bizjournals/how-to/growth-strategies/2017/07/america-s-opioid-epidemic-and-the-workplace-3.html
  13. Shadovitz, D. (2018). The Truth About the Opioid Crisis at Work. Retrieved from http://hrexecutive.com/truth-about-the-opioid-crisis-at-work/
  14. Confronting the Opioid Crisis. (2018). Retrieved from https://www.tauc.org/ihdp/tcu_spring_2018/EDE2F9809912E53AD5D01D0707F8396A/TCU_SPRING_2018.pdf
  15. Opioid Safety Information for Employers | Cigna. (2018). Retrieved from https://www.cigna.com/helpwithpain/employers
  16. Johnson, A. (2018). Opioid Crisis: Keeping the Workplace Drug-Free and ADA Compliant. Retrieved from https://hrdailyadvisor.blr.com/2018/05/31/opioid-crisis-keeping-workplace-drug-free-ada-compliant/
  17. Is Your Workplace Prepared for the Opioid Epidemic?. (2018). Retrieved from https://www.ahip.org/is-your-workplace-prepared-for-the-opioid-epidemic/
  18. Terzian MD, R. (2018). Clinical Corner: The Opioid Crisis in the Workplace. Retrieved from http://www.healthadvocate.com/site/article/the-opioid-crisis-in-the-workplace
  19. National Crisis: Opioid Abuse in the Construction Industry. (2018). Retrieved from https://www.assp.org/news-and-articles/2018/08/28/national-crisis-opioid-abuse-in-the-construction-industry
  20. Teater MD, D. Evidence for the efficacy of pain medication. Retrieved from https://www.nsc.org/Portals/0/Documents/RxDrugOverdoseDocuments/Evidence-Efficacy-Pain-Medications.pdf
  21. Lipari, R. & Hughs, A. (2017). How People Obtain the Prescription Pain Relievers They Misuse. Retrieved from https://www.samhsa.gov/data/sites/default/files/report_2686/ShortReport-2686.html
  22. Wynn, R.L. (2017). Opioid Medication Disposal Programs: Reviewing Their Effectiveness. Retrieved from https://www.wolterskluwercdi.com/blog/opioid-medication-disposal-programs-reviewing-their-effectiveness/
  23. Wyman, Nicholas. (2017). America’s Workforce Is Paying A Huge Price For The Opioid Epidemic. Retrieved from https://www.forbes.com/sites/nicholaswyman/2017/12/12/americas-workforce-is-paying-a-huge-price-for-the-opioid-epidemic/#6421b0b71bd3
  24. Wedell, Katie. (2018). $5M pilot program to encourage employers to hire recovering addicts. Retrieved from https://www.daytondailynews.com/business/employment/pilot-program-encourage-employers-hire-recovering-addicts/RBCRy95fVIFcmjwFMeBVBL/