Helping Employees in Recovery from Opioid Use Disorder

The opioid epidemic has been impacting the U.S. since at least the turn of the 21st century. From 1999 to 2021, nearly 645,000 people died from an opioid overdose, including prescription and illicit drugs, according to the Centers for Disease Control and Prevention. The number continues to climb due in part to the proliferation of fentanyl, a powerful synthetic opioid.

This crisis has spilled over into the workplace as well. Data from the nonprofit National Safety Council in 2019 showed that while 75 percent of U.S. employers had been directly affected by opioids, only 17 percent of them felt “extremely well-prepared” to address the issue.

“The impact on the workplace cannot be overstated,” said Cheryl Canzanella, a retirement solutions partner at Movement Mortgage based in Jacksonville, Fla. and speaker on the opioid crisis who lost her husband to opioids. “Opioid use disorder is hitting America’s workforce hard, and organizations are paying a huge price.”

By learning more about opioids in the workplace, along with how to help affected employees, employers can be better prepared to handle this crisis when they encounter it.

What Is Opioid Use Disorder?

Considered a chronic condition, opioid use disorder is “a problematic pattern of opioid use leading to problems or distress,” according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. One may be diagnosed with opioid use disorder if they have a strong desire or urge to use opioids; they give up or reduce their activities because of opioid use; they take larger amounts of opioids over time or use them for longer than they intended; they have recurring problems at work, school or in social situations; and they experience withdrawal symptoms.

Jo McGuire, executive director of the National Drug and Alcohol Screening Association, said that in a word, opioid use disorder is “insidious.”

“People who never imagined they would fall into substance use disorder can become intensely addicted to pain medication in a very short time,” she said. “Opioids create a physical dependency that change how the brain functions and reacts to pain and pain tolerance. Combine that with the side effects of having intense physical pain symptoms when one ceases their opioids use [the ‘dope sick’ effect] and it becomes a tremendous challenge for those who feel the only way to treat that pain is with more meds. It’s a cyclical nightmare, and no one who finds themselves struggling in this way wanted it or sought it out.”

In the workplace, opioid use disorder can cause significant difficulties, Canzanella said.

“It is a huge problem for businesses and one that will get much worse if not addressed immediately,” she said. “If not addressed, it can lead to absenteeism, impaired employees, accidents and decreased job performance, creating a negative impact on employee health, safety, productivity and the overall bottom line to company revenues.”

However, if businesses properly tackle opioid use disorder—which they may be legally required to do—they can end up helping the affected employee and everyone involved.

The correct response “could put a positive spin on the [negative] impacts and could contribute to an overall healthier and more supportive work environment for all employees,” Canzanella said.

Employers’ Obligation to Employees

In the workplace, there are protections for people recovering from, or regarded as having, opioid use disorder. The Americans with Disabilities Act (ADA) prohibits discrimination against employees who are in recovery and not engaging in illegal drug use. Plus, according to Kathryn Russo, an attorney at Jackson Lewis in Long Island, N.Y., who specializes in legal issues related to workplace drug and alcohol testing, opioid use disorder is a disability under the ADA and comparable state laws.

The disorder “likely is a ‘serious health condition’ under the FMLA [Family and Medical Leave Act], so employers must be aware of their obligations under those laws,” she said. “They may be required by law to address it … by allowing medical leave to obtain treatment and potentially offering other reasonable accommodations.”

Additionally, McGuire said that employers cannot discriminate in cases where ADA protections provide relief to those who are seeking treatment and where FMLA applies.

“This can be the opportunity one needs to get into recovery and begin their journey to healing,” she said.

Drug Testing for Opioids

Russo said the laws on drug testing are complex and depend in part on the employer’s industry, as well as whether an employer is covered by certain federal regulations.

“For example, employers that are regulated by the operating agencies of the U.S. Department of Transportation are required to conduct certain types of drug tests, and the tests must include opioid testing,” she said. “Employers who conduct drug testing and are not regulated by federal regulations may conduct drug testing under applicable state and local laws. Most state and local laws do not dictate whether to test for opioids.”

Typically, drug tests for opioids only focus on codeine, heroin and morphine.

“Employers who have concerns about the use of additional types of opioids may wish to consider expanding their drug testing panel to include synthetic or semi-synthetic opioids such as hydrocodone, hydromorphone, oxycodone, oxymorphone and fentanyl, assuming they are permitted under applicable law,” Russo said.

While drug testing is a valuable tool, McGuire said, it should be used to create proactive responses, and employers need to have a prevention and intervention mindset.

“Random drug testing can aid significantly in creating protective boundaries that motivate a person in recovery to achieve the accomplishment of a negative test result,” she said. “My colleague [recently] received an email from a person in recovery thanking them for providing the drug test. It was an incredibly expressed gratitude by a person who got their life back and kept their job. When employers back away from drug testing, they are putting their own liability on the line, but they are also avoiding opportunities to create avenues of help for those who fall into the trap of substance use disorder.”

Supporting Employees in Need

Along with following the FMLA, ADA and other applicable laws—and doing drug testing when necessary—employers need to lead with compassion, experts said. McGuire suggested allowing employees to go to 12-step meetings before work and during lunch, replacing the word “addict” with “person in recovery,” and being patient and supportive.

“Stand beside them shoulder-to-shoulder in their fight, because they are fighting for their lives as if this was a battle with cancer or any other horrible disease,” she said. “Give them dignity, respect, value and worth.”

Employers can also watch out for work performance indicators that an employee is struggling and offer employee assistance program services with substance abuse professional evaluations. These can help an employee determine if it’s time for outside intervention.  

“This is really a huge mindset change” for employers McGuire said. “And company policies must reflect that they are prepared to embrace recovery-friendly workplaces.”

Kylie Ora Lobell is a freelance writer based in Los Angeles.