Drug addiction was no longer front-page news by the time President Ronald Reagan left the White House. But fast forward three decades, and a nationwide opioid addiction is making headlines news again, creating a resurgence in the use of deadly illegal substances.

Opioids are a family of drugs that includes heroin, synthetic drugs such as fentanyl, and pain relievers like oxycodone, hydrocodone, codeine and morphine, according to the National Institute on Drug Abuse (NIDA). Prolonged use can lead to addiction and in 2016, opioids killed a record 42,000 people, the Centers for Disease Control says; 40% of those deaths involved a prescription opioid.

The impact of drug use on the workplace is substantial. But there are steps employers can take to both curb problems and prevent future abuse.

The workplace dilemma

Not since the dangers of tobacco or alcohol use entered the public conscientiousness has there been anything as destructive as opioid abuse, Terri L. Rhodes, CEO of The Disability Management Employer Coalition, told HR Dive.

The workplace is bearing much of the fallout of the current drug epidemic. U.S. Bureau of Labor Statistics numbers show drug overdose as the fastest growing cause of death at work, surpassing traffic accidents, violence and toxic-chemical exposure. Of the 5,190 workplace fatalities in 2016, overdoses made up a small percentage of deaths, but they increased by more than 30% that year.

Forced to deal with chronic absenteeism, lateness, turnover, lost productivity and even crime caused by addiction, employers have a real stake in assisting employee combat addiction.

The cost of addiction is also sobering; the healthcare costs of substance abuse alone amount to $600 billion a year, NIDA says. And for employers, there also can be associated workers' compensation costs and productivity losses, according to Dr. Todd Simo, HireRight's chief medical officer.

Legal triggers

Workers who are using drugs illegally aren't ​covered by the Americans with Disabilities Act (ADA); those who were formerly addicted are protected from discrimination based on that past drug use, however.

And many employees are using drugs such as opioids legally, which means employers must exercise care when conducting drug tests, Simo notes. A positive result could easily trigger the ADA's accommodation requirements.

​And if an employer believes that drug use was involved in a workplace accident or injury, this could trigger a post-accident/injury test under the Occupational Health and Safety Administration (OSHA), says Simo. 

Addiction screening and the labor market

Workplace drug-testing isn't without controversy, but it remains one of employers' key defenses against bad hiring decisions. Simo notes that the existence of drug-screening policies varies by organizations' sizes and industries, but says he believes all employers should be concerned about the effects of drugs on safety and productivity.

A Princeton University study found that drug addiction is driving 20% of men out of the workforce. Some say this is worsening the tight labor market, but Simo says he isn't seeing employers struggle to find talent as a direct result.  "From a talent perspective, based upon the [Princeton study], an illicit drug user is not your ideal candidate. From an access to talent perspective, I have not seen a drug-free workplace (DFWP) as a major barrier to [hiring qualified workers]," says Simo. In his experience, Simo says he's seeing employers receive fewer, but better, applicants.

At least one expert, however, says employers may want to reconsider zero-tolerance policies. As marijuana use gains acceptance — and even protection — employers may want to end that testing, Andrew Challenger, vice president of global outplacement and executive coaching at Challenger, Gray & Christmas, Inc., said in a statement. Companies are starting to treat marijuana like alcohol or legal drugs, he said.

Employers’ role

Rhodes says employers can take preventive measures, starting with recognizing the need for pain management. Opioids ease many people’s pain, but the result can be debilitating abuse, she says. The key, she says, is awareness, early detection and intervention.

“Opioids work by essentially supplanting the brain’s dopamine reward system. Therefore, for those addicted to these drugs, it is very difficult to obtain pleasure through any means other than consuming them,” says Rhodes. “Opioids are among the most highly addictive drugs, legal or illegal, in widespread use today.”

Although employers can’t do much medically to help addicted workers manage pain, says Rhodes, they should be aware of the signs and symptoms of chronic pain syndrome:

• Stress, depression, and anxiety;
• High pain ratings/drug dependency;
• Disability out of proportion to physical findings; and,
• Somatization, which is the production of recurrent and multiple medical symptoms with no discernible organic cause.

Some employers have added pain management to their wellness programs to help workers cope with back pain and arthritis — a move that could help curb opioid dependence.

According to Rhodes, at the core of the opioid epidemic are physicians and the physician community, which she says are over-prescribing medications with little regard for the consequences. From a benefit perspective, she says insurance companies and prescription benefit management companies must prohibit doctors from over-prescribing pain killers, adding that sanctions for those that do so might be necessary.

Sanctions can rise to the level of having physicians' prescription licenses taken away, but even monetary sanctions could be effective, she suggests. "The insurance companies don’t teach the doctors about absence management or pharmaceutical management, but they have contracts with hospital networks and physician groups where these doctors are employed.” She recommends that insurance companies write up agreements on prescribing medications and put in place monitoring systems to oversee doctors who are over-prescribing too many dangerous medications.

Finally, Rhodes also recommends that employers make sure their insurance carriers have protocols for monitoring opioid prescriptions and providing statistics on what’s occurring; get employee assistance programs’ support; and educate employees about opioid addiction and where to go for help.