A Painful Epidemic
As today's opioid problem rapidly spreads into the workplace, employers must tread carefully as they seek out a remedy.
By Julie Cook Ramirez
When legendary musician Prince succumbed to a drug overdose last year, the public was shocked.
Despite his flamboyant lifestyle, the music icon was said to have led a relatively clean life. A strict vegetarian, he abstained from alcohol and illegal drugs. But as authorities and journalists delved into the entertainer's final months, a startling picture emerged. Plagued by debilitating hip pain brought on by decades of performing in high-heel boots, the "Purple Rain" singer had been relying heavily on Fentanyl, a powerful prescription opioid, to combat the extreme discomfort. Ironically, it was the medication he took to keep up his grueling recording and concert schedule that ultimately ended his creative streak.
Prince's very public death is increasingly the private fate of tens of thousands of people. According to the Centers for Disease Control and Prevention in Atlanta, opioid-related overdoses took the lives of 33,000 Americans in 2015. That's just slightly less than the 38,300 Americans who died in traffic fatalities that same year. Just this April, the agency said its findings suggest the opioid epidemic might be much worse than previously thought, with thousands of opioid-related fatalities going uncounted because the drugs often are not listed on autopsy reports as contributing causes of death.
Driving this grim trend is a steep rise in the use of opioid painkillers. According to the Rockville, Md.-based Substance Abuse and Mental Health Services Administration, 35 percent of American adults were prescribed opioid painkillers in 2015. When you factor in the number of people who obtained such drugs by other means -- from friends, relatives or drug dealers -- more people use prescription painkillers than cigarettes, smokeless tobacco or cigars, combined.
Not surprisingly, such widespread use has led to widespread problems. One-third of Americans who took a prescription opioid for at least two months say they became addicted to the drug, according to a 2016 Washington Post-Kaiser Family Foundation survey. "Most drug addictions today don't begin on the street -- they start in a doctor's office with legal, valid prescriptions," says Deborah Hersman, president and CEO of the National Safety Council in Itasca, Ill. "The most dangerously misused drug today may be sitting in [someone's] medicine cabinet."
The epidemic also has a staggering economic effect on both public and private sectors. A 2016 study by researchers at the National Center for Injury Prevention and Control at the CDC estimated the annual economic burden to U.S. society at $78.5 billion, including $20 billion in lost productivity from nonfatal overdose cases alone.
Naturally, HR leaders are taking notice. A 2017 survey of 501 HR decision makers by the NSC found 71 percent of employers have seen direct effects of prescription drug misuse, most notably opioids. Forty-eight percent have experienced business harm, with 39 percent reporting employees missing work due to opioid use; 29 percent citing impaired or decreased job performance; and 15 percent saying the drugs have caused a workplace injury or near-miss. And 10 percent reported having a worker overdose from opioids on or off the job.
In the face of a crisis that cuts across every demographic and income level, HR is challenged with getting up to speed on the opioid issue, educating its staff and workforce, formulating a drug-testing policy, and putting supports in place to help employees who find themselves struggling with opioid addiction, all the while ensuring they remain in compliance with employment law.
Help on the Way
Fighting the opioid crisis has become a national priority. The federal 21st Century Cures Act -- approved in the U.S. Senate by a 94-5 vote during the waning months of the Obama administration -- includes $1 billion for opioid-addiction prevention. In April, newly appointed Health and Human Services Secretary Tom Price announced $485 million in grants -- the first of two rounds of funding provided for in the Act -- to support a comprehensive array of prevention, treatment and recovery services nationwide.
Individual states have also begun taking action to combat the epidemic. Wisconsin Gov. Scott Walker signed an executive order creating the Task Force on Opioid Abuse, while Maryland Gov. Larry Hogan declared a state of emergency and committed an additional $50 million over the next five years to beef up enforcement, prevention and treatment services.
Employers, meanwhile, are struggling to cope with the problem. Just 19 percent of respondents to the NSC survey say they feel "extremely prepared" to deal with it. That finding simply reflects how quickly opioids became a widespread crisis, says Steve Wojcik, vice president of public policy of the National Business Group on Health in Washington.
"Up until recently, there wasn't much awareness among the general public, because the medications originally were sold as being much less addictive than they really are," says Wojcik. "Over the last number of years, [they have] exploded onto the scene in a widespread way across the country, affecting lots of different people from all age groups in lots of different industries."
HR's first step must be to rid its workplace of denial, according to Neil Capretto, an addiction psychiatrist and medical director at Gateway Rehab in Moon Township, Pa., who describes opioid addiction as "the biggest drug crisis in our country we have ever seen." The problem is so widespread, he says, it would difficult to find a workplace that has not been hit by opioid addiction.
"If you have more than 10 employees, chances are at least one of them has a problem with opioids," Capretto says. "Just because you have a group of high-end MBAs or attorneys doesn't mean you are exempt from this problem."
Through workshops, Capretto educates HR professionals and supervisors about the problem of opioid dependence and teaches them how they can reach out to employees who need help. A common challenge for HR leaders is concern about whether they may legally act because the employee is typically taking a legally prescribed substance, says Tess Benham, senior program manager for prescription-drug-abuse initiatives at the NSC. By taking action, she says, they fear they might "run afoul" of the Americans with Disabilities Act, the Health Insurance Portability and Accountability Act or an Equal Employment Opportunity Commission ruling.
Many companies already have a framework in place for addressing issues of drug use in the workplace, Benham says. Often described as "drug-free workplace policies," 81 percent still fail to cover the use of prescription medications, according to the NSC survey. And while 57 percent of companies drug test all their employees, the NSC found 41 percent of those administering such tests don't include opioid pain relievers. Benham recommends employers not only expand testing to include opioids, but also educate themselves about which drugs are most commonly abused, so they can be sure to include them in their testing protocol.
Where employers risk legal problems is in being too quick to terminate an employee for testing positive for prescription opioids, says Jesse Dill, a senior attorney with Walcheske & Luzi in Brookfield, Wis., who frequently counsels clients on the legalities of workplace-drug policies. Although 65 percent of respondents to the NSC survey consider abuse of prescription opioids a justifiable reason to fire someone, Dill cautions that doing so may get an employer in hot water.
"If a drug test results in a positive determination that there is a legal substance in the system, it may have been prescribed for a protected reason under the ADA," says Dill. "Rather than reacting with discipline, the employer may be required to engage in an interactive process to see if a reasonable accommodation can be provided."
Benham says employers should look at a positive test result "through the lens of prescription medications and how their use may be impairing the workplace." Accommodating a legitimate medical need for that drug might require an employee to be placed in a less "safety-sensitive" position or possibly even on FMLA-mandated leave until their condition has improved to the point where they no longer need the drug in question.
Erasing the Stigma
Not only do zero-tolerance policies increase an employer's chances of being unintentionally non-compliant with employment law, Capretto says, it also makes it more difficult to detect who is struggling and in need of a referral to an employee-assistance program or addiction specialist.
What tends to happen in workplaces that embrace a punitive approach -- "If we catch you, you're going to be fired" -- is employees will take the problem underground and this, in turn, puts employers at greater risk, because the problem will go on longer without being addressed, says Capretto.
Often, he says, an employee's opioid problem comes to light not through a positive drug test, but through their behavior in the workplace. That's why it's important to train supervisors and employees how to spot the signs of opioid dependence, such as drowsiness, confusion, euphoria, slurred speech, social withdrawal or increased absenteeism. Workers with substance-abuse disorders miss 50 percent more days than their non-addicted counterparts, up to six weeks annually, according to analysis from the NSC, NORC at the University of Chicago and Shatterproof, a New York-based nonprofit organization dedicated to reducing the devastation of addiction.
Only 13 percent of respondents to the NSC employer survey say they are "very confident" their workers could spot signs of opioid misuse in a colleague. Yet just 24 percent offer employee training on the topic -- a huge failing, according to Benham.
"One of the single most underutilized things an HR decision maker can do is to educate their employees," says Benham. "Companies that train their employees around the risks of substance use . . . felt better-prepared and more confident in their ability to address substance use in their workplace."
According to Gary Mendell, founder and CEO of Shatterproof, the stigma associated with addiction often prevents employers from intervening when they recognize the symptoms of opioid abuse.
Shifting away from the mind-set that addiction is the fault of the afflicted is key to successfully helping employees overcome a dependence on opioids, he says.
Getting the issue out in the open and letting employees know they have no reason to be ashamed gives HR a better chance of getting them the help they need, says Mendell, adding that it doesn't cost a penny and it can go a long way toward helping tackle the opioid crisis.
"Companies can take charge and make a quick shift in how this disease is viewed within their organization and end the shame and stigma at zero cost," says Mendell. "It can happen over decades or it can happen in one day by leadership making that shift."