James Davis | HR Daily Advisor

At the recent #SHRM2018, I attended a session entitled “Addressing Prescription Overuse in the Workplace,” given by Norbert J. Alicea, Executive Vice President with Health Advocate’s EAP+Work/Life Services, and Raffi Terzian, the Senior Vice President of Clinical Operations and Senior Medical Director at Health Advocate. Their session addressed the astounding and alarming impact that addiction has on the workplace.

Much of the session was eye-opening and deeply concerning. Perhaps one of the most powerful things that Alicea said was that “People lose their family 5 years before they lose their job, it’s the last thing to go.” Addicts on average experienced destruction because of their addiction for at least 5 years before their addiction cost them their jobs. That’s 5 years that an addict would, at the very least, be underperforming at work and, at worse, be destructive to his or her organization.

I can’t think of a better way to characterize how important it can be to address addiction in the workplace.

The Numbers

The session covered a wealth of facts and figures. Here are a few that were presented, all about 2016:

  • 116 people died every day from opioid overdose—over 42,000 a year.
  • 2,100,000 people misused prescription opioids for the first time.
  • The economic cost due to opioid misuse and overdose was $504,000,000,000 (2015).
  • The total cost for opioid addiction and overdose treatment for enrollees in large employer plans was $2,628,000,000. In 2006, it was $278,000,000, just shy of a 10-fold increase.

While opioid deaths and new opioid addictions grow every year, and while organizations lose resources and productivity, employees who are abusing drugs continue to work. The numbers above are just a tiny slice of the true impact of opioid and prescription drug use and abuse. But how do they specifically influence the individual workplace?

Alicea and Terzian explained that, according to the National Safety Council, employees who abuse drugs are 2–5 times more likely to:

  • Take unexcused absences.
  • Be late for work.
  • Quit or be fired within 1 year of employment.
  • Be involved in workplace incidents.
  • File workers’ compensation claims.

Those costs add up very quickly with just one employee struggling with substance abuse at work and even faster if there are multiple abusers.

Addiction Is a Disease

Terzian introduced the session by saying, “We have to view opioid use through the lens of addiction. It’s not a moral failing, it’s a brain disease.” Both presenters repeated this statement many times because it’s that important. Alicea elaborated, “I’ve never run into the person who wants to be an addict in 25 years.”

The image of a hooded figure slumped in an alleyway with a needle in his or her arm does not represent the clear majority of prescription drug abusers. Most are now, or were, like everyday people, with families, lives, and careers. The difference? They have a powerful addiction, and without help, they will succumb to it.

The Red Flags of Addiction

If employers are to help, they need to be able to identify the warning signs of a drug abuser. Alicea exclaimed, “I’d bet every person in this room, in this conference, across the states, knows someone with a substance abuse problem. We all know at least one person. But if I asked that question, we won’t see a lot of hands go up. That’s the power of denial.” The presenters also mentioned that drug abusers’ fellow employees know about substance abuse problems long before the employers do. How? Because the warning signs are visible to those who know them best.

The more of the following red flags that an employee exhibits, the “greater the probability of an issue,” said Alicea.

Monday and Friday absenteeism—Users who have kept it together for the workweek might be hurting to use their drug of choice unimpeded or be spent from using over the weekend.

Absenteeism the day after payday—These habits are expensive. Payday might be the only time a user can afford to purchase his or her drugs.

General tardiness and/or absenteeism—Especially opioids can drain users of energy and make it difficult for them to come to work on time, or at all.

Poor quality of work and/or poor quantity of work—If a user can’t use at work, he or she might be experiencing the beginning of withdrawal. If he or she can use at work, the effects of the drugs have an equally distracting effect. Either way, his or her work will be affected.

Theft—The power of addiction leads many to make choices that you or I would never consider, especially if they are struggling to pay for their habit. Stealing equipment and other goods and money from work can help fund their addiction.

If drug abusers’ fellow workers know about their cohorts’ drug problems, “they are looking to see what HR or a manager is doing about this problem,” says Alicea. By not addressing the problem, what message is the company sending to its drug-abusing employees, never mind its loyal and clean employees?

Drug Abusers Know Where to Apply

Alicea said, “people who use drugs and alcohol know exactly where to go and apply for a job. They know.” What does that mean for employers that don’t drug-test new employees? It means a high probability that the workplace will experience continuous problems from drug-abusing employees. After the session, I asked Alicea and Terzian about that phenomena. They related to me a few examples of organizations that, for various reasons, wanted to avoid preemployment drug tests. “And they wonder why they constantly have problems,” said Alicea.

What Can You Do?

Once an employer realizes that employees who abuse opioids and other prescription and illegal drugs need help, it can begin to find a way to administer that help.

“A lot of companies had zero-tolerance policies. A lot of them are doing away with it, and I’m all in favor of a second chance,” said Alicea. He explained, “If you have an employee who worked for you for 10 years and they are relatively good, and they end up testing positive, and you terminate them—you don’t know if the new person has a problem, too, and you lose all of that knowledge.”

Alicea said the best way to help is to offer employees a one-time chance to get clean through a program (and prove it after the program is over) or be fired. Work, he said, represents a critical part of many people’s identity. Remember, by the time they are potentially losing their jobs, many drug abusers have already pushed their friends and family out of their lives. Their work identity might be all they have left. And that can be a powerful motivator, says Alicea. That makes them decent candidates for rehabilitation.=

Alicea said, “by threatening the job, the core values of a person, that person has a high probability of success in making the change provided that it’s monitored.” He focused heavily on the value of monitoring and reinforced it when we talked after the session. He said, “the success rate in treatment today is really, really low. But if you have someone monitoring that person for 90-120 days after the treatment, the rate is really, really high.” The reason is that they know that if they don’t follow through with aftercare, they will lose their job—their core personality—and that’s too much.

The Takeaway

This topic is incredibly complicated; the research is far from complete; and even with treatment, drug abusers have very real challenges ahead. If you deal with substance abusers at your organization—and it’s just a matter of time before you do—it behooves you to explore how you can help those people.

Episode 16: Encouraging Proper Use of the ER

The ER can be an invaluable resource when employees face a medical emergency. However, choosing the ER when other alternatives may be a better fit can have a big impact on healthcare costs for individuals and their organizations. In this episode of Health Advocate’s Ask the Expert series, we’re joined by Amy Kinsley, a nurse and Senior Personal Health Advocate, to discuss employee use of the emergency room.

By Raffi Terzian, M.D., M.P.H., FACEP
Senior Medical Director,
Senior Vice President of Clinical Operations

The impact of the opioid epidemic has been felt across the United States, including in the workplace. This is a critical public health problem with wide-ranging social and economic implications. According to the Centers for Disease Control and Prevention (CDC), 115 Americans die each day from an opioid overdose.

Opioids are a class of drugs that include illegal drugs such as heroin, synthetic opioids such as fentanyl and a number of prescription pain relievers. Opioids work by binding to specific receptors in the body that mitigate pain while also activating pleasure centers in the brain. A number of side effects may be observed in relation to opioid use such as drowsiness, altered mental status, nausea, constipation and slowed breathing. In an overdose, a person may become unresponsive with respiratory depression leading to death. An acute overdose can be reversed with the use of naloxone if used in a timely fashion.

Prescription opioid misuse and abuse

The 2016 National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that an estimated 11.8 million people had misused opioids in some form in the past year, the vast majority attributed to prescription pain reliever misuse. Prescription opioids are misused when one takes a larger dose than prescribed, uses a medication in a different manner than it was intended or takes another person’s medication. There is an increased risk of dependence and addiction when opioids are misused or abused. As outlined by the CDC, risk factors for prescription opioid abuse and overdose include: obtaining overlapping prescriptions, having mental illness or a history of substance abuse, taking high daily doses of prescription opioid pain relievers, and living in rural areas and having low income.

The impact on employers

In 2017, the Council of Economic Advisers released a report estimating that the economic cost of the opioid crisis was $504 billion in 2015, or 2.8 percent of the GDP that year. For employers, there is a significant impact with regard to lost workplace productivity and the costs associated with healthcare spending. According to an analysis from the Kaiser Family Foundation, which tracked the impact of the opioid epidemic on those with employer-based health coverage, the annual cost of treating addiction and overdose increased by more than eight-fold between 2004 and 2016.

There is growing concern among employers about the issue of opioid misuse and abuse in the workplace. The National Business Group on Health Large Employers’ 2018 Health Care Strategy and Plan Design Survey found that 80 percent of employers are concerned about inappropriate use of opioids, while thirty percent have restrictions in place for prescription opioids and twenty-one percent have programs in place to manage prescription opioid use. Some strategies that employers are using include working with pharmacy benefit managers to limit quantities, formularies and/or coverage of opioids. Allowing coverage for alternative approaches to pain management may also be an option. Additionally, employers can provide workplace training to improve awareness as well as access to resources such as an Employee Assistance Program (EAP).

Broader policy interventions

As an example, the CDC guideline for prescribing opioids for chronic pain provides recommendations for prescribing in primary care settings. In addition, a number of states have implemented prescription drug monitoring programs (PDMPs), electronic databases that track controlled substance prescriptions. The National Institutes of Health recently introduced the HEAL (Helping to End Addiction Long-term) initiative to highlight research in the areas of improved treatment for opioid misuse and addiction and novel approaches to pain management.

While employers may face challenges in addressing this crisis, creating awareness in the workplace and taking proactive steps can lead to a healthier and safer work environment for all employees.

Contact Us

Health Advocate’s EAP+Work/Life Program is an important resource to help organizations address substance abuse issues, offering clinical psychologists and resources to help employees and their family members overcome addiction, and  also coaching to supervisors to support employees and direct them to appropriate resources. Find out how we can help you put the right program in place to help keep your employees and organization healthy and safe.

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Help with the human side of recovery after a traumatic event

Health Advocate assists organizations with every phase of the disruption of everyday business and the return-to-work cycle. Our services ensure that your organization is ready for potentially disruptive life events, able to respond successfully to these events (including critical incidents like natural disasters, threats of violence, or sudden death of an employee), and equipped to accelerate employee recovery and return-to-work outcomes. You can be assured that we will connect you with the right solution and the right people at the right time.

Learn more about Disruptive Event Management

By Norbert Alicea, MA, CEAP, Executive Vice President, EAP+Work/Life Services

Amid the flurry of alarming disruptive events from hurricanes, floods, wildfires and other natural disasters, to acts of violence, a growing number of employers are recognizing the need to have a quick response in place to help employees impacted by a traumatic event. More organizations are turning to Employee Assistance Programs (EAPs) for support to plan for these critical events and provide direct assistance to help employees recover, stay motivated, and create a path forward.

Although it’s not always possible to predict when a massive flood or other disruptive incident may occur, Health Advocate partners with organizations to ensure that they have the right tools in place for recovery and to accelerate a return to work, no matter what the event.

How we do it: A customized response

There is no one-size-fits-all approach to recovery or planning for a critical event. Our vast national network of highly trained counselors and psychologists are experienced in adapting to situations to deliver the appropriate level of support, with a 24/7 response anywhere in the country.

For example, in the case of natural disasters like a hurricane, our team serves as a hub, connecting those impacted to essential resources and relief services such as FEMA (Federal Emergency Management Agency) that are necessary to begin reestablishing some sense of normalcy and reducing the feeling of being overwhelmed during this difficult time. In situations when our team cannot be physically present, we provide telephonic support to help with anxiety and stress. Later, in the healing phase of recovery, our counselors address the personal impact of the disaster with individuals and the steps they can take to get back on their feet.

We also provide help to the friends and family of those affected as well as to those who are impacted by news of the event.

An unexpected employee death drives EAP involvement

Among the common disruptive events, the most likely issue employers will typically face is the unexpected death of an employee. In fact, supporting employees who are impacted by a coworker death accounts for 70 percent of Health Advocate clients’ requests for help.

Again, a flexible response is crucial. Some deaths may be natural after a long illness, for example, while others may be the result of a tragic accident or a suicide. Our team adjusts their strategies accordingly, providing customized support to employees as a group and on an individual basis as needed.

Just as importantly, our team consults with the organization’s leadership about the next best steps to support their staff through the loss. When a tragedy strikes, employees look to leadership for direction. It’s essential that leaders know how to acknowledge the event with transparency and facts, demonstrate the seriousness of the loss and an awareness of the impact to the organization and their workforce, and to communicate an expectation of recovery.

Now’s the time to plan for a crisis

Whether a sudden death of an employee or a large-scale natural disaster, a disruptive event can happen in seconds, but the effects can be long-lasting. It’s important to have a plan to help employees cope with the trauma, minimize disruption and lost productivity and get your business back to normal as quickly as possible. Research shows that companies that have a plan in place after a tragedy have reductions in disability claims, worker’s compensation claim costs, healthcare costs, absenteeism and employee turnover.

Contact Us. We’re Always Ready.

Learn more about how Health Advocate can help you prepare for and address a full range of disruptive incidents to create a culture of psychological safety with a focus on maintaining productivity, returning to work and staying at work.


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