As Opioid Epidemic Rages, Worksite Policies Overlook Prescribed Drugs

How to craft drug policies to include prescription medications

Stephen Miller, CEBS By Stephen Miller, CEBS March 17, 2017

Seventy-one percent of U.S. employers say they have been affected in some way by employee misuse of legally prescribed medications, including opioids, according to a new survey.

"Most drug addictions today don't begin on the street; they start in a doctor's office with legal, valid prescriptions," said Deborah Hersman, president and CEO of the National Safety Council, a nonprofit chartered by Congress. "Employers must understand that the most dangerously misused drug today may be sitting in employees' medicine cabinets. Even when they are taken as prescribed, prescription drugs such as opioids can impair workers and create hazards on the job."

Most employers have a drug-free workplace policy directed at illegal drugs, along with an alcohol abuse policy, but most don't have a prescription drug policy in place, Hersman said during a press briefing. Meanwhile, "misuse has grown rapidly, and employers have struggled to keep pace."

The council's survey findings, released on March 9, build on 501 interviews with HR decision-makers across the U.S. at organizations with 50 or more employees. All respondents were involved in, or ultimately responsible for, their workplace's strategy and policies on health and safety (including drug and alcohol policies) or health care benefits.

7 in 10 Employers Have Felt Effects of Employees' Prescription Drug Use

Incidents include:

Rx misuse-2.jpg

Source: National Safety Council.
(Click on graphic to view in separate window.)

Other findings from the survey include:

  • 19 percent of employers feel "extremely prepared" to deal with prescription drug misuse in the workplace.

  • 81 percent lack a comprehensive drug-free workplace policy.

  • 41 percent of those that drug test employees are not testing for synthetic opioids.

"Encouragingly, 70 percent would like to help employees who are struggling with prescription drug misuse return to their positions after completing treatment," said Hersman.

[SHRM members-only HR Q&A: What laws should companies be aware of when implementing a drug testing program?]

Coverage of Alternative Therapies

Hersman advised employers to work with their insurers to cover alternative therapies so that employees can avoid taking opioids or other addictive medications for chronic pain. Alternative therapies include acupuncture, guided imagery, chiropractic treatment, yoga, hypnosis, biofeedback and others.

While 88 percent of survey respondents were interested in their health insurer covering alternative pain treatments, 30 percent of those employers indicated they would not act on that interest by negotiating expanded coverage with insurers—suggesting a missed opportunity to provide employees with healthier pain-relief options.

Establishing a Policy

Taking medications with a valid prescription is not illegal, which has made enacting prescription drug policies and understanding the need for them difficult, Hersman noted.

The National Safety Council provides a free Prescription Drug Employer Kit to help employers create prescription drug policies and manage opioid use at work. The kit recommends actions that HR managers can take, including:

  • Define the employee's role in making the workplace safe. A drug-free workplace program (DFWP) should state what employees must do if they are prescribed medications that carry a warning label or may cause impairment. Commonly abused medications include hydrocodone (prescription medications Lortab and Vicodin, for example); benzodiazepines (tranquilizers like Valium, Librium, Xanax); barbiturates (phenobarbital, butalbital, secobarbital, downers); methadone (increasingly prescribed as a painkiller); buprenorphine (often used to treat heroin addiction); and stimulants (like Ritalin and Dexedrine).

    The DFWP should also spell out the steps an employer will take if it suspects a worker is using these kinds of medications without a prescription, in larger doses than prescribed or more frequently than prescribed.

  • Add prescription drug testing to illicit drug testing. There are tests that detect legally prescribed and commonly abused medications, such as those listed above. Working with legal counsel, the employer should decide if additional testing is warranted for pre-employment screening, or for pre-duty, periodic, at random, post-incident, reasonable suspicion, return-to-duty or follow-up situations.

  • List the procedures or corrective actions the employer will follow when an employee is suspected of misusing prescription drugs or for an employee with confirmed prescription drug abuse. This should include how the misuse will be identified, what the worker's leave options are, what medical certifications are required for medical leave and the conditions that must be met before the employee can return to work.
  • Obtain legal advice. An attorney experienced in DFWP issues should review the policy before it's finalized.

  • Train supervisory staff and educate employees. Educate managers and supervisors about prescription drug abuse and what to do if they suspect an employee has a problem.

  • Review service coverage for behavioral health and/or employee assistance program (EAP) needs. Evaluate the behavioral health portions of health insurance policies and EAP contracts to ensure employees are covered for abuse of prescription drugs.

Employers have been held legally responsible when workers who were injured on the job and prescribed medications have accidentally overdosed, "but the biggest reason employers should care about the issue is out of concern for their employees," Hersman noted. "Research indicates that those struggling with substance abuse have better sustained recovery rates if their employers help them to receive treatment and monitor their recovery, than if treatment is initiated by family or friends," she said. "For some workers, employer engagement may be the difference between life and death." 

The Opioid Epidemic Affects Millions

According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), 4.3 million Americans are engaged in nonmedical use of prescription opioids, meaning they are taking these drugs without medical authorization, often purchasing them on the black market. Abusers frequently began taking prescription opioids under a doctor's care, then became addicted. Approximately 1.9 million Americans met the criteria for prescription painkillers "use disorder" based on their use of prescription opioids in the past year, SAMHSA reports.

Similarly, the American Society of Addictive Medicine (ASAM) found that, in 2015, 2 million adult Americans had a substance use disorder involving prescription opioids.

"Women are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher doses and use them for longer time periods than men," according to ASAM. As a result, "Women may become dependent on prescription pain relievers more quickly than men."

Related SHRM Article:

Drug-Free Program May Have Gone Too Far, SHRM Online Employment Law, March 2017

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