Interact Sensitively with Employees Addicted to Opioids
Opioid addiction is running rampant across the U.S. According to the National Institute of Drug Abuse, 8-12 percent of patients prescribed opioids develop an opioid use disorder. Read this blog post to learn more.
Employees who abuse opioids often are given a second chance by their employers. But well-meaning employers could wind up being sued for discriminating against those workers in violation of the Americans with Disabilities Act (ADA) if they don't handle the situation very carefully.
Opioid addiction has been rampant in the U.S. for some time. More than three out of five drug overdose deaths last year involved an opioid, and overdoses rose 70 percent in the 12 months ending September 2017, according to the Centers for Disease Control and Prevention.
So what can HR professionals do about it? If a worker admits to the problem, the path is fairly clear. But if the employer merely suspects that an employee is addicted to prescription pain relievers but has no real proof, the employee should be treated like any other employee who is having attendance or performance issues, said Kathryn Russo, an attorney with Jackson Lewis in Melville, N.Y.
An employer should never accuse someone of having an addiction, because if the employer is wrong, the accusation could lead to an ADA claim, Russo cautioned. Although current drug use isn't considered an ADA disability, a history of drug addiction is. Moreover, someone using prescription drugs might have an underlying condition covered by the ADA.
If an employee admits to opioid abuse, or the problem is discovered through drug testing, the employer should discuss it with the employee to determine if he or she needs a reasonable accommodation, such as leave to obtain treatment, Russo said. The illegal use of drugs need not be tolerated at work, she added.
Reasonably accommodate the employee so long as there's no direct threat to the health and safety of himself or herself, or others, recommended Nancy Delogu, an attorney with Littler in Washington, D.C.
Drug Testing
The Equal Employment Opportunity Commission has opined that employers may ask about an employee's use of prescribed medicine or conduct a drug test to determine such use only if the employer has reasonable suspicion that its use will interfere with the employee's ability to perform the job's essential functions or will pose a direct threat.
Many employers are expanding their drug-testing panels to include semisynthetic opioids such as hydrocodone, hydromorphone, oxycodone and oxymorphone, in addition to traditional opioids such as heroin, codeine and morphine, Russo said. This is lawful in most states as long as the employer does not take adverse employment actions when drugs are used legally, she noted, which is why an employer should use a medical review officer in the drug-testing process. If the medical review officer concludes that the positive test result is the result of lawful drug use, the result is reported to the employer as negative.
Sometimes an employer will say it has reasonable suspicion that the employee came to work impaired by drug use and is considering a mandatory drug test. At that point, some employees will say the drug test would be positive and the test consequently is not necessary.
Discussions with Employees
If there are performance problems and the employee has admitted to opioid addiction, some employers tell employees that they can remain employed so long as they go through inpatient treatment. Delogu discourages that approach. Employers aren't workers' doctors, so they shouldn't be deciding whether someone needs a treatment program, she explained.
But if someone voluntarily seeks to enter an addiction-recovery program, that person may have legal protections under state law, said Wendy Lane, an attorney with Greenberg Glusker in Los Angeles. For example, California has a law requiring employers with 25 or more employees to reasonably accommodate alcohol and drug rehabilitation.
Delogu recommended that employers that believe there is a problem with substance abuse ask if the addicted employee needs assistance from the employee assistance program.
An employer can require that an employee who has violated a policy be evaluated by a substance abuse professional and complete treatment prescribed for them, without dictating what that treatment will be, she said. The employer may choose to forgo disciplinary action if an employee agrees to these terms and signs an agreement to this effect. The employer then would not have to be informed about the person's decided course of treatment, whether inpatient, outpatient or no treatment at all, she said. The employee typically will be subjected to follow-up drug testing to make sure he or she hasn't resumed the use of illegal drugs.
Many employers are willing to give employees with performance problems resulting from opioid addiction a second chance, she noted.
SOURCE: Smith, A. (1 November 2018) "Interact Sensitively with Employees Addicted to Opioids" (Web Blog Post). Retrieved from https://www.shrm.org/ResourcesAndTools/legal-and-compliance/employment-law/Pages/employees-addicted-to-opioids.aspx
What employers can do to combat risks of workplace opioid abuse
How can employers combat the risks associated with workplace opioid abuse? With an increase in opioid use, employers are now tasked with the challenge of addressing opioid misuse in the workplace. Continue reading to learn more.
The opioid epidemic presents a unique challenge for employers. While opioids can be beneficial for employees suffering from pain, they also pose grave risks and dangers for companies as even appropriate use of the drugs can cause impairment and lead to accidents.
For example, if an employee had an accident and suffers an injury, you may see the physical signs of the injury. However, it’s not as obvious if the employee was prescribed opioids for the pain associated with that injury. If the employee doesn’t disclose the prescription, they could resume their everyday duties, like operating machinery, when they should be restricted while using the drug.
Due to the increasing prevalence of opioid use, employers are likely now challenged with addressing misuse in the workplace. Often, companies may not know the best approach to supporting employees dealing with an opioid addiction. When speaking with employers, it’s important to stress the need for organizations to be well-versed in opioid misuse and ways to proactively identify and address it.
Employers can work to combat opioid use in their organization by providing accommodations and updating their policies, procedures and employee communications. Here are a few ways they can get started.
Short-term accommodations
If an employee is taking prescribed opioids for an injury and has specific limitations or restrictions, an employer can work with a disability carrier to determine potential short-term accommodations that can be made to meet the employee’s needs. Short-term accommodations can help keep an employee comfortable and productive at work during his or her recovery.
Policies and procedures
If an employer hasn’t done so already, it should consider putting a comprehensive drug policy in place to help it address issues that may arise if an employee misuses prescription drugs. The policy should include a description of available assistance options for employees who are struggling with substance abuse and clearly state consequences for employees who violate the policy, empowering supervisors to take appropriate action in response to employee issues.
Destigmatizing use
It’s easier to help someone if they come forward, but right now, stigma surrounding opioids can cause employees to keep their prescription use to themselves. Encouraging open lines of communication can help companies destigmatize prescription drug use so their employees feel comfortable disclosing the medications they’re taking that could limit them at work.
Fostering transparency, combined with short-term accommodations and clear policies, can help employees feel more comfortable coming forward with their condition. Remind employers that their disability carrier can be a great resource to help with education, recommend proactive ways to address misuse at their organization and create accommodation plans for employees in need. With these steps, employers can help support their employees and, ultimately, make the workplace a safer place for all.
SOURCE: Jolivet, D (16 October 2018) "What employers can do to combat risks of workplace opioid abuse" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/what-employers-can-do-to-combat-workplace-opioid-abuse-risk
Senate passes bill to combat opioid epidemic
Recently, the Senate passed a bill to help battle the opioid crisis. This bill is designed to battle opioid and other prescription drug misuse within the United States. Read this blog post to learn more.
Both parties got behind a bill designed to fight the misuse of opioids and other addictive medications, with a sole Republican voting against it as it passed in the Senate.
See also: Employers take steps to address opioid crisis
As reported by the Associated Press, Utah Republican Mike Lee was the sole dissenting voice as the bill was passed 99-1.
According to the reports, the legislation’s reach is broad, with provisions for deeper scrutiny of arriving international mail that could contain illegal drugs; money for the National Institutes of Health research on nonaddictive painkillers; paving the way for pharmaceutical companies to conduct research on alternatives; approval for the Food and Drug Administration to require drug manufacturers to provide opioids and similar drugs in smaller quantities and packages; and provides federal grants for treatment centers, emergency worker training and prevention research.
See also: The days of employers ignoring the opioid crisis are over
It also would push physicians to discuss pain management alternatives with Medicare patients, something that could have an effect on Department of Health and Human Services data indicating that a third of Medicare Part D prescription plan users in 2017 were prescribed opioids.
“I recognize these provisions are just a start, but we are losing 116 lives every day. And we need to save as many as we can—as soon as we can,” Sen. Gary Peters (D., Mich.) told the Senate.
Funding for the provisions of the measure will have to come from separate spending bills, and for the bill to become law, it will have to be reconciled with legislation that passed the House back in June. Despite the high level of tension between Democrats and Republicans at present, according to the Wall Street Journal, “Senate aides are optimistic the measures can be reconciled and passed by the end of the year.” Still, opioid use is definitely a bipartisan issue, hitting red and blue states alike, with preliminary data from the Centers for Disease Control and Prevention indicating that in 2017 U.S. overdose deaths from all drugs set a record and ballooned to more than 72,000.
SOURCE: Satter, M. (18 September 2018) "Senate passes bill to combat opioid epidemic" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/09/18/senate-passes-bill-to-combat-opioid-epidemic/
The days of employers ignoring the opioid crisis are over
What do employers need to know to help their employees and help reduce the risk of the opioid crisis? The opioid crisis is affecting companies' productivity, medical claims, work injuries and their bottom line. Read this blog post to learn more.
Productivity, medical claims, work injuries, and the company’s bottom line — what do these things all have in common? They are all being drastically affected by the effects of substance abuse. The opioid crisis that is running rampant across the United States is having an impact on employees at every level.
As an employer, what do you need to know to support your employees and reduce the risk of this national crisis?
First, you need to educate yourself on the facts. According to the National Institute on Drug Abuse, every day, more than 115 people in the U.S. die after overdosing on opioids. It is not just the deadly heroin/fentanyl combination that we have been hearing about in the news, sources of opioid addiction include prescription pain relievers such as hydrocodone, oxycodone, oxymorphone, morphine, codeine, and other prescribed substances.
See also: Taking A Page From Pharma’s Playbook To Fight The Opioid Crisis
The Center for Disease Control and Prevention estimates prescription opioid misuse in the U.S. cost $78.5 billion per year; affecting medical spend, productivity, and law enforcement supervision.
Substance abuse does not discriminate on any demographic, however if your business is construction, entertainment, recreation, or food service, the National Safety Council found your employees are twice as likelyas the national average to have substance abuse disorders.
Secondly, you need to take action. The most important thing an employer can do is to have a proactive plan in place to help your employees live a healthy lifestyle. It is easy to get in the habit of saying “that does not happen here,” but the reality is substance abuse can — and does — happen anywhere.
Solving the opioid crisis won’t happen overnight, but here are some steps to take to build a better relationship with your employees and quite possibly help someone overcome a substance abuse problem.
Train your staff. Explain what resources are available to help them help your employees. If you have an employee assistance program in place, leverage it, and have the information easily available so any employee can access the information at any time. This will help lower the fear barrier for employees who are not ready to ask someone they know for help. If you do not have the right resources in place today there are many programs available, and it is important that you adopt one that will fit your culture and help employees be high performers.
See also: Employers take steps to address opioid crisis
Show employees you care. Look for signs and symptoms that an employee might have a problem with substance abuse. Make sure supervisors, managers, and team leaders are aware of these signs and what actions they should take. Have an open door policy, and make sure your employees feel they can ask for assistance when they need it. It is important to know how to handle sensitive, often painful, discussions in a professional and action-oriented manner. It is essential that you have the right steps in place to ensure leadership is aligned with the organization’s strategy on how best to help your at-risk population.
Be transparent. Have clear policies in place that promote a drug-free workplace. Consider expanding your drug testing panel to include opioids.
Share the savings. Consider sharing the dollars a successful well-being program will save your organization’s bottom line through lower prescription drug costs and less lost productivity due to illness and time away from work.
See also: A look at how the opioid crisis has affected people with employer coverage
If your organization is struggling with how to successfully address the challenges of substance abuse and opioid addiction, seek out employee benefit consultants to help you develop a strategy for success. Like anyone with an addiction, there is no shame in asking for help.
SOURCE: Panning, C (7 September 2018) "The days of employers ignoring the opioid crisis are over" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/employers-cannot-ignoring-the-opioid-crisis?feed=00000152-a2fb-d118-ab57-b3ff6e310000
Employers take steps to address opioid crisis
By addressing opioid misuse, employers could in turn have more productive workers and lower healthcare costs. Continue reading to learn more.
President Donald Trump declared the nation's opioid crisis a "public health emergency" last month, underscoring employer concerns about this growing epidemic.
The opioid crisis cost the U.S. economy $95 billion in 2016, and preliminary data for 2017 predict the cost will increase, according to a new analysis from Altarum, a health care research and consulting firm. Addressing opioid misuse could lead to more productive workers and lower health care costs.
U.S. employers are increasingly seeking ways to reduce the abuse of prescription opioids, according to new findings from the Washington, D.C.-based National Business Group on Health (NBGH), which represents large employers.
NBGH's Large Employers' 2018 Health Care Strategy and Plan Design Survey found that the vast majority of big employers (80 percent) are concerned about abuse of prescription opioids, with 53 percent stating that they are very concerned. Thirty percent have restrictions for prescription opioids, and 21 percent have programs to manage prescription opioid use.
The survey was conducted between May 22 and June 26, and reflects the strategies and plan offerings of 148 U.S. employers, two-thirds of which belong to the Fortune 500 or the Fortune Global 500.
"The opioid crisis is a growing concern among large employers, and with good reason," said Brian Marcotte, NBGH president and CEO. "The misuse and abuse of opioids could negatively impact employee productivity, workplace costs, the availability of labor, absenteeism and disability costs, workers' compensation claims, as well as overall medical expenses."
Given the widespread nature and expanding scope of the opioid crisis, some employers are working directly with their health plans and pharmacy benefit managers (PBMs) to address the issue, the survey showed. Those that are working to manage opioid use most often use the following strategies:
- Limiting the quantity of pills on initial prescriptions for opioids.
- Limiting coverage of opioids to a network of pharmacies and/or providers.
- Expanding coverage of alternatives for pain management, such as physical therapy.
- Providing training in the workplace to increase awareness and recognition of signs of opioid abuse.
- Working with their health plans to encourage physicians to communicate about the dangers of opioids and to consider alternatives for pain management.
Apart from these measures, employers are:
- Increasing communications and training for managers and employees to raise awareness of the issue.
- Identifying people who may be at risk for addiction who could benefit from help.
- Encouraging employees to take advantage of an employee assistance program, the health plan and other resources for help and treatment.
Different Pain Management Approaches
Janet Poppe, senior director for payer and employer relations at Pacira Pharmaceuticals, based in Parsippany-Troy Hills, N.J., advises using a multitherapy pain management strategy to minimize opioid use—especially following surgery, which she called "the gateway to the opioid epidemic."
"Opioid monotherapy is the current standard of care for postsurgical pain management," Poppe said on Nov. 14 at the National Alliance of Healthcare Purchaser Coalitions' 2017 annual conference, held in Arlington, Va. She cited research showing that:
- 98.6 percent of inpatient surgery patients receive opioids to manage postsurgical pain.
- 92 percent of postsurgical patients who receive opioids for acute pain report adverse side effects such as urinary retention or respiratory depression, the treatment of which can be costly.
In another study, more than 10 percent of patients who were prescribed an opioid within seven days of surgery were identified as long-term opioid users one year after surgery. Other research shows that 1 in 15 patients who receive an opioid post-surgery become chronic users.
Local anesthetics, anti-inflammatory drugs and nonopioids such as sodium-channel blockers are among the options available to address pain without the addictive and debilitating effects of opioids, Poppe said. "Using two or more nonopioid pain relievers that act on the body in different ways can produce a better result, at a lower cost, than using opioids."
"There is a need to generate widespread public awareness of the role that postsurgical opioids play in the larger public health crisis in the U.S.," Poppe noted. Health plan sponsors should work with their insurers or third-party administrators to alleviate the risks associated with opioid dependence by encouraging nonopioid pain-management approaches, she advised. Employers can:
- Cover and demand opioid-free options for employees.
- Ask provider networks what they are doing to reduce opioid use post-surgery.
- Educate employees about discussing alternative pain strategies with their doctor. Pacira'sPlanAgainstPain website offers resources.
- Change benefit designs to steer employees to surgeons and facilities using alternatives to opioids
"To stem widespread opioid abuse, state actors and employers must urge insurers to remove barriers to care, including prior authorization for medication-assisted treatment (MAT) and nonopioid treatments for pain management," Caleb H. Randall-Bodman, a senior analyst for public affairs with Forbes Tate Partners in Washington, D.C., said in an e-mail.
"Patients, especially those in great need, will take the most affordable and accessible treatment available. As such, the epidemic will not end until patients have access to 1) affordable, comprehensive pain management, and 2) comprehensive treatment for substance use disorders," said Randall-Bodman, who works with the American Medical Association's taskforce to reduce opioid abuse.
SOURCE: Miller, S (28 November 2017) "Employers take steps to address opioid crisis" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/steps-to-address-opioid-crisis.aspx
While Talk About Opioids Continues In D.C., Addiction Treatment Is In Peril In States
How is Washington handling the opioid crisis? Let's find out in this article from Kaiser Health News.
Opioids were on the White House agenda Thursday — President Trump convened a summit with members of his administration about the crisis. And Congress authorized funds for the opioid crisis in its recent budget deal — but those dollars aren’t flowing yet, and states say they are struggling to meet the need for treatment.
The Oklahoma agency in charge of substance abuse has been told by the state’s legislature to cut more than $2 million from this fiscal year’s budget.
“Treatment dollars are scarce,” said Randy Tate, president of the Oklahoma Behavioral Health Association, which represents addiction treatment providers.
It’s like dominoes, Tate said. When you cut funding for treatment, other safety-net programs feel the strain.
“Any cuts to our overall contract,” he said, “really diminish our ability to provide the case management necessary to advocate for homes, food, shelter, clothing, primary health care and all the other things that someone needs to really be successful at tackling their addiction.”
In just three years, Oklahoma’s agency in charge of funding opioid treatment has seen more than $27 million dollars chipped away from its budget — thanks to legislative gridlock, slashed state taxes and a drop in oil prices (with the additional loss in state tax revenue that resulted).
Jeff Dismukes, a spokesman for Oklahoma’s Department of Mental Health and Substance Abuse Services, says the already lean agency has few cost-cutting options left.
“We always cut first to administration,” he said, “but there’s a point where you just can’t cut anymore.”
The agency may end up putting off payments to treatment providers until July — the next fiscal year. Tate says that could be devastating.
“Very thinly financed, small rural providers are probably at risk of going out of business entirely — up to and including rural hospitals,” he said.
Getting treatment providers to open up shop in rural areas is really hard, even in good times, and more financial uncertainty could make that problem worse. In the meantime, according to an Oklahoma state commission’s opioid report, just 10 percent of Oklahomans who need addiction treatment are getting it.
That statistic is similar in Colorado. And as 2018 began, Colorado’s escalating opioid crisis got worse, when the state’s largest drug and alcohol treatment provider, Arapahoe House, shut its doors.
The facility provided recovery treatment to 5,000 people a year. Denise Vincioni, who directs another treatment center, the Denver Recovery Group, says other facilities have scrambled to pick up the patients.
Most of Arapahoe’s clients were on Medicaid. Autumn Haggard-Wolfe, a two-time Arapahoe House client who is now in recovery, worries the facility’s closing will have dire consequences, especially for people who need inpatient care, as she did.
“I feel like the only other option right now in therapy would be jail for people,” she said, “and people die in there from withdrawing.”
Arapahoe House’s CEO blamed its closure on the high cost of care and poor government reimbursement for services.
The mother of Colorado state lawmaker Brittany Pettersen struggled with addiction, and was treated at Arapahoe House. Pettersen says treatment centers rely on a crazy quilt of funding sources and are chronically underfunded — often leaving people with no treatment options.
“We have a huge gap in Colorado,” Pettersen said, “and that was before Arapahoe House closed.”
She is pushing legislation in the state to increase funding for treatment. But to get tens of millions of dollars in federal matching funds, Colorado lawmakers need to approve at least $34 million a year in new state spending.
That price tag may simply be too high for some lawmakers. But either way, she added, “It’s going to take a lot to climb out of where we are.”
Colorado did get new federal funds to fight the opioid crisis through the 21st Century Cures Act, passed in December of 2016, but it was just $7.8 million a year for two years — divvied up among a long list of programs.
Read the article.
Source: Daley J.,Fortier J. (5 March 2018). "While Talk About Opioids Continues In D.C., Addiction Treatment Is In Peril In States" [Web Blog Post]. Retrieved from address https://khn.org/news/while-talk-about-opioids-continues-in-dc-addiction-treatment-is-in-peril-in-states/
