Andy Dean Photography/Shutterstock
The health insurance company Cigna announced a new initiative last week in which it is “intensifying its commitment to curtail the opioid epidemic by focusing new drug prevention and treatment efforts in targeted US communities.” Cigna said its goal was to reduce the number of opioid overdoses among its customers in these communities by 25 percent by December 2021:
Initially, Cigna will focus its local efforts in areas where a sizable number of Cigna commercial customers reside and where there are higher than average overdose rates, including communities in the states of Connecticut, Maryland, New Jersey and Virginia and in the metropolitan areas of Chicago, New York, Philadelphia and Washington, D.C. The goal is to reduce prescription and illicit opioid overdoses in these areas, and Cigna will advance initiatives that impact both Cigna customers and the communities at large. To support this initiative, Cigna and the Cigna Foundation will expand and accelerate the impact of community-based organizations that are leading localized programs. Cigna intends to learn from initial efforts during the three year time period and expand to other communities over time.
The main channel for these efforts is through health care providers, with whom Cigna is working to limit the prescription of opioid pain medication, address warning signs of opioid addiction, and guide patients toward less dangerous pain management options. Most US adults receive health insurance coverage through their employers, so partnerships with employers are also a key component of this effort, Cigna added:
Belden Inc., a manufacturer of electronic networking equipment based in St. Louis, Missouri, faces the same labor market issue as most other industrial employers in the Midwest, including the challenge of hiring and retaining workers for safety-sensitive roles in places where opioid addiction has reached epidemic proportions. Belden’s CEO John Stroup is taking an innovative approach to tackling the opioid problem at his company’s factory in Richmond, Indiana, where this past winter, one in ten applicants failed their drug tests, as did several people already employed there. At CNN Money last week, Lydia DePillis profiled Stroup’s efforts to give these workers a second chance:
For Stroup, the decision was a simple cost-benefit analysis: How much would it cost to help people get sober in this Rust Belt town of 37,000, compared to what he was losing by not having them available to work? After a few meetings with board members and addiction experts, he came up with a plan. If an applicant or a current employee failed a drug test, but they still wanted the job, Belden would pay for an evaluation at a local substance abuse treatment center.
People deemed to have a low risk of developing an addiction could spend two months in a non-dangerous job before they are allowed to operate heavy equipment again, as long as they passed periodic random drug tests for the rest of their time at the company. People at high risk would spend two months in an intensive outpatient monitoring and treatment program, with the promise of a job at the end if they made sufficient progress. On average, Belden figured it would have to shell out about $5,000 for each person it gave a second chance to.
The experiment started in March and has so far had eight participants. Two at-risk current employees made it through the monitoring period and are back to work, while others are still being evaluated. It will take a few more months to see if the program really works, but the few Belden employees who spoke to DePillis said they were heartened to see the company trying to help current and prospective employees with opioid issues recover rather than discarding them.
Naloxone, commonly sold under the brand name Narcan and available without a prescription in every US state except Nebraska, is an opioid receptor antagonist used to treat overdoses of heroin and other opiates. Delivered via injection or a nasal spray, the drug has been credited with saving many addicts’ lives and has lately been the subject of numerous awareness campaigns in the US urging people who interact frequently with opioid users to have the antidote on hand and know how to administer it.
Last month, US Surgeon General Jerome Adams urged employers to stock naloxone at worksites as well, and train employees on how to use it, Allen Smith reported at SHRM:
“For a heart attack, we train employees how to do CPR until the paramedics arrive,” Adams noted April 19 in Washington, D.C, at Business Health Agenda 2018, a conference sponsored by the National Business Group on Health, speaking about the opioid epidemic. “Why is that not the case with naloxone and Narcan? We need to make these emergency treatments as ubiquitous as knowing CPR and calling for a defibrillator when someone is having a heart attack, or using an EpiPen when someone’s having an allergic reaction.”
Even before the surgeon general’s statement, a few clients of Nancy Delogu, an attorney with Littler in Washington, D.C., made naloxone available at work. They made this decision after employees overdosed on opioids at work. …
Drug use among US employees has been increasing in recent years, with marijuana accounting for about half of the American workforce’s illegal drug habits. With a tight talent market, greater mainstream acceptance, and state-level legalization of marijuana, some employers have begun relaxing their drug testing policies, abandoning the zero-tolerance approach in favor of case-by-case judgments. The biggest substance abuse problems in the US, however, are not illegal drugs but rather alcohol and prescription opioid painkillers. Opioid addiction, as well as the underlying physical health issues that lead to these drugs being prescribed, has been persuasively identified as a significant driver of the decline in American workforce participation rates, particularly among men in what ought to be their prime working years.
Even more disconcerting is that the number of US employees dying from drug- or alcohol-related causes while at work has also risen sharply in recent years. While in absolute terms, those numbers remain very small, the rapid rate of increase is cause for concern, Gillian B. White warned at the Atlantic last month:
Last year alone, the number of workers who died at work because of drug- or alcohol-abuse-related incidents increased by more than 30 percent, to more than 200. While that number may seem small, it’s evidence of how rapidly the problem is growing—less than five years ago, fewer than 70 people died from overdoses at work. Since 2012, the number of people dying from drug or alcohol related causes while on the job has been growing by at least 25 percent each year, according to the Bureau of Labor Statistics. …
The crisis of opioid addiction in the US is no longer something employers can afford to ignore. A growing body of research points to opioids as a significant factor in the hollowing out of the US workforce, particularly among prime-aged men. We’ve also heard many stories in recent years about employers having difficulty hiring for safety-sensitive roles in certain geographies because of the lack of qualified candidates able to pass a mandatory drug test.
So for most US businesses, opioid addiction is an issue that affects both their workforce and their talent pool, and employers who find ways to support workers affected by it are doing both economic and social good. Phil Albinus thinks through some of the ways employers can help at Employee Benefit News:
There could be an increase in benefits like telemedicine services, which would broaden the reach of medical treatment to rural areas where doctors are often in short supply. In addition, employers (if they have not already done so) may review service coverage for behavioral health and/or employee assistance program needs. An evaluation of the behavioral health portions of health insurance policies and EAP contracts will help to ensure employees are covered for abuse of prescription drugs. …
Recent research by the National Center for Injury Prevention and Control has indicated that prescription opioid abuse, dependence, and overdoses cost the US economy nearly $80 billion in 2013. Opioid misuse can cost employers nearly $20,000 in average annual medical expenses, especially since one in three prescriptions provided under employer health care plans is being abused, according to research from the health-care firm Castlight Health. Castlight also found that painkiller abuse is four times more likely among baby boomers, and that the epidemic is particularly bad in the rural south. Indiana is another hotspot for the epidemic, where 80 percent of employers report being affected by the problem.
One Indiana company, the engine manufacturer Cummins Inc., has tried to tackle the issue head-on since discovering evidence of opioid misuse among its workforce in 2013. As the Wall Street Journal‘s Rachel Emma Silverman reports, they got both aggressive and proactive in their approach: The company, which employs 55,000 people, added opioids to the panel of drugs it tests employees for, but has sought to be flexible in its response to positive tests, since painkillers are most often legally prescribed and aren’t abused by a majority of workers. If an employee tests positive for opioids, they are directed to treatment if needed, as well as moved out of any safety-sensitive jobs in the company. And the company’s efforts don’t end there, as Silverman explains:
A recent report showed that more US employees are testing positive in workplace drug tests, and while the main culprit is marijuana, amphetamine abuse also appears to have risen sharply over the past five years. One possible explanation for this increase is that millennials, the first generation to be routinely prescribed amphetamines like Ritalin and Adderall for attention deficit hyperactivity disorder in childhood (and to routinely abuse them as “study drugs” in high school and college), now make up a majority of the workforce, and have brought their amphetamine habits along with them.
At Quartz, Carey Dunne talks to Alan Schwarz, whose new book ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic addresses this issue, about what has happened to the Adderall generation as they have grown up and entered the working world:
If you used Adderall throughout college, quitting when you start working can be difficult. This isn’t just because ADHD medications like Adderall are highly addictive Schedule II-controlled substances—putting them in the same category as cocaine—but also because many users come to see them as a driving factor in their success. “It stands to reason that if you feel as if you succeeded in college partly because of these drugs, you’re more likely to feel as if you need them to succeed in the workplace,” Schwarz says. … Meanwhile, the number of adults with prescriptions for ADHD medication is moving past 5 million, and prescriptions among 26- to 34-year-olds are the driving force.
“You’ll likely see more [prescription stimulant use] in professions that are dominated by people in their 20s,” Schwarz says. As an example, he cites a millennial-run tech company in New York City where an employee “keeps Adderall in an Altoids case in her open purse for anyone to grab as necessary.” The company’s founder, a woman in her 20s, takes Adderall in order to sleep just three and a half hours a night and says it’s “necessary for survival.”
The dilemma, of course, is that many adults do suffer from ADHD and need these medications to function at work, and it’s not always easy to separate legitimate users from abusers. Compounding the problem is the fact that employers aren’t always eager to crack down on drugs that can make employees more productive rather than less: