The misuse and abuse of prescription opioids has become a serious health concern. Employers should recognize the health and safety implications of this problem and address it in their drug and alcohol policy, as well as through education and employee assistance programs.
Opioids in the Workplace
According to the Centers for Disease Control, the United States is facing an opioid overdose epidemic. Deaths due to opioids quadrupled between 2000 and 2014. At least half of these deaths were due to prescription opioids, which makes it a serious concern for employers.
It is safe to assume that at any time, a number of employees within your company may be taking some form of prescription opioids, as they are currently the most widely prescribed drugs for pain relief. Opioids are also present in some other prescription medications. Employers should make sure to address the opioid epidemic, as these drugs present a serious risk to employees, particularly those in safety-sensitive positions. (Learn more in "Prescription Opioids and Safety Sensitive Work") Employers also face potential costs in terms of lost productivity, incidents and injuries, and litigation as a result of prescription drug impairment.
Opioids and Their Effects
Opioids include natural opiates derived from the poppy seed (morphine, heroin) as well as semi-synthetic and synthetic opioids, which have the same effects on the body. (Learn more in "An Introduction to Opiates and Drug Testing"). Opioids are most often prescribed to manage pain, but they also affect the central nervous system. People respond differently to these drugs but they can cause drowsiness, poor memory and confusion, decreased cognitive functioning, and impairment of neuromuscular coordination. The effects of opioids are increased when used in combination with alcohol or other psychiatric medication. Abuse of opioids, even with a single large dose, can cause severe respiratory depression, which could be fatal.
These side effects could also lead to altered judgement as well as slower movement and reaction time in the workplace. Based on current research evidence, the American College of Occupational and Environmental Medicine recently issued practice guidelines that persons who are on opioids for an acute or chronic condition should not perform safety-sensitive work in order to prevent potential accidents and injuries to the employee, coworkers, and the public.
Opioids provide safe and effective pain management when they are used as prescribed for acute pain and for a short period of time. However, these drugs are powerful and highly addictive, and when they are taken in high doses, taken for extended periods, used in higher doses than prescribed (or higher than therapeutic ranges), or are illegally abused, there is a high potential for impairment and subsequently for lowered productivity, errors, and risks in the workplace.
Additionally, overuse and/or extended use of opioids can result in tolerance, where higher doses are required to relieve pain, and in physical dependence, where the person experiences withdrawal symptoms when the drug is discontinued. Tolerance and dependence can lead to increased use of the drug and make it difficult for the person to stop using it. Psychological effects of misuse and substance abuse of opioids can include withdrawal from social interaction, secretive behavior, anxiety, mood swings, apathy, and depression. Eventually, addiction can occur, which is characterized by compulsive drug seeking behavior.
Managing Opioids in the Workplace
In the past, workplace drug and alcohol use and testing policies covered opiates associated with illegal drug use and addiction. (Learn more in "8 Things Employers Should Know About DOT Drug and Alcohol Testing".) However, the drug misuse and abuse landscape has changed and employers need to give attention to the potential health and safety risks associated with all opioids, including those which are legally prescribed. In some instances, neither the employee nor the prescribing physician may be aware of the potential occupational health and safety risks.
Managing prescription opioids in the workplace presents challenges different to those of alcohol and illegal drug use in terms of the rights of the employee. When the employee tests positive for this drug, he or she may present a legal prescription, which could even be for an injury sustained at work, and the employee may or may not have a problem with dependency or addiction. This, however, does not rule out the fact that the employee might be impaired and unable to function effectively and safely at work. Workplace policies, employee education, supervisor training, drug testing, and employee assistance programs can all work together to help you manage opioids in the workplace.
Workplace drug and alcohol policies (Learn more in "The Importance of a Good Drug and Alcohol Policy in the Workplace") should be revisited to make provisions for prescription opiates, including employees’ responsibilities with regard to potential impairment from these drugs. The company’s legal team should be involved in policy development, particularly as it relates to drug testing, to ensure that all state guidelines are included and that it does not encroach on employees’ legal rights.
The most important contribution of employee education is not only to prevent incidents and injuries, but also to provide the knowledge necessary to avoid dependence, addiction, and overdose before it occurs.
Employees need to be educated about the side-effects of prescription opioids and the potential of impairment as well as the risks in the workplace. They should know to discuss concerns with their health care provider should an opioid painkiller be prescribed, especially if they are in a safety-sensitive occupation. They should also be informed of the potential for dependency and addiction to opioids, who they can turn to in the event of a problem, and what assistance the employer can provide.
The policy regarding opiates in the workplace should be explained to employees, including the reasons for the policy and their responsibilities towards the employer if an opioid has been prescribed for them. They should know when drug tests will be conducted, how results will be managed and the consequences of a positive result.
All supervisors should have in-depth knowledge and understanding of the policy relating to prescription drug use, including any changes in drug-testing policy and procedures. They must be encouraged to consider safety and make job accommodations where necessary if an employee informs them that they are on prescription opioids.
Supervisors should be trained to recognize the signs of potential impairment, how to document suspected problems clearly and fairly, and how to manage situations of possible drug misuse or abuse sensitively and confidentially.
The most commonly used tests for drugs do not protect employers against the opioid epidemic because they do not test effectively for the semi-synthetic and synthetic opioids, which are the types generally prescribed for pain management. Employers should consider introducing the 12-panel test, which more effectively identifies opioid painkillers than the common 5 panel and 7 paneltests.
Any drug testing policy should include clear guidelines on what type of testing will be conducted, who handles the test results, the role of the medical review officer who interprets the results, and how confidentiality will be maintained.
Employee Assistance Programs
Considering the high cost of employee turnover, support for those who have a problem with opioid abuse is the most cost effective solution. This includes confidential access to treatment, changing the employee’s job temporarily if treated while remaining at work, or reintegration into the workplace after successful treatment.
Employers should recognize that prescription drugs can have a major impact in the workplace and that the most important action is to have a strong policy in place. Employees and supervisors should be educated about the dangers of these drugs and trained to recognize the signs of impairment. Substance abuse should be treated as a disease for which assistance programs are available to help the employee achieve full recovery.