The Other Epidemic: Opioid Misuse and Your Employees
The ongoing COVID-19 pandemic is still making headlines, displacing another epidemic that started earlier and worsens every year. In 2017, the Department of Health and Human Services (HHS) declared the opioid epidemic a public health emergency. While drugs like cocaine and methamphetamine are also major causes of addiction and overdose, the opioid crisis has been particularly crushing in communities across the United States. In many cases, a substance use disorder begins with a doctor’s prescription for routine pain relief, because the pharmaceutical manufacturers have deliberately misled the public about how highly addictive prescription opioids, such as OxyContin, are. The misuse of prescription opioids may lead, over time, to abuse of illegal drugs such as fentanyl and heroin, especially if the doctor will no longer renew the script.
According to the Centers for Disease Control and Prevention (CDC), more than 107,000 Americans died from drug overdoses in 2021, a 15 percent increase from 2020. Of those, over 71,000 – approximately two-thirds of all overdose fatalities – were caused by fentanyl and other synthetic opioids, a 23 percent increase from 2020. This continues to be a public health crisis of epic proportions, and should be on every employer’s radar, especially those that sponsor a group health plan.
Raising Employees’ Awareness
Employers disregard opioid misuse at their own peril. According to a 2017 report in the Journal of Occupational and Environmental Medicine, 60 percent of adults with a pain medication disorder are in the work force. For employers with a high number of workers’ compensation claims, this should be of particular concern, as an addiction may begin after an opioid is prescribed for an injury.
Education is paramount, for both management and employees. Many individuals trust that prescription drugs are safe, and addiction only happens to “other people” taking illicit “street” drugs. The thought that pharmaceutical management of chronic back pain could lead, within months, to heroin addiction seems an impossibility. But naiveté about opioids has led to this very nightmare for millions of Americans and their families. Everyone is at risk.
According to the Mayo Clinic and Johns Hopkins Medicine, simply taking a drug like OxyContin for more than a few days greatly increases the risk of long-term use and thus addiction. While opioids can be a necessary part of the treatment protocol for certain patients, such as those suffering from terminal cancer, an otherwise healthy individual should be made aware all treatment options, their efficacy and relative risks. Although the patient’s physician and pharmacist should be educating the individual about proper opioid use, it’s clear that is not occurring with sufficient regularity. Employers can help to fill in the gaps.
To begin, keep a close eye on your workers’ compensation and short term disability claims as you become aware of them. If it seems possible the employee’s health condition could result in an opioid script, consider providing them with information about the risks of such legally prescribed medication. You could also proactively offer such information to all employees taking a medically-necessitated leave, as you may not be apprised of all diagnoses.
The National Safety Council (NSC) has created a toolkit addressing opioids in the workplace, with various resources geared toward different audiences, including human resources departments, supervisors and employees. You can find it at https://www.nsc.org/pages/prescription-drug-employer-kit. For example, you could consider sharing the first two pages of the “Understanding Opioids” document with employees at the point their leaves commence.
The Business Health Care Group (BHCG) also offers a free opioid toolkit at https://bhcgwi.org/opioid-toolkit/. This organization is based in Wisconsin, but the resources are universally applicable for raising awareness. One of these is a PowerPoint template with content you can use to create your own presentation, customized for your workplace and benefit plans. It contains comprehensive detail on identifying opioids, recognizing opioid misuse, seeking help, how to safely dispose of medication, and possible alternative treatments. You could use this presentation for manager training, annual benefits enrollment and/or new hire orientation.
Helping Employees Avoid Opioids
The State of Michigan is one of seven states that currently have a non-opioid advance directive form available. If your employees reside in any of these states, you may want to consider providing the applicable directive to employees, perhaps in annual enrollment materials or via your benefits administration system, if employees can find benefits-related resources there. It allows individuals to inform their health care providers that they do not want to be administered or prescribed an opioid, outside of clearly defined and limited circumstances. The directive should be included in a patient’s medical records, unless it is later revoked. It may be of particular importance to individuals in recovery from a substance use disorder.
Michigan’s non-opioid directive is found at https://www.michigan.gov/opioids/find-help under “Additional Resources.” (The form is available in English, Spanish and Arabic editions.) An employer is not obligated to provide the directive, but there is no harm in doing so. If you do wish to extend it to employees, it’s best to include a brief explanation, letting employees know they are responsible for giving a signed copy to all of their medical and dental providers.
Supporting Those Who Need Help
Sometimes education will not be enough. Employees and their dependents, struggling with opioid misuse and addiction, will need a higher level of assistance, both in the workplace and from the benefits plan. Take a close look at your leave policies and health coverage specific to substance use, to ensure employees have robust support if they are struggling with opioids.
In August 2020, the Equal Employment Opportunity Commission (EEOC) released guidance regarding the rights of opioid users in the workplace. While employers can terminate employees who illegally use opioids, those who are legally taking prescribed opioids are generally protected by the Americans with Disabilities Act (ADA). (There are some exceptions, such as transportation workers.) The employer must consider reasonable accommodations that allow the individual to continue working safely, such as shift changes or a transfer to another position. But it does not mean the employer is required to accept poor performance or behavioral issues.
A substance use disorder or addiction is a “serious health condition” per the Family and Medical Leave Act (FMLA). This means an eligible employee can take FMLA leave for the treatment of a substance use disorder or addiction if the necessary medical documentation is provided. In addition, an employee may request FMLA leave to care for a family member who is in treatment for a drug problem. An employer is under no obligation to pay the employee during an approved FMLA leave, although the employee may simultaneously be eligible for payment via an insured disability policy, salary continuation through an employer-paid disability plan, or coverage under a state disability plan.
Reevaluate the mental health and substance use disorder benefits in your health plan. Assuming your plan provides such coverage, you should confirm it is in compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). In short, the plan must provide the same level of benefits for mental health and substance use disorder treatment as for medical and surgical treatment. This means, for example, that the plan cannot place limitations or greater member cost-sharing on hospitalization for an opioid overdose than for a heart attack.
Consider what employees are paying for outpatient treatment of mental health and substance use disorders. While it may technically be permissible to have counseling services subject to the deductible and coinsurance, that cost burden may discourage individuals from seeking the necessary treatment. You may want to change employees’ liability to a flat-dollar copay with network providers, just as they would pay for a medical office visit with a primary care doctor.
Above all, do your best to remove the stigma from recognizing and treating a substance use disorder or addiction. Employees may already feel ashamed and scared, so they need encouragement and compassion when seeking and completing treatment. If you offer an employee assistance program (EAP), regularly communicate its availability to your workforce, so they understand they have 24/7 access to trained professionals, who will keep their information completely confidential. Ensure that managers and supervisors are familiar with the EAP, and know to recommend it to employees as an effective way to address a wide variety of life and wellbeing issues.
Opioid misuse continues to ravage American communities and families, including those who believed themselves immune to such health and social problems. Employers are in a unique position to see employees’ struggles up close, as a spiraling addiction is often reflected in behavioral and job performance changes, which could be hidden from others. There are a variety of meaningful steps you can take, from education to benefits plan design, to help bring this crisis to an end.