Conquering Prescription Drug Abuse in the Workplace

By Adele Vollbrecht, RN, MS, CCM, MSCC, LNCC, and Donna Carlisle, LRC, NCC, CCM, MSCC

Prescription drug abuse is a pervasive problem in the workplace which, consequently, means it is a challenge for employers. The misuse of any drug by workers, prescription or otherwise, can lead to lost productivity, absenteeism, injuries, fatalities, theft and low morale. It also can inflate health care, legal liability and workers’ compensation costs. It’s estimated that drug abuse costs U.S. employers $81 billion annually.

Prescription drugs are the third most commonly abused category of drugs, behind alcohol and marijuana. About 48 million people have abused prescription drugs in the United States, representing nearly 20% of the population. Misuse of prescription medications is especially acute among young adults between the ages of 18 and 25. Canadian statistics fall in line very closely with American statistics.

People do not leave their substance abuse problems at the door upon entering the workplace. Once they’re at work, the consequences of their actions may have a negative effect not only on them, but also on their co-workers and the overall workplace environment. This is especially true when caution and safety are absolute necessities, such as on an assembly line, at a construction site, or when operating heavy machinery or transporting others.

No business is immune from the effects of prescription drug abuse. Even a small company may have someone on staff who is taking medications in a manner inconsistent with their intended use. Knowing this, all businesses should have comprehensive substance abuse policies in place. They should provide access to treatment for employees who abuse prescription drugs and involve professional case managers to ensure treatment approaches are effective and lasting.

Develop a comprehensive policy

Some substance abuse policies merely send the message that the misuse of prescription drugs, and any use of illicit drugs, is not condoned. They outline internal drug testing procedures and spell out potential penalties, but basically stop there.

While there is legal value in documenting and communicating the obvious, a strong policy needs to go a couple of steps further.

Employees need to know, for example, that they can seek assistance with an abuse problem confidentially without jeopardizing their jobs. In most workplaces, there’s a stigma associated with asking for help. Even if they recognize the need for intervention, people fear that coming forward and being honest can ruin their careers. Effective substance abuse policies make it clear that the health and well-being of each employee is paramount, and that seeking help is preferable to hiding a problem until it endangers others. Policies also may spell out a company’s leave-of-absence and return-to-work processes, should that become necessary.

Comprehensive policies could also incorporate information on the appropriate use of prescription medications into overall wellness and risk-prevention strategies. While prescriptions typically are accompanied by pages of information detailing proper use and possible side effects, that valuable information often is ignored. Few people educate themselves beyond the instructions on the bottle that explain dosage and frequency. By incorporating important usage information into substance abuse policies and supporting those policies with meaningful training, employers can reinforce the dangers of misusing prescription medicines.

Provide access to treatment

Encouraging employees to come forward with substance abuse concerns is an important first step, yet most supervisors and human resources representatives are ill-equipped to provide counseling or therapy. So, unless a company provides access to proven treatment options, simple acknowledgement may not lead to the most favorable results.

Employers should provide programs that place employees face to face with substance abuse experts. These include both wellness programs and employee assistance programs (EAPs) with substance abuse coverage that provides screening, therapeutic counseling, and referrals for employees and, if necessary, family members. Many such programs have post-discharge maintenance planning for follow-up, since care and support following treatment may be required to help employees manage the chronic nature of many co-occurring disorders.

Assistance and wellness programs cost money, but most employers find them to be smart investments. The Gillette Co., for example, saw a 75% drop in in-patient substance abuse treatment costs after implementing an EAP. When workers with substance abuse disorders get treatment, employers and employees alike benefit through:

• Improved employee health and lower total health care costs over time
• Less absenteeism
• Improved job performance
• Reduced costs associated with short- and long-term disability and workers’ compensation
• Fewer accidents and less corporate liability

Involve case managers

Case managers offer a collaborative process to assess, plan, implement, coordinate and evaluate outcomes to meet the needs of a worker with prescription drug abuse issues. This can be accomplished by effective communication with the worker, the medical provider and the employer, as needed, to help the employee regain pre-injury status.

The primary focus is to assess medical treatment and identify case-specific problems by using evidence-based medical outcome criteria. This often results in a reduction of indemnity and medical exposures through cost-effective health care delivery assistance and coordination of an employee’s rehabilitation.

Claim representatives and case managers work closely with caregivers so that injured employees have recovery plans tailored to their needs, the job and the employer’s business.

Involvement of a case manager often can benefit both the employer and employee by actively involving both parties in the recovery process. This is especially important for employees, because they gain a sense of control over what is happening, develop an understanding of their recovery goals and proceed with greater confidence. Additional advantages of case management services often include the following:

• Expertise to educate an employee about his or her diagnosis and explain the caregiver’s treatment plan at the employee’s level of understanding
• Expertise to work in collaboration with all providers that may be involved within the overall treatment plan and, if needed, research and assess alternative treatment options
• Work with the employer to assist in the identification of transitional work opportunities based upon medical limitations and/or functional abilities as determined by the employee’s caregiver
• Assist to promote cost-effective health care delivery, timely rehabilitation and optimal outcomes
• Problem-solving and analytical-assessment skills

Prior to nurse case-management involvement, employers should utilize preferred-provider networks that will assist with injury and pharmacy management. Insurance carriers may consider providing employers with access to network provider lists to support them before they need it. This can help employees locate qualified, preferred medical providers in their areas. Preferred providers deliver quality, cost-effective care and understand the importance of employees remaining on the job or returning to work as soon as it is appropriate.

Prescription drug abuse among employees is a costly and potentially dangerous challenge for companies. That’s why employers of all sizes should be vigilant about creating and promoting strong substance abuse policies, providing access to treatment and utilizing case managers. Reputable insurance carriers offer excellent resources and expertise to employers who need counsel in establishing broad-based programs to help employees in need.

Help is just a phone call away.

Adele Vollbrecht, RN, MS, CCM, MSCC, LNCC, is a Manager of Case Management at CNA Insurance. She has more than 12 years experience in Workers’ Compensation Disability and Injury Management with in-depth knowledge of pharmacy trends and injury management practices.

Donna Carlisle, LRC, NCC, CCM, MSCC, is a Business Analyst at CNA with 22 years experience in workers’ compensation disability and injury management. She has an extensive background in case and cost management services with a strong emphasis in statistical analysis, product development, quality assurance and vendor management.

References

1. National Council on Alcoholism and Drug Dependence, “Drugs and the Workplace”
2. National Council on Alcoholism and Drug Dependence, “Drug FAQs/Facts”
3. National Council on Alcoholism and Drug Dependence, “Drug FAQs/Facts”
4. An Analysis of Worker Drug Use and Workplace Policies and Programs. Office of Applied Studies, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. July 1997.
5. SAMHSA, CSAT, “Substance Abuse in Brief: Effective Treatment Saves Money,” January 1999.

Notes

This material is for illustrative purposes and should not be construed as legal or other professional advice. CNA recommends consulting with a professional before applying this material in any particular situation. All products and services may not be available in all states and may be subject to change without notice. Copyright CNA. All rights reserved.