Detecting and Dealing with Workplace Opioid Abuse

by Bobby Pirtle

To supervisors and managers who grew up during the 1960s and 1970s, the mention of addiction to heroin and other opiate drugs conjures images of skinny junkies wasting away in a filthy apartment, an alley, or a gutter. It was something that happened to other people in other places.

But that’s no longer true. The problems associated with abuse of these drugs appear to be greater than ever, and the users are well-hidden throughout America’s workplaces. A recent study of 200 Indiana employers conducted by the National Safety Council and the Indiana Attorney General’s Prescription Drug Abuse Prevention Task Force reported that prescription drug abuse currently affects 80 percent of companies.

Think there’s a difference between prescription drugs and heroin? Think again. Among the most-abused drugs are synthetic opioids that are prescribed by well-meaning doctors. Familiar painkillers such as Vicodin, Oxycontin and Percocet were developed to mimic the effects of opiate drugs such as heroin in a more controlled fashion.

About two in three of the employers who were surveyed saw prescription drug abuse as a bigger problem in their workplaces than illegal drugs, with one in five reporting that there had been an injury or a near-miss related to prescription drugs. A quarter said employees had borrowed or sold prescription drugs at work, and 40 percent said that an employee had missed work time because of prescription drug abuse.

According to a medical journal, American employers lost more than $25 billion to prescription opioid abuse in 2009, and experts believe the problem has grown far larger. Just as chilling, the Centers for Disease Control reports than 44 Americans die each day as a result of abusing prescription opiates.

Opiates and opioids

Generally, the word “opiate” has been used to represent drugs that are derivatives of the opium poppy, such as heroin, morphine, and codeine. Another term, “opioid” has been used to describe synthetic drugs built upon the chemical structures of opiates. Familiar prescription painkillers known as Oxycodone, Hydrocodone, Fentanyl, Vicodin, and Percocet fall into this category. However, the terms are becoming interchangeable.

Why has use of these drugs increased so much? The simple reason is that they are highly effective painkillers, so doctors are comfortable prescribing them. In fact, the Workers Compensation Research Institute reports that 65 to 85 percent of injured workers who received pain medications from 2010 to 2012 were given prescriptions for opioid drugs.

Many workers receive those prescriptions, use the drugs for a few days, and stop taking them when their pain improves. But for some workers, the feelings experienced while on opioids are so pleasurable, or the need for pain relief so strong, that they become addicted. Some become so dependent on the drugs that they visit multiple doctors for prescriptions, a tactic known as “doctor shopping.” State officials and pharmacies have worked together make doctor shopping more difficult, so many addicts are forced to buy from friends, coworkers, or street dealers.

Prescription opioids carry high prices on the street, and when users can no longer afford them (or can’t find any), many turn to an option that packs a much stronger punch for a fraction of the cost: heroin. The drug has become so plentiful that in many areas, it is now cheaper than marijuana. Users typically begin by snorting or smoking heroin, but as their tolerance grows, many begin to inject it.

Opioids and workers

According to the federal Substance Abuse Mental Health Services Administration, roughly 10 to 12 percent of workers are under the influence of alcohol or illegal drugs while at work. Those numbers are likely to be higher in a number of industries, particularly construction, manufacturing, and trucking.

Even if workers aren’t addicted and are simply following a doctor’s directions, the powerful painkillers can create a hazard. The familiar “do not operate heavy machinery” labels are there for a reason, and heavy machinery includes cars and other worksite vehicles.

Signs of abuse

The old stereotype of the junkie described earlier is less applicable today. Many opiate abusers with costly habits are not readily identifiable as addicts. They come from nearly every walk of life, and many have good jobs and what appear to be stable families. But as addiction progresses, their hunger for and focus on their next “high” tends to crowd out the other aspects of their lives.

Opioid addicts tend to be in one of two stages while at work. If they are under the influence of the drugs, at first glance, they may seem to be relaxed and functioning well. However, there may be evidence of mood swings or major changes in energy level. They may appear to nod off while on the job or fall asleep at their workstations, in their cars, or even while using the bathroom.

Then, as the effects of the last dose wear off and the craving for the next begins, they may display signs of withdrawal. The symptoms often appear to be the same ones associated with flu or gastrointestinal “bugs,” including nausea, diarrhea, sweating, shaking, aches, and a runny nose. They may also become irritable and anxious. A worker whose addiction has progressed to injected heroin may need to repeat a dose every few hours, going through the cycle several times a day.

Other warning signs of abuse include an unusually high number of pill bottles in trash cans. Addicted employees may develop serious financial problems, requesting advances on pay or trying to borrow money from or sell things to coworkers. It’s not unusual for addicts to withdraw from the social aspects of work, and a once-gregarious worker may suddenly become quiet and sullen.

Steps to take

Pre-employment and random drug screenings are an excellent strategy for detecting (and providing a deterrent against) drug abuse in the workplace. However, the survey of Indiana employers discovered that while 87 percent of the employers conduct drug testing, just 52 percent include screens for opioids. In addition, only 53 percent of the employers had policies addressing the use of prescription drugs on the job (although 80 percent reported having had an issue with such use in the past).

Would you or your team recognize that an employee was abusing opioids? The Indiana survey found that 60 percent of employers doubted their staff’s ability to spot warning signs, but fewer than 30 percent offer supervisors training about detecting abuse of prescription drugs. The National Safety Council recommends that employees and supervisors receive training to help them spot addiction and respond effectively.

Should you fire an employee who abuses opioids on the job? While 76 percent of employers believe they’re entitled to do so, Indiana Attorney General Greg Zoeller cautioned that an employee who is being treated for addiction might be considered to have a disability. He urged employers to seek legal counsel to clarify their policies.

A better approach than firing for most companies can be an employee assistance program that ensures that employees with any type of substance abuse problem can get treatment, rehabilitation, and support, so they can successfully return to work.

Don’t ignore it

It’s human nature to not want to confront someone about addiction, or to mention a colleague’s apparent addiction to a manager. But when it comes to opioid addiction, there are two important reasons that people should be encouraged to speak up. The first is that a worker with an addiction will place himself and his fellow workers at risk of injury, and could become involved in criminal acts such as theft to support his habit.

Even more important, addictions may become significantly worse over time, possibly ending in an accidental overdose. Speaking up about what appears to be an abuse problem could very likely save that worker’s life.

Reminder: There are several courses on recognizing drug and alcohol abuse in the TargetSolutions site available to all CSD Pool members at no cost.

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