By Dana Wilkie | SHRM
What employers should know about opioid addiction
If you live in the United States, your chances of dying in a car crash are 1 in 103. Your chances of dying from an opioid overdose? One in 96.
In other words, for the first time in U.S. history, opioid overdoses have surpassed vehicle crashes as one of the leading causes of death in the country, according to the National Safety Council’s (NSC’s) latest report analyzing 2017 data on accidental deaths.
How did opioid overdoses become so prevalent? And how does opioid use—and misuse—affect employers and their workers?
How the Pendulum Swung
In 2015, more than 52,000 people in the U.S. died from drug overdoses, almost two-thirds linked to opioids like Percocet, OxyContin and their “street” alternatives, heroin and fentanyl, according to the U.S. Centers for Disease Control and Prevention (CDC).
But the NSC found that just two years later, opioid overdose deaths alone—not all drug overdose deaths—surpassed vehicle crashes as one of the leading causes of preventable deaths.
“It is shocking,” said Ken Kolosh, manager of statistics at the Chicago-based NSC, a not-for-profit organization that examines the causes of preventable deaths in the U.S. “There’s been a long-term trend toward improving motor vehicle safety but a very rapid increase in opioid deaths. Since 2005, when you look at the death rate per 100,000 people, the car crash death rate improved by 19 percent. Over the same period, accidental deaths caused by opioid use have increased 430 percent.”
Dr. Bartley Bryt is chief medical officer at MagnaCare, which provides employers with health plan management services. The opioid epidemic in the U.S., he surmises, happened because of a convergence of social, economic and political dynamics.
More than 20 years ago, he notes, political, medical and consumer groups promoted the notion that the medical community wasn’t addressing pain adequately.
“First came the consumerization of health care, with provider groups, hospitals and emergency rooms handing out these patient surveys about treating pain,” Bryt said. “Politicians started saying, ‘You’re not doing enough about pain.’ Drug companies put out some pretty effective drugs. People said they felt better. And we got this momentum moving so that we ended up with more patients requesting these drugs, quicker access to the drugs, and patient dissatisfaction if they didn’t get the drugs.”
Years later, when it became clear that some patients were growing addicted to opioids, he said, the pendulum swung in the other direction.
Lawmakers and the media turned a spotlight on the problem. Regulatory agencies began cracking down on opioid prescriptions. Doctors began prescribing fewer of them.
The prescribing of opioids in the U.S. per capita peaked in 2012 and has fallen ever since, according to the CDC. It notes that opioid prescribing peaked at 81.3 prescriptions per 100 people in 2012, and by 2017 it had fallen to 58.5 prescriptions per 100 people.
That, Bryt said, led some patients to turn to the black market to get the pain medications on which they’d come to rely. But on the black market, people don’t always know what they’re getting. Street dealers might hand over illicitly manufactured drugs that include heroin and fentanyl from Mexico, China and other places. That means those buying on the black market may get a product that is much more potent—and addictive—than what they got from their doctors.
“It’s particularly dangerous when the person using the opioids does not know what they are getting,” said Stefan Kertesz, a professor in the Division of Preventive Medicine at the University of Alabama at Birmingham. “A person might have tolerance to opioids at one level, but if they get a surprise dose of something much more potent, they can die.”
Spotting Opioid Addiction Isn’t Easy
As with most substance misuse, whether it’s of alcohol or drugs, workplace managers will see evidence of only a small portion of the people with the use disorder, Kertesz said.
“Many people will have consequences of addiction that are kind of below the radar of the workplace,” he said. “The types of problems that can sometimes emerge include a fall in performance, missed deadlines without identifiable reasons or failing to operate equipment appropriately.” Frequent absenteeism on Mondays and Fridays (or the day after a payday) is another red flag.
In all of these situations, Kertesz cautioned, there can be several possible causes, not just addiction. An employee may appear hungover not because of opioid use, but perhaps because of sleepless nights due to a sick child or a marital problem. Hence, managers should proceed with caution and guidance from HR professionals on how to assess the root of the employee’s problem.
“I’m an addiction medicine professional, but I still would call our HR professionals to sort out how to proceed,” Kertesz said.
Moreover, he said, it’s important for employers to recognize that most people who are on prescribed opioids don’t develop an addiction. Managers can’t assume that opioid use has led to addiction.
One-third of Americans have received an opioid prescription in the past two years, according to one poll. Most of these people never develop an addiction, according to the 2017 National Survey on Drug Use and Health.
Among those who receive opioids long term for pain, the percentage who might go on to develop a diagnosable opioid use disorder is likely to be 8 percent or less, Kertesz said. That risk is lower in older adults with no prior addiction history, though higher in younger people, he said.
Help for the Addicted
Still, it’s a good idea for employers to have restrictions in place for prescription opioid use.
The National Business Group on Health, a nonprofit association of more than 420 large U.S. employers, issued a recommendation last summer that employers work with their health plans and pharmacy benefits managers to ensure they are following national guidelines for prescribing opioids.
During the Society for Human Resource Management 2018 Annual Conference & Exposition, two health experts shared tips for approaching workers who managers suspect may have an addiction.
“I always tell managers and supervisors to use [we] messages,” said Health Advocates’ Vice President of EAP+Work/Life Services Norbert Alicea. “When you’re speaking to an individual about work-performance issues, stay away from those blame statements that include the word ‘you’: ‘You need help. You have an alcohol- or substance-abuse problem.’
“I think it’s a lot better that they take a step back and address it as, ‘We have a problem. The organization has a problem. We are concerned about your work-performance issues and, based on what we have observed in the last hour, we’re going to send you for a medical evaluation, which includes a drug and alcohol test.’ “
And don’t be too quick to fire a worker with an addiction, Alicea said.
“If you have an employee who’s worked for you for 10 years—and they’re a relatively good employee, and they end up testing positive—to terminate that employee, retrain another employee, and then go ahead and hire [another employee] … will cost you more money in the long run than to give that person an opportunity for rehabilitation by putting them on a last-chance agreement.”