Earlier this month, the CDC issued a Guideline for Prescribing Opioids for Chronic Pain (PDF). These Prescription Drug Guidelines are recommendations for primary care clinicians who are prescribing opioids such as OxyContin and Percocet for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses

1) when to initiate or continue opioids for chronic pain;
2) opioid selection, dosage, duration, follow-up, and discontinuation;
3) assessing risk and addressing harms of opioid use.

This is one part of the public health response to the alarming rise in prescription drug abuse. According to the CDC, more than 16,000 Americans died from prescription painkiller overdoses in 2013, more than four times the total in 1999. Highly addictive opioids once prescribed only for treatment of cancer and end-of-life care are now being prescribed for things like soft tissue injuries.

Why should employers care?

The problem of prescription drug abuse is very significant in the workplace. In an article in Safety + Health Magazine, Prescription painkillers and the workforce. the authors note:

“As part of a 2014 study, the Cambridge, MA-based Workers Compensation Research Institute examined 264,000 claims from 25 states. Researchers found that 65 percent to 85 percent of injured workers in most states received narcotic painkillers.

Opioids – a group of drugs that include oxycodone and morphine – are prescribed by doctors to relieve pain, but can affect safety, health and productivity, as well as increase workers’ compensation costs. The highly addictive drugs also can result in side effects such as confusion, drowsiness and nausea.

“There are more side effects related with opioid use than just addiction and death,” said Tess Benham, who manages the National Safety Council’s initiative to prevent prescription drug overdoses and deaths. “Employees using opioids should not be doing safety-sensitive work because of the impairment associated with opioid painkillers.”

In February, NSC polled 1,014 adults, 427 of whom reported having been prescribed an opioid painkiller within the previous three years. Nearly half of users participated in a potentially unsafe activity while using an opioid – 39 percent went to work, 35 percent drove a vehicle and 14 percent operated heavy machinery.”

In Opioids in the Office, Risk Management Monitor reports on a new study about prescription narcotics by the Workers Compensation Research Institute. The report, “Longer-Term Use of Opioids,” found that one in 12 injured workers who started prescription narcotics were still using them three to six months later. The study examined long-term narcotic use in 21 states, and how often doctors followed recommended treatment guidelines for monitoring injured workers under their care.

The National Safety Council has been in the forefront of urging employers to take steps to address employee addiction to opioid pain medications . Among the recommendations:

1. Educate all employees about the hazards associated with prescription pain medication use, especially injured employees.
–The risks of opioid pain medication use, especially for workers with sleep apnea, COPD or other respiratory problems
–Hazards associated with using together multiple forms of opioid pain medication such as short-acting and long-acting drugs together;
–Dangers of using alcohol and sleep aids with opioid pain medications;
–The risks of addiction and drug overdose.
3. Use caution and require prior approval for the use of methadone to treat chronic noncancer pain.
4. Screen injured workers for depression, mental health conditions and current or prior substance use.
5. Require network providers to utilize state prescription drug monitoring programs.

What employers can do: Tools and resources for workplace programs
Here are some tools and resources that employers can use to address the prescription drug problem in their workplace:

Drug-Free Workplace Policy Builder – Prescription and Over-the-Counter Medications
In this tool, the Department of Labor advises:

“Employers should not implement a blanket policy requiring all employees to disclose prescription drug use for legitimate medical purposes. Moreover, the Americans with Disabilities Act and the Rehabilitation Act of 1973 permit an employer to ask disability-related questions only if they are job related and consistent with business necessity. However, there are some prescribed and over-the-counter medications, such as amphetamines and benzodiazapines, that may result in a positive drug test. In this event, a Medical Review Officer (MRO) or other appropriate company personnel may inquire to determine if the employee has a legitimate medical explanation, such as a physician’s prescription, for a positive drug test.
However, employers may want to consider incorporating language regarding prescription and over-the-counter drug use by employees who perform jobs that directly affect public safety and health. Because important privacy interests and non-discrimination protections must be balanced with the need to address workplace drug use, employers are strongly encouraged to consult with an attorney specializing in employment law before deciding to cover prescription and over-the-counter drug use in their drug-free workplace policy.”

Remember
Your employee assistance program should be an integral component of your drug treatment programs. At ESI EAP, we offer a complete Drug Free Workplace and DOT Compliance Program, including
substance abuse education and prevention, as well as substance abuse and addiction treatment programs. We also offer DOT compliant training for safety-sensitive workers.

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