by Dave Gardner
America’s expensive and deadly workplace problem is finally coming out of the closet, and in the process creating new hope for employers dealing with a frustrating obstacle to their business operations.
The drama involves the increasing use of opioids in the workplace, often featuring legal prescription drugs such as OxyContin, Percocet and Vicodin. Some of these drug users will move on to heroin in their pursuit of warmth, drowsiness, and contentment, with greatly reduced levels of stress and emotional discomfort.
Opioid use is deadly serious. According to the U.S. Centers for Disease Control and Prevention (CDC), 91 overdose deaths are occurring daily across the nation, with at least 13 of those deaths occurring in Pennsylvania each day. The scenario is also creating catastrophic costs for employers and a tally of more than $55 billion a year, with each worker who becomes addicted costing their employer 25 percent of gross pay.
Margaret Jarvis, MD, medical director of the Geisinger Marworth Treatment Center, also serves as vice president on the board of the American Society of Addiction Medicine. She applauded the fact that many employers, and the public, are finally talking about opioids and treatment options are increasing, but also warned that addiction to these drugs is still worsening in Pennsylvania.
“If all of us in this arena quadrupled the number of treatment programs available, it still wouldn’t touch the full number of patients,” said Dr. Jarvis.
She explained that opioid addiction that eventually spills over into the workplace inevitably originates with a step ladder of pharma abuse or illegal drug consumption during a weak personal moment. Many users on the pharma track already have risk factors for addiction, and primary care physicians are often unprepared to deal with this scenario because a segment of the pharmacy pathway is not fully understood and needed research is vastly underfunded.
“We just don’t have a lot of understanding of who becomes addicted and who doesn’t, partly because the effects of varied DNA within people is so amazing,” said Dr. Jarvis. “Environmental factors such as family, childhood abuse and previous drug problems are all involved, but there also are many unknowns with risk factors.”
According to Dr. Jarvis, employers should have deep concerns about Washington’s attempts to greatly modify or repeal the Accountable Care Act, also known as Obamacare. This legislation’s mandatory essential benefits include mental health care, and without this requirement behavioral health dollars undoubtedly would be among the first to be abolished when costs are cut.
This stands in direct opposition to the fact that many more Americans, in the future, will need mental health care.
“Employers would then have to make tough dollar decisions,” said Dr. Jarvis. “Employees with a drug addiction problem and without insurance coverage are still legally protected.”
Another dark side of the opioid drama involves the reality that these drugs can affect brain cell operation in the long term, even after use is discontinued. This damage can decrease cognition and create a situation where the employer must watch for ongoing behavioral changes which can begin quietly.
Absenteeism, especially after a holiday, is a danger sign that active drug use is occurring, along with employee sharing medications from friends and family. Employees under the influence may also appear sleepy.
Dr. Jarvis is hoping that every employer with an AED machine to treat cardiac arrest will also have the drug Narcan immediately available for use. This is a prescription medicine that blocks the effects of opioids and reverses an overdose, and has been proven to save lives in a variety of scenarios.
In addition, a bi-partisan agreement has been achieved that altering the use of prescription opioids is vital for the public good. However, as these changes progress, Dr. Jarvis worries that sophisticated suppliers and dealers of the illegal opioids will evolve and push other mind-altering drugs.
“As we wrestle with all of this, it’s important to realize that alcohol remains our number one drug problem,” said Dr. Jarvis. “The opioids kill quick, but alcohol kills slowly and in large numbers.”
When employees witness workplace behaviors that may indicate altered consciousness, the employer should only address the situation if completely certain, according to Michelle Grushinski, past president of the NEPA chapter of the Society of Human Resources Management. She also explained that drug tests can be very helpful during pre-employment, post-accident, and case-by-case situations, with care taken in random employee selection for testing.
“We all must train our supervisors what to watch for, such as slow motor skills, behavioral changes, and inappropriate happiness,” said Grushinski. “The supervisor should see two or more signs before taking action, and the employer must have a consistent policy.”
Charles DeShazer, MD, senior vice president & chief medical officer with Highmark Blue Cross Blue Shield, outlined that his organization is concentrating on three areas of opioid assistance with proven strategies for employers. One emphasizes opioid non-use as pain killers, because total abstinence offers the most control of potential substance abuse.
“Pain relief and addiction vary by genomics, and each person has a unique DNA combination, so the best way to avoid trouble is not use opioids at all,” said Dr. DeShazer.
Highmark’s second strategy recognizes that some opioid administration for pain relief is appropriate, but physicians must assure safe utilization. This can be accomplished with controls set up by pharmacy benefit managers and compliance with CDC safe pharma guidelines.
Highmark’s third strategy revolves around effective treatment, intervention, and access when needed. Data clearly indicate that these types of active programs are needed, because opiates claimed at least 60,000 American lives during 2016 and the death toll is still headed upward for 2017.
“Every addiction costs at least $15,000 in medical claims, so addiction clearly is also a financial issue,” said Dr. DeShazer.
Dr. DeShazer sees a strong ray of hope by studying the historical use of opioids in America. Addiction peaked during the late 1800s and the 1960s into the early 1970s, but in both cases societal intervention ebbed the epidemic.
“We’re are now seeing a decrease in numbers of prescriptions being written for opioids,” said Dr. DeShazer. “Many people are always looking for more powerful highs, but treatment for addiction is advancing and becoming more sophisticated.”
A somewhat different view of the battle against opioids was delivered by John Cosgrove, executive director of the All One Foundation and Charities. He has become a frequent participant in community forums and panel discussions about these drugs, and has noticed the business community is finally talking about the problem.
“This new communication is generating awareness,” said Cosgrove. “Nothing is more powerful than a community coalition, but the answers we find must be comprehensive.”
He also has recognized that simply blaming the nation’s physicians for opioid addiction through pharma use is foolish. Cosgrove noted that, with any perplexing issue, a blame game seems to develop instead of the public focusing intently on true mitigation of the problem.
Cosgrove also emphasized that addiction is not a moral failing. Instead, it is a segment of a public health crisis involving disease, making denial of the crisis the prime enemy. He urges the region’s populace, including employers, to stop being amazed that opioids are all around.
“Once we shine light on a problem like this and openly discuss it, we learn we are not alone,” said Cosgrove. “Only then can we totally use the community resources that are available. Because the problem of addiction is finally coming out in the open, I am increasingly confident we will make progress.”