The statistics in the news about the opioid epidemic are staggering—49,000 overdose deaths in 2017, up from 42,000 in 2016. In 2015, 2 million Americans were addicted to prescription drugs and another 600,000 were addicted to heroin. All this has serious consequences for employers. A recent National Business Group on Health survey of 62 large employers found 60% experienced at least one issue arising from prescription opioid drug misuse or abuse in the workplace, including increased medical or pharmacy costs for chronic opioid users (40%), increased absenteeism or missed work among chronic opioid users (40%) and employees overdosing on prescription opioids (18%).
Behind these numbers are stories of individuals and families who have struggled with this condition. It has touched just about every part of our society. The promising news is that employers are well positioned to take action. There are four areas in which an employer can exert a positive influence:
- Prevention. We know that overprescribing has been a major contributor to this epidemic. Employers can demand that their health plans and dental carriers monitor the prescribing behavior of their network providers as well as to be sure that pharmacy benefit managers have evidence-based formularies that restrict access to dangerous levels of these drugs. We also know that there are risk factors for developing addiction. These include a young age at first exposure (less than 25 years), untreated behavioral health conditions, and the history of PTSD or Adverse Childhood Events (PTSD in childhood). Medical and behavioral health providers are learning to screen for these conditions and treat them early.
- Identification and harm mitigation. It is important that healthcare providers screen their patients for substance use disorder and, if a problem is identified, that they can quickly get that individual the necessary services. For opioid use disorder this includes having good access to medication-assisted treatment that has been proven to stabilize people and allow them to successfully engage in treatment and in work.
- Treatment. One of the new challenges that employers face is the proliferation of out-of-network treatment facilities that are very expensive and have poor track records for treatment success. Behavioral health and medical carriers have been working hard to develop high-quality, in-network treatment facilities, including Centers of Excellence. Promoting these facilities and steering individuals to them through advocacy programs and a well-integrated EAP can really improve the impact of the benefit dollar in these cases.
- Supported return to work. Our understanding of substance use disorder as a chronic condition has guided the development of more deliberate return to work programs and support for recovery services. This can take the form of an enhanced EAP offering, supervisor and manager training, and access to recovery-support programs that minimize the risk of relapse.
In addition to these four areas, many employers are working to lessen the stigma attached to substance abuse so that people can come forward and ask for help for themselves or a family member before the disease leads to the most devastating consequences.
Without a doubt, this is a tough issue to deal with at work or in a family. But there are positive steps to take that can make a big difference and literally save lives.