He’s one of your best employees, but lately, he seems to be having trouble concentrating. He doesn’t have the energy that he had before his injury and has even begun coming back late from his lunch breaks because he falls asleep while sitting in his car.
He told you he was prescribed OxyContin for the painful back injury he sustained on the job. Is this a case of opioid overuse or dependence? And if it is, what should you — his supervisor — do about it?
Treatment practices contribute
The workplace is not immune from the effects of the opioid epidemic that is raising alarm across the U.S. In fact, treatment practices for work-related injuries are likely contributing to the problem, since pain from those injuries is increasingly being managed with powerful prescription opioids. The Workers’ Compensation Research Institute says opioids were the pain medicine of choice for about 65 to 85 percent of injured workers in the U.S. from 2010 to 2012.1 The Institute calls opioid overuse a “top priority health problem.”
The effects of this epidemic on public health have been stunning. Opioid overdose deaths and substance abuse treatment admissions rose sharply between 1999 and 2010, according to a 2011 analysis2 by the Centers for Disease Control and Prevention – the same time period in which opioid pain reliever sales quadrupled.
While opioids can help effectively manage pain, repeated or long-term use increases the probability of dependence and addiction. When their physician-authorized refills run out, some users are desperate enough to switch from prescription drugs to cheaper, riskier substitutes, like heroin.
A dangerous slide
“What starts as a perfectly reasonable use of the drug for pain relief, soon starts to slide into taking too many, too often,” writes Steve Albrecht, D.B.A., in a Psychology Today article entitled, “The Opioid Addict in Your Office.”3 “Once the patient slips from, ‘one pill every four to six hours,’ to ‘six pills a day,’ and then on to double figures, what started as a legitimate medical use has given way to addiction.”
Signs to watch for: trouble concentrating, a lack of energy and mood swings (in the impairment phase) and irritability, anxiety, nausea and watery eyes (in the withdrawal phase).
While identifying drug abuse is important, bringing the opioid epidemic under control must begin with prescription best practices. The Centers for Disease Control and Prevention (CDC) has issued guidelines4 for prescribing opioids for chronic pain that are based on three key principles: 1) Nonopioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care; 2) When opioids are used, the lowest possible effective dosage should be prescribed; and 3) Providers should always exercise caution when prescribing opioids and monitor all patients closely.
Supervisors have a number of testing options that will help them determine if an employee has a drug (or alcohol) problem, such as pre-employment testing; reasonable suspicion testing and post-accident testing. Many companies have employee assistance programs (EAPS) to which the employee can be referred.
Some addicted employees may be reluctant to ask for help — out of fear that they will lose their job or an unwillingness to admit that they have become dependent on a legal substance. Likewise, some supervisors may find it difficult to take action about a possible drug problem. Albrecht offers this motivation: confronting an opiate-impaired employee could save his or her life.