It's estimated over 300,000 emergency room visits occur each year due to opioid misuse. And it's not just emergency rooms which are affected—workplaces are, too. Some employees misuse prescription medications to improve job performance, overcome lack of sleep, or to alleviate pain. Other employees are affected by the opioid crisis at home, when their family (children and aging parents) misuse, as well.
There are clear implications for employee health, absenteeism, productivity, and safety. In late 2016, two national surveys indicated the need for more prescription misuse prevention in workplaces. Although 70 percent of employers are negatively affected by prescription misuse, less than 25 percent actually educate workers on prevention. Also, at least 30 percent of employers provide no access to alternative treatments that can be especially helpful in addressing pain.
Most company approaches to prescription drug abuse focus on harm reduction and risk mitigation, rather than prevention, which begins with awareness. This reactive mindset is not surprising, given news stories on the crisis focus on the supply side (the over-prescription problem) and treatment. Moreover, standard drug testing only goes so far in addressing the problem, as these are, ostensibly, prescribed drugs.
Almost no attention has been given to training employees through proactive prevention and awareness. Indeed, employee training is the strongest driver of employer preparedness to deal with the problem. A proactive approach can help those at risk and actual misusers of prescription drugs. This can save employers greatly on both medical and productivity costs. A recent cost calculator, developed by researchers and the National Safety Council, helps employers estimate costs associated with employee substance abuse in general.
The nationwide crisis presents brokers with a timely opportunity to deliver a real solution. Employers can now use evidence-based worksite programs that engage employees at the earliest stages of their prescription use in a non-threatening way and steer them (and their family members) to safe alternatives. This article will demonstrate what such evidence-based programs ought to look like, their efficacy, how to implement them, and the corollary benefits that accrue to brokers who promote such programs.
Awareness + training = prevention
The way the Center for Disease Control (CDC) operates its alert and advisory systems for threats is instructive. Just witness how the agency contained the Zika outbreak. The CDC's alerts went beyond warnings sent to communities across the U.S. They took proactive, coordinated steps, from controlling mosquito populations to eliminating the conditions. By doing so, the CDC was able to address both the sources of the disease and the conditions that promoted its spread. A similar approach to the prescription drug crisis would likewise address the problem at its root, dealing with the underlying conditions that prompt Rx misuse, and raising awareness to promote more responsible, health conscious behaviors.
We recently conducted a study which focused on improving employee health consciousness around prescription misuse. The study shows employees who participated in the training improved their knowledge of and attitudes toward prescription misuse. Specifically, over 100 workers from different worksites show significant increases in their knowledge of alternatives to prescription drugs for pain, energy, mood and stress. Also, the program can help to destigmatize substance abuse prevention and treatment, and improve overall employee well-being.
Best practices model
The program was one of two programs singled out in the Surgeon General's landmark 2016 report, “Facing Addiction in America,” which met their criteria for effective workplace prevention of substance abuse.
Findings point to the efficacy of early intervention via a simple one-hour onsite or web-based training. It is easy to increase employee knowledge of prescription drug use, misuse, and, most importantly, health-based alternatives when offered through a health benefits package, employee assistance, or wellness program. The positive outcomes from this research align with the stringent criteria that Substance Abuse and Mental Health Services Administration's (SAMHSA) has laid forth for exemplary programs. SAMHSA's guidelines for evidence-based programs, if properly implemented at the worksite, can effectively educate a sizeable portion of at-risk employees who are otherwise hard to identify, let alone reach.
How to implement
A simple lunch and learn can incorporate many tips and guidelines for employees. There are many such resources available. We suggest this program be delivered by the company wellness coordinator, trainer, or HR professional who also has awareness of policies and benefits. The following three key factors should be included to ensure positive outcomes:
1. Emphasize a positive, strengths-based message that focuses on health consciousness: We each have the ability to take responsibility for our awareness of personal and family health issues before they become a problem.
2. Explain that health consciousness has three aspects:
a. Be conscious of the primary motives behind using prescription drugs (e.g., for pain, sleep, energy, anxiety, concentration);
b. Know the risk/benefits of using prescription drugs; and
c. Know healthy alternatives to such use (making sure to tie in any and all benefits available from the employer).
3. Review personal scenarios of most relevance to employees. These can include topics such as dealing with an aging parent who may be misusing, talking to teenagers and pre-teens, monitoring and dispensing of one's own use, avoiding sharing of prescription drugs with coworkers, etc.
Brokers stand to benefit greatly by making clients aware of this low-cost, public health approach for many reasons, including:
It's a timely deliverable that translates into lowered medical and productivity costs (absenteeism/presenteeism, etc).
Many negative articles in the news focus on the problem. You can be different by bringing positive news. You have an easy employer/employee touch point that presents a more solutions-oriented approach.
Employee prevention education easily integrates with various benefits you already know about. A company's EAP and/or well-being initiative can be an effective delivery mechanisms for prescription drug education and prevention. You can help employers take a big picture or integrative approach and bring much needed relief to an increasingly critical employer pain point.
Prevention education is also a “tip of spear” for addressing the employee engagement problem. While the program engages employees on the particular issue of prescription misuse, it's an opportunity to engage workers on other company sponsored programs, and raise awareness of them. You can help reinforce your client's message that they care about their team.
Prevention programs can be a hard sell, and it's a challenge to demonstrate a concrete business return. Employers need to know worksite awareness and education programs can be very effective in engaging people at the earliest stages of their prescription use and in a non-threatening way, steer them to safe alternatives. Brokers have the opportunity to reap the benefits of implementing and supporting such a program that has the potential to affect tens of thousands of individuals within their networks.
Of the 20.5 million Americans 12 or older who had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin.
Source: American Society of Addiction Medicine
Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.
4 in 5 new heroin users started out misusing prescription painkillers.
In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.
Source: American Society of Addiction Medicine