Employers Play Key Role in Preventing Painkiller Abuse

An estimated 12.9 million people in the workplace are using drugs illicitly, and working beside them are millions of co-workers taking powerful painkillers legitimately prescribed by their doctors for their intended purpose. Some members of both groups will become addicted, affecting their health, behavior, relationships, and workplace productivity and accuracy, according to experts interviewed by BNA.

Employers are in a key position to help and have much to lose by not taking some kind of action, and yet many companies minimize the extent of the issue.

“Many [employers] will say, 'There is nobody in my workplace that has a problem with substance abuse,' especially painkillers, but that's just not true; it's not possible,” Marina London, a licensed social worker and spokesperson for the Employee Assistance Professionals Association, told BNA.

Employers can help treat worker drug issues, however acquired, by creating a comprehensive program that employees feel safe using, London said. And they can help employees with pain issues avert many of the problems that come from a singular focus on medicines and getting back to work quickly, by taking a more holistic approach.

Ideally an employer program would have the support of top management, be integrated with health care benefits, and be well communicated, London said.

A Substantial Problem for Employers

According to the latest figures from health care information giant IMS Health, over 120 million prescriptions for controlled substance painkillers are dispensed annually.

These substances include codeine and codeine-combination medicines, synthetic narcotic analgesics, and morphine/opium derivatives--powerful analgesics that also carry a severe danger of addiction.

Citing figures from the Substance Abuse and Mental Health Services Administration (SAMHSA), Omar Manejwala, a physician and medical director at alcohol and drug addiction rehabilitation provider Hazelden, noted in a recent communication with BNA that an estimated 8 percent of the employed population abused drugs within the last month. “That's approximately equivalent to the estimated prevalence of diabetes,” which is 8.3 percent, Manejwala said. Drug abuse affects all professions and all socioeconomic classes, he said. “For an employer to believe there is no drug addiction in their workplace would be as absurd as believing there is no diabetes, both of which are treatable chronic diseases,” he said.

Manejwala told BNA that painkiller addiction can be a “silent” problem. Individuals may have a valid prescription for the substance they are taking, he said. Further, Manejwala said, unlike alcohol, pills are not likely to be seen and do not emit any telltale odors. In addition, he said, the symptoms of withdrawal are similar to the flu, and thus can be hard to detect.

“It's a big problem,” management attorney Nancy Delogu, a Littler Mendelson shareholder who specializes in the area of workplace substance abuse, told BNA. “Prescription drug addiction has skyrocketed in the last five years.”

Delogu said employers are not constrained by the Americans With Disabilities Act from terminating workers who are engaged in illicit drug use.

Very often, however, employers call her because they have a good employee they believe is addicted but want to retain. She said she often helps employers draft policies encouraging employees to come forward for help with substance abuse issues before their jobs are impaired.

Westley Clark, a physician and the director of SAMHSA's Center for Substance Abuse Treatment, told BNA that employers often over-focus on workers who may be using drugs illicitly--without a prescription and for nonmedical purposes--while not recognizing employees who are misusing painkillers while under a doctor's care.

Both groups can get help from addiction treatment plans, but there is another dimension to the problem of employees whose initial problem began with pain.

While narcotics can help employees dealing with pain, they are not a panacea and should always be used as part of a comprehensive pain management program, Clark said. Effective treatments also can include physical therapy and acupuncture, he said, among other types of care.

Sometimes employees misuse medicine because they are rushing back to work instead of taking the time to recover from an injury or chronic situation, Clark said.

Employers should be aware of the hazards in trying to take a short cut to getting an injured worker back to work quickly, Clark urged. “In our zeal to return to normal, we deny the fact that we have a problem,” he said. “Pain medications seem like a panacea,” he said, “but you need to acknowledge that you're not up to snuff and there should be no disincentives to gradually returning to normal.”

Clark added that physically demanding jobs and jobs where accidents are more apt to occur are particularly likely to have workers who are dealing with how to manage chronic pain.

According to London, when it comes to addressing substance abuse, “the senior executive team sets the tone.” She noted that when executives are open about the issues, taking the attitude “All of us have problems, we can all use help,” you get the “biggest bang for the buck” with drug treatment programs. “If you just pay but don't support and endorse,” she said, it weakens any efforts the company may make.

Some executives feel it makes the company “look bad” to have a drug program, London said, especially in white collar occupations, but being a white collar worker is no protection against suffering from an addiction.

First and foremost, employers should include information about addiction in employee newsletters, post signs indicating the symptoms of addiction and how to confidentially access help, and, for high-risk or safety-sensitive populations, screen for addiction (with urine drug screens, etc.), Manejwala said.

Employers also should remind workers they will not be terminated for seeking help, he added.

Attorney Delogu stressed that even if a manager suspects a drug issue, any conversation with an employee should focus on performance and refer the employee to the EAP for evaluation, if necessary. An employee who is referred for treatment should be treated like anyone else with a health condition and provided their full rights under the ADA and the Family and Medical Leave Act, she said.

If a company tells a worker it suspects he or she is using drugs, the employee could become protected under the ADA's “perceived as” provision, Delogu said. Focus on the absenteeism or other workplace behavior, she advised.

In many cases, employees who have been referred to a rehab program will be asked to sign a “last chance” or “return to work agreement,” Delogu noted. These agreements need to be very clear, she said. They may stipulate, for example, that an employee agrees to future drug testing by the employer or that a health care worker will not have access to the narcotics dispensary.

“There's an art” to making sure such agreements cover all the bases, she said.

“I have clients call and say 'We love the guy and we think he has a problem, we would like to get him into a 30-day program,' ” Delogu said. “I say, 'You can't do that, but you can refer him to the EAP.' ”

By Cathleen O'Connor Schoultz