Opioid Addiction at Work: What Employers Need to Know
By: Reva Nelson
You can’t go more than few days without a major headline about opioid addiction and the massive toll it has taken on families, communities and our society. What is less discussed is that opioid addiction at work is also a serious concern for employers.
Across the U.S., prescription painkiller abuse is costing employers somewhere between $18 billion and $25.5 billion a year, due to missed workdays, lost productivity and medical expenses, according to recent analysis by the Centers for Disease Control and Prevention study and a study by Castlight Health.
As many as 71% of U.S. employers say they have been affected by employee misuse of legally prescribed medications as such opioids in a 2017 survey by the National Safety Council, based on more than 500 interviews with HR decision makers.
“It’s extremely prevalent, and employers and HR professionals need to be aware of this changing landscape,” says Tess Benham, senior program manager for the prescription drug initiative of the National Safety Council.
“Opioid addiction presents new challenges, such as impairment, safety, productivity and reputational risk for the firm, but also new opportunities to support employees and family members to get treatment,” she says.
Stay focused on performance.
“Employers need to recognize that addiction is a common illness that affects a wide array of people, from homeless people to first ladies,” says Ed Stellon, executive director of the Heartland Health Outreach. “It’s a disease like any other.”
But it’s often treated with judgment, unlike other illnesses. “It’s critical that employers recognize that they may carry some bias, and it’s important to check that bias right away,” says Stellon.
He urges employers to focus on the quality of work product and adherence to workplace policies and procedures. “We want to bring them in line with our expectations. We want to help them succeed -- not judge them.”
Take a fresh look at your policies and procedures.
While addiction is a disability covered by the Americans with Disabilities Act (ADA), “actively using drugs or violating an employer’s substance abuse policy is not protected,” said William R. Pokorny, labor and employment lawyer and partner with Franczek Radelet.
It’s worth making sure that those policies and procedures address over-the-counter (OTC) and prescription drug use such as opioids. “Employers should have a well-written and clear policy for employees on when drug use at work is appropriate,” advised Benham.
Companies with safety-sensitive positions -- operating heavy equipment, for example -- should be sure to include a provision in its drug and alcohol policies that require employees to notify HR if they are taking prescription medication or over-the-counter medication that may impair their ability to do their job safely.
Note that employees who voluntarily disclose to a supervisor or to HR their use of a prescription or OTC medication are protected by the ADA; conversely, employees whose drug misuse may impair workplace safety that is found through drug testing or after a safety incident are not protected under the ADA.
Seek input before taking action.
If you suspect an employee is misusing opioids, familiarize yourself with what employers can ask their employees, without getting into risky ADA territory.
“Seek input from an HR professional who is familiar with the ADA or legal counsel before taking action, said employment lawyer Pokorny. “These situations are complicated; you don’t want to go down the wrong road.”
Refer employees to EAP or treatment resources.
If your company has an employee assistance program (EAP), make sure employees are aware of it and know how to access it for confidential treatment.
“Make that referral and do what you can to make sure the employee follows up on it,” says Pokorny. “At same time,” he says, “it’s important to document performance issues and make sure employees understand what the expectations are.”
If you don’t have a EAP, it’s useful for HR professionals to be aware of who the treatment providers are in your community and how employees can access counseling, rehabilitation services and other mental health or alternative treatments.
Insurance coverage under the ACA
The good news (for the time being) is that treatment is more available (and more likely to be covered by insurance) than ever before.
In 2008, the Mental Health Parity and Addiction Equity Act required insurers and group health plans to cover behavioral health and substance abuse treatment at the same level of benefits they provide for medical/surgical care.
Yet there are no guarantees that this coverage will last. The House Republicans’ proposal to replace the ACA, known as the American Health Care Act (AHCA), passed the House on May 4, 2017. The AHCA rolls back Medicaid expansion, which is estimated to have provided drug treatment for close to 1.3 million people, according to a study by Harvard University and New York University.
Under the bill, states can obtain waivers to the requirement to provide minimum essential benefits -- allowing insurers to limit the scope of services they cover, such as addiction treatment. It also would repeal essential health benefits requirements for Medicaid plans, allowing states to stop covering drug treatment.
The proposed legislation is currently under review in the Senate, where it is likely to undergo substantial revisions. The final version will require Senate approval and the president’s signature to become law.
Be prepared to make reasonable accommodations.
When an employee asks for time off to seek treatment, the employer should be prepared to grant it within reason.
“This doesn’t mean the employer has to excuse performance issues, such as coming to work under the influence, violating safety precautions or workplace policies, or simply not showing up to work,” said Pokorny.
Reasonable accommodations might include time off to seek treatment, or temporarily modifying job responsibilities or performance expectations for protected medical use, etc.
Avoid getting too personally involved.
Supporting employees to get treatment does not mean employers should get personally involved in the employee’s decision-making or personal situation.
For example, said Pokorny, employers can refer employees to an EAP, but it’s not a good idea for the employer to tell an employee to go to a specific provider or treatment program as employers themselves don’t serve as healthcare experts.
“You have to defer to the employee,” he adds.
Opioid addiction is a shockingly common problem, and it can affect anyone, including highly functioning, successful professionals. Supporting workers to get treatment is not only right for the employee, it’s also right for the company -- saving money over the long term.
“Workers who have been in recovery for a year miss five fewer days per year than someone who is misuing substances, and one fewer day than the general population,” said Benham. “And they are less likely to change jobs than other workers.” That’s definitely a win-win.