‘Be the Change’ to Address Opioid Abuse in Your Workplace

It’s time to stop focusing on blame and start looking at solutions to make a difference by helping your employees with opioid abuse in the workplace.

That was the message from former Judge Jodi Debbrecht Switalski, a lawyer who specializes in medical malpractice and business liabilities related to substance use and abuse. Switalski spoke at The Alliance’s Opioid Epidemic Summit on July 24, 2018 at Monona Terrace.

As a treatment professional, prosecutor and judge in Detroit, Switalski saw firsthand the tragedies that occur when opioid use escalates to substance abuse. The consequences spread beyond the user to touch the family, friends, employer and community.

Every year, Switalski puts a Christmas ornament on her tree bearing the picture of a little boy who died when he was 18 months old from an opioid overdose caused by taking his mother’s Oxycontin pills.

The mother began taking Oxycontin when it was prescribed for pain following the boy’s birth, then gradually moved from legal to illegal use. After the mother modeled the behavior of taking pills to feel better, the toddler copied her actions and spent more than eight months in a coma before dying.

Switalski was involved in the prosecution of the parents, who pled guilty to manslaughter. She said approximately 40 percent of emergency room visits for opioid abuse each year involve children under age 6.

The Rx Gateway

A doctor’s prescription is the gateway to abuse for four out of five people who move from opioids to heroin, Switalski said.

She shared a grim list that reflects the opioid epidemic’s growing reach:

• 46 percent (almost half) of all Americans have someone in their family who suffers from substance abuse, which may involve use by themselves, a family member or a close friend.
• 75 percent of overdose deaths involve opioids.
• 65,000 people died of a drug overdose in 2017, with opioids making up the majority of the drugs involved.
• Most opioid users are ages 25 to 55, which is also the age range for high rates of overdose deaths.
• One in five young adult deaths in the U.S. is related to a prescription drug.
• Young adults who are opioid users typically start using opioids when they receive a prescription meant to treat pain following wisdom teeth extraction or treatment for a sports injury.
• 87 percent of opioid abuse users are white and are drawn from the upper middle class, since access to good insurance benefits often means more access to opioids.

Bigger, Broader Problems

Switalski warned that the full extent of the opioid epidemic is yet to be determined. For example, deaths from opioid use are likely undercounted, Switalski said, because the coroners who investigate deaths in rural communities often lack a medical background. Young users in rural communities die at higher rates because they lack access to treatment for addiction. According to Switalski, treatment doesn’t work anyway without recovery services.

She also cautioned employers against limiting substance abuse treatment to opioid abuse alone. Other drugs  – legal and illegal – as well as alcohol are all part of the problem.

“Maybe we should take it a little bit further and say we have an addiction epidemic in this county,” Switalski said. “I’m going to take it one step even further and say that we have a wellness epidemic in this country and it’s measured by opioid overdoses.”

This epidemic is closely tied to mental health issues and violent crimes, including school shootings.

“Substance abuse and mental health and violence don’t occur in isolation and they don’t stay out of the workplace,” Switalski said.

Are Employers Ready?

Studies show more than 70 percent of employers have been impacted by prescription drug use or abuse. Yet they are often ill-prepared to cope with workplace issues, with a study showing that:

• 19 percent feel extremely prepared to deal with prescription drug misuse.
• 76 percent are not offering training on how to identify signs of misuse.
• 81 percent lack a comprehensive drug free workplace policy.
• 41 percent of those who drug test all employees are not testing for commonly-used synthetic opioids such as oxycodone and fentanyl.

Workplace prescription drug use or abuse is costly for employers. Opioids cost U.S. employers $504 billion annually due to higher health care costs, higher absenteeism, lower productivity, more workers’ compensation claims and safety risks.

Five Steps to Take to Avoid Opioid Abuse

Switalski listed five steps that employers should take to protect themselves and their employees from the addiction epidemic.

1. Develop and update a written policy. The policy should:
   • Inform employees about drug use and abuse, including definitions of key terms;
   • Provide a notice about employee responsibilities and prohibited behaviors;
   • Be easy to understand, written at roughly the fifth-grade level.
   • Specify whether employees are required to disclose their use of legal prescription drugs.
   • Offer remedies for employees.
   • Address the full range of issues such as serving alcohol at workplace parties; drug testing; disciplinary actions, procedures and corrective actions; and the appeal process for impacted employees.
2. Educate employees. Employees need information about alcohol and drug use and abuse; how abuse can impact their families as well as their performance in the workplace; and the risks, benefits and side effects from using alcohol and drugs, including prescription drugs. Employees should continually encourage employees to seek help through an Employee Assistance Program (EAP) or other sources.
3. Provide supervisor training. Supervisors need to know the company’s written policy, understand the Americans with Disabilities Act (ADA), and learn how to recognize suspected signs of drug use or impairment. Supervisors need to know how to communicate with employees as well as how to document workplace use or abuse. Taking action is key to keep the workplace safe, while referrals to EAP programs or other sources of help are essential to help employees. Finally, supervisors need to know how to help employees return to work.
4. Make sure your EAP is ready to help your employees. Decide what questions you will ask to determine whether the EAP is equipped to help employees with addiction issues. For example, is the program certified? Does it have a well-qualified medical review officer (MRO)? How does it help employees get access to care that can help them recover? Does it make referrals for medication-assisted treatment, which can improve the effectiveness of addiction treatment?
5. Use drug testing appropriately. The federal government introduced new guidelines for urine testing programs effective October 2017. In addition, safety and federal disability laws apply. Drug tests should always be done by a certified lab with the results retained for one year. The written policy should spell out key issues, such as when and how the test is administered. Administration of drug testing policies must be consistent to show it is non-discriminatory. Defining the employees’ responsibility is important.

Switalski also urged employers to work with their pharmacy benefits manager (PBM) to have appropriate policies in place to restrain use of opioids and offer medication-assisted treatment.

Just Say ‘KNOW’

A nationwide campaign in the 1980s urged people to “Just Say No” to drugs.

Today, Switalski has updated that slogan to “just say know” to emphasize the power of educating yourself about the impact of opioids on your family, your friends, your workplace and your community.

With more knowledge, employers can move beyond “blaming” people who progress from legal prescriptions to opioid misuse. Instead, they can shift their focus to ways to “be the change” that can curb the addiction epidemic.

Switalski believes we can all, “Do something.”