With the rise of prescription opioid painkillers, the face of drug addiction has changed. “Most drug addictions today don’t begin on the street; they start in a doctor’s office with legal, valid prescriptions,” states Deborah Hersman, President and CEO of the National Safety Council (NSC). She goes on to explain, “Even when they are taken as prescribed, drugs such as opioids can impair workers and create hazards on the job.”

As employers strive to provide a safe work environment and maintain productivity, they may initially overlook the impact of prescription drugs in the workplace. However, a recent NSC survey shows that 71% of U.S. employers acknowledge being affected by these drugs, including opioids. While most companies have policies in place that cover illegal drug use, as well as alcohol abuse, dealing with prescription opioid abuse presents a different challenge.

Opioid Facts

First, what are opioids? Opioids are drugs that work in the same way that opium works. They interact with the brain’s nerve cells to relieve pain and increase pleasure. The good news is that they work quickly, allowing people to function without discomfort. The bad news is that it’s easy to become addicted over time.

Doctors can legally prescribe opioids, such as morphine (including morphine patches), oxycodone, or hydrocodone for all types of pain. Opioids are often given after surgery or an injury, and for chronic pain. There are also illegal forms, including heroin or illicitly-manufactured fentanyl.

How well do opioids perform? Perhaps too well; over two million people in the United States are dependent on or abuse them. More than four million use them without medical oversight. The International Narcotics Control Board estimates that Americans take 99.7% of the world’s hydrocodone supply. Some other facts about opioids to consider:

• Overdose is the leading cause of accidental death in the U.S. In 2015, there were 52,404 deaths from overdose. Of these, 20,101 were from prescription drugs and 12,990 from heroin.
• Over 75% of the nearly 21 million Americans affected by substance abuse are in the workforce, including family members who deal with addicts on a daily basis.
• Women are more likely than men to suffer from chronic pain and use prescription opioids for longer periods of time. The Centers for Disease Control and Prevention (CDC) reports that women also seem to become dependent more quickly than men.
• 80% of people who use heroin started with prescription drug abuse. They switched because opioids were too expensive and difficult to obtain.

From Prescription to Abuse

How misuse becomes addiction is a common story. A physician prescribes a painkiller for a legitimate medical reason. Most people take the medication according to directions, then stop when they feel better. For others, the feeling of euphoria that accompanies the pain relief is too good to give up. They continue to seek the drug, requiring larger doses to get the desired effect. The body adapts to having the drug; without it, withdrawal symptoms develop. Nausea, vomiting, muscle and bone pain, insomnia, diarrhea make it easy to return to drug use. Without treatment or intervention, the situation can escalate to overdose. (Learn more in "A Look At Prescription Drug Abuse Statistics".)

Opioid Abuse Effects in the Workplace

What does prescription opioid abuse look like in the workplace? According to the NSC survey, employers reported the following frequency of incidents among abusers:

• 39% absenteeism or missed work.
• 39% use of opioids on the job.
• 32% positive drug screen result.
• 29% impaired or poor job performance.
• 22% negative impact on employee morale.
• 15% near-miss accident or injury (Learn more in "Prescription Opioids and Safety Sensitive Work".)

Surprisingly, nearly three out of ten employees did not notice any incidents related to prescription drug use. This indicates a possible lack of awareness or education about the signs of misuse or abuse. Only 13% of employers felt “very confident” that they could detect misuse, and just 24% offer training on prescription drug abuse.

Dealing with Opioid Abuse in the Workplace

As with other types of substance abuse and addiction, employers should develop policies for prescription drug and opioid use. One difference from traditional drug-free workplace programs is that the employee bears a responsibility in reporting use of prescriptions that carry a warning about impaired function or possible misuse. The employer must provide specific actions if a worker is suspected of taking opioids without a prescription; if a large dose is being used; or if the medication is being taken more frequently than directed by a physician. (Learn more in "Managing Opioids in the Workplace".)

If prescription drugs are not part of the current drug testing panel, they should be added. Results are interpreted by the Medical Review Officer, who can directly follow up with any employee who has a positive result. (Learn more in "An Introduction to Opiates and Drug Testing".)

For companies with Department of Transportation contracts, information about disqualifying medications was updated on September 18, 2017. (Learn more in "DOT vs. Non DOT Testing: What's the Difference?") Although a physician can provide written supporting documentation or a Medical Examiner may occasionally approve the use of a prescribed medication, the policy is clear: “If a driver uses a drug identified in 21 CFR 1308.11 (391.42(b)(12)) or any other substance such as amphetamine, a narcotic, or any other habit forming drug, The driver is medically unqualified.”

Any type of substance abuse presents a risk to a company and its workers. According to Eric Goplerud, vice president of the Public Health Department at NORC at University of Chicago (formerly the National Opinion Research Center), companies can do more to help employees get treatment than family or friends. "Employers have some real skin in the game," he said. "Only about 10 percent of substance abusers obtain treatment, so if employers were to get that closer to 50 percent, which is the treatment rate for people with depression, it could mean major cost savings.” He estimates that each person who successfully recovers from drug abuse saves a company more than $3,200 a year.

Including prescription opioid drug use in the drug-free workplace policy is an important step to reduce company liability, as well as to assist employees who require treatment. Hersman states, “Encouragingly, 70% [of employers surveyed] would like to help employees who are struggling with prescription drug misuse return to their positions after completing treatment.”

The National Safety Council has developed some tools to assist employers:

• The Substance Use Cost Calculator to help companies determine the cost of drug abuse in the workplace.
• Free Prescription Drug Employer Kit, with information to create policies and manage opioid use on the job.