On Oct. 26, 2017, President Donald Trump confirmed what experts had long-observed in many U.S. communities: opioid use had reached epidemic levels, and the epidemic merited the declaration of a public health emergency.
In 2017, opioid overdoses claimed the lives of more than 49,000 Americans, per statistics from the National Institute on Drug Abuse. Estimates by the Centers for Disease Control indicate that about 115 overdose deaths occur per day, and the epidemic itself is still far from over.
The widespread impact of opioid addiction means no community entity, from schools, sports teams to places of worship, is exempt — and that includes employers. Opioid addiction forced an estimated 20% of men to leave the workforce, according to a 2017 paper by a Princeton University economist. Others are tasked with taking care of family members and neighbors affected by the epidemic.
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Opioid headlines in 2017-18
Meanwhile, employers are left with disengaged workers who may miss significant chunks of time. One prominent study revealed the epidemic has cost the U.S. $1 trillion since 2011, much of that total reflected in lost wages, productivity and tax revenues. And recruiters are stuck in locales hit hard by opioids, with little to no skilled labor available to fill copious job openings. So how have employers fared in facing these challenges? HR Dive asked a group of experts for their observations over the past year, as well as their recommendations for moving forward.
Rethinking health plans and prescriptions
Many employers have taken important first steps to address the epidemic by talking with their health plans and pharmacy benefit managers (PBMs).
"Best case scenario, employers have updated their benefits and policies to limit coverage of opioids, expand coverage of alternative pain treatment and enhance payment for substance abuse and addiction programs," Shira Wilensky, national practice leader, health and well-being at OneDigital, said in an email to HR Dive.
Likewise, workers are generally aware that a problem exists, said Mary Kay O'Neill, partner, health, at Mercer.
"Local government has been hit very hard as they try to provide adequate services for those who are impacted," she told HR Dive in a statement. "As employers have asked their PBMs to change their formularies limiting the size of the first opioid prescription, the PBMs have provided that change to all clients as part of their quality improvement programs."
At the same time, sources said that there's more opportunity around education than employers might first think.
"There is still plenty of room for progress among employers to address the costs associated with position vacancies, workforce shortages, recruitment and healthcare," David Guth, CEO of healthcare nonprofit Centerstone, told HR Dive in an email. "Through the education and training of leaders and managers, a culture of a recovery friendly workplace can have a significant impact on the costs associated with shortages due to addiction or substance use disorders."
Employees may not even know the full extent of their employers' efforts in combating the crisis. That's a missed opportunity for engagement, Wilensky said. A brief mention of policy changes during open enrollment may not be enough.
"This is about employers empowering their employees to be advocates for themselves and in their communities. It is a huge opportunity for employers to send a message that they care about their employees and the communities they serve," she said.
The caregiver effect
Those in charge of taking care of loved ones need to know that they have tools at their disposal, Guth said. "An important element of the recovery includes employment coaching — training newly recovered employees to become more engaged, responsible employees by addressing a whole host of environmental barriers to employment — like transportation, housing and ongoing support."
Employers can help to break down some of those barriers by leveraging short-term leave, employee assistance programs and other offerings. But a supportive culture can make outreach efforts stretch farther, Wilensky said. Drug abuse can be a shame-inducing experience, and the fear of a penalty can prevent some from getting much-needed help.
"The more we can show some compassion and care about our employees, the more they want to care about their job."
National practice leader, health and well-being, OneDigital
"They may have been suffering in silence for quite some time to where their manager has noticed a decline in performance and addressed the impact on work productivity, but not stopped to ask if the employee is 'ok' or try to understand the cause of performance decline," Wilensky said. "The more we can show some compassion and care about our employees, the more they want to care about their job."
Claims data shows that young adults are disproportionately affected by the epidemic, O'Neill said. She recommended use of employee assistance programs, and suggested HR work with leave administrators to meet the needs of a given family.
"There are a number of employees whose families are in crisis," O'Neill said. "They need accurate information, support and time to deal with this issue."
Looking to alternatives
Alternative treatment options, including but not limited to physical therapy, have been adopted by some employers in addressing the epidemic. U.S. Surgeon General Jerome M. Adams made these options a talking point among employers during a speech in April. But Wilensky explained that there are some barriers to alternative therapies.
"It's easier to pay for a claim than to put a preventive program in place to avoid the person needing care in the first place," she said. "It's a culture and mentality with 'quick fix' at the core. It's because physical therapy is labeled as 'alternative.' Automatically, the connotation is that it's less effective or less 'science-based,' which is obviously not true."
It's also easy to attack the problem through prescription sizes, O'Neill said, but a more difficult path to change the way doctors treat pain. "This change is occurring but slowly," she said. "The other important steps include screening people for opioid use disorder, getting them to high quality treatment promptly and having a plan to get people back to work. There are employers that are leading the way on this and they have the biggest impact on what other companies will take on."