Protecting Workers from Opioid Misuse and Addiction

Abstract

In this chapter we discuss the roots of the opioid crisis and its relationship to work and the workplace. Opioid overdose mortality, in combination with increased deaths from alcohol and suicide, are devastating to American families across the nation. The profound impact on American workplaces includes compromising occupational safety and health, increased workers’ compensation and health insurance costs, rising absenteeism, and lost productivity. The President’s Council of Economic Advisors estimates that over a million workers are out of the workforce due to the opioid crisis. The impact on workers is equally profound including job loss, divorce and family disruption, and potential imprisonment, injury, illness, and death. Contained within this chapter are the review of several studies that document opioid mortality by occupation and industry that conclude that pain from occupational injuries, illnesses, and stress are important pathways to opioid misuse and addiction. A major focus is on the significant opportunity that effective workplace programs offer to prevent and respond to opioid misuse and addiction. Several key policy interventions are recommended including prevention of workplace physical and emotional pain, safe prescribing practices, alternative pain management methods, worker education and training, and moving away from stigmatizing punitive workplace substance abuse programs and replacing them with supportive programs.

Questions for Thought and Discussion

• 1. What are some of the major impacts of the opioid crisis on employers and the workplace?

• 2. What are some of the major impacts of the opioid crisis on workers and their families?

• 3. How does the public health model of prevention fit into a strategy for avoiding opioid misuse and addiction in the workplace?

• 4. Which industries and occupations are most affected by the opioid crisis and why?

• 5. What economic and public health disparities are associated with despair, chronic stress, and deaths from suicide, alcohol, and opioids?

• 6. What is ergonomics and why is prevention of musculoskeletal disorders a primary intervention in preventing opioid misuse?

• 7. What are examples of occupational stress factors that may increase risk of substance abuse?

• 8. What are the key criticisms of punitive workplace substance abuse policies?

• 9. What are the potential benefits of developing peer advocacy programs in the workplace?

• 10. What can be done to improve access to treatment and recovery programs in the workplace?

Glossary of Terms

Addiction

Opioid addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control, and those changes may last a long time after a person has stopped taking drugs.

Bureau of Labor Statistics (BLS)

BLS is a unit of the US Department of Labor. It is the principal fact-finding agency for the US government in the broad field of labor economics and statistics and serves as a principal agency of the US Federal Statistical System.

Carpal tunnel syndrome

Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand and arm. Carpal tunnel syndrome is caused by a compressed nerve in the carpal tunnel, a narrow passageway on the palm side of your wrist.

Centers for Disease Control and Prevention (CDC)

CDC is part of the federal Health and Human Services Agency. CDC works to protect America from health, safety, and security threats, both foreign and in the United States. Whether diseases start at home or abroad, are chronic or acute, are curable or preventable, or are caused by human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.

Dependence

Dependence occurs when users become susceptible to withdrawal symptoms. Withdrawal symptoms occur only in patients who have developed tolerance.

Employee assistance programs (EAP)

An EAP is a confidential work-based intervention program designed to assist employees in resolving personal problems that may be adversely affecting them. EAPs assist workers with issues like alcohol or substance use disorder as well as a broad range of issues such as child or elder care, relationship challenges, financial or legal problems, wellness matters, and traumatic events like workplace violence. EAPs may be internal or external and typically refer to users rather than providing direct counseling.

Ergonomics

Ergonomics is the science of fitting the job to the worker. Workstations and tools are designed to reduce work-related musculoskeletal disorders. Work-related risk factors include lifting, bending, reaching, pushing, pulling, moving heavy loads, working in awkward body postures, and performing repetitive tasks.

Fentanyl

Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. It is a prescription drug that is also made and used illegally. Like morphine, it is a medicine that is typically used to treat patients with severe pain.

Government Accounting Office (GAO)

The GAO is a federal agency that monitors and audits government spending and operations. The GAO tracks how the legislative and executive branches of the government use taxpayer dollars and then provides results directly to Congress.

Hierarchy of controls

The hierarchy of controls is the accepted method in the field of occupational safety health for selecting corrective measures to prevent occupational exposures, injuries, and illnesses. The hierarchy starts with the most effective approach and the least effective is at the bottom as follows: elimination, substitution, engineering controls, administrative controls, and personal protective equipment.

Industry

Any general business activity, commercial or public enterprise, for example, automobile industry or healthcare industry.

Job burnout

Job burnout is a special type of work-related stress—a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity. It has been related to adverse workplace conditions including unsafe, unhealthy, and stressful work environments. Some experts are critical of the term job burnout claiming it blames the victim. Rather they offer the term “moral injury” due to adverse working conditions.

Life expectancy

Life expectancy is the average period that a person may be expected to live.

Member assistance programs (MAPs)

MAPs are peer-based member assistance programs that were developed within the labor movement. MAPs emphasize the role of peer counselors—trained union members who volunteer their time to prevent drug abuse, motivate their coworkers who have drug abuse problems to accept referral for help, and support them when they return to work—union members helping each other to stay clean and sober.

Musculoskeletal disorders (MSDs)

MSDs are soft tissue injuries caused by sudden or sustained exposure to repetitive motion, force, vibration, and awkward positions. These disorders can affect the muscles, nerves, tendons, joints, and cartilage in your upper and lower limbs, neck, and lower back.

National Institute for Occupational Safety and Health (NIOSH)

NIOSH is the federal agency, located within the CDC, responsible for conducting research and making recommendations for the prevention of work-related injury and illness.

Occupation

Occupation refers to the work a person does and consists of routine and nonroutine tasks necessary to perform their job.

Occupational health

Occupational health refers to the identification and control of the risks arising from physical, chemical, biological, and ergonomic workplace hazards in order to prevent work-related disease.

Occupational illness

An occupational illness results in disease due to exposure to chemical, biological, physical, or ergonomic health hazards. Ergonomic injuries that cause sprains and strains are considered occupational illnesses that are often associated with opioid use.

Occupational injury

An occupational injury is bodily damage such as a cut, laceration, amputation, contusion, abrasion, or broken bones, damaged tissue, ligaments, or other body parts resulting from a sudden work-related traumatic incident.

Occupational safety and health

Occupational safety and health is the discipline within public health that focuses on the identification and control of workplace hazards. The goal of occupational safety and health is to prevent workplace injury and illness and the related negative impacts on workers and employers.

Occupational Safety and Health Administration (OSHA)

OSHA is the federal agency within the US Department of Labor with the responsibility of ensuring safety at work and a healthful work environment. OSHA’s mission is to prevent work-related injuries, illnesses, and deaths. OSHA promulgates and enforces federal safety and health standards. Employers are required to comply with OSHA standards.

Occupational stress

Occupational stress is psychological stress related to one’s job. It may include ongoing or progressing stress an employee experiences due to the responsibilities, working conditions, work environment, organizational culture, or other pressures of the workplace.

Opioids

Opioids are natural or synthetic chemicals that interact with opioid receptors on the nerve cells in the body and brain and reduce feelings of pain. They are a class of drugs that include prescription pain relievers, synthetic opioids, and heroin.

Opioid use disorder

Opioid addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control, and those changes may last a long time after a person has stopped taking drugs.

Overdose

Opioid overdose occurs when a person has physical and mental symptoms that occur after taking too many opioids causing excessive stimulation of the opiate pathway. This can lead to decreased respiratory function and possibly death.

Presenteeism

Presenteeism is when a worker is present at work when they should not be, such as when they have an illness or family problem.

Public health model of prevention

The public health model uses the principles of primary, secondary, and tertiary prevention. Primary prevention features interventions designed to prevent exposure from occurring. Secondary prevention occurs during the early stages of disease before onset of signs and symptoms. Tertiary prevention includes methods that aim to ameliorate the impact of disease once it has been established.

Recovery

Recovery is defined as achieving sustained remission from the symptoms of substance use disorder.

Stigma

Stigma is a mark of disgrace associated with a particular circumstance, quality, or person. Stigma related to drug use leads to treating users in a derogatory and discriminatory manner.

Substance use disorder

Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.

Substance use disorder treatment

SUD treatment commonly consists of a combination of group and individual therapy sessions that focus on teaching those in recovery the skills needed to get and stay sober as well as how to navigate various situations without turning to drugs or alcohol. Additionally, medication treatments often play a significant role in in SUD treatment. Source: American Addiction Centers.

Tolerance

Tolerance is the term used to explain that opioid users need to take increasingly higher dosages of drugs to achieve the same opioid effect.

Withdrawal

Withdrawal relates to a user’s growing tolerance. Most times, people who use opiates hit a level where they no longer feel pleasurable effects but continue to use because of the very painful physical and psychological symptoms that follow discontinuance of an addicting drug.

Zero tolerance policy

These policies feature zero tolerance for drug use where anyone testing positive for drug use is terminated from employment. There may or may not be exceptions for prescription drug use where a licensed provider prescribes the medication.