SuperManager Podcast: Navigating the Opioid Crisis in the Workplace

Christine: You’re listening to SuperManager, the podcast for people who manage people and business. With ideas, trends and expert interviews to help you be a SuperManager.

Sam: Welcome to this week’s episode of our SuperManager podcast. This week we’re talking about the opioid crisis and how it affects people in the office. And I’ve got my team of friends with me from our HR collaboration group. We’ve got

Tara: Tara Gregor – Breakwell, a workplace wellbeing resource and partner,

Natalie: Natalie Myer – Meyer Group, insurance and benefits.

Jerry: Jerry Richardson. I’m a lawyer at Evans and Dixon. I work with employers and I help them manage their relationships with their employees through the courtship, the marriage and the divorce.

Rod: Rod Mccann with Mccann Consulting, dealing with self funded employee benefits, specializing in the pharmacy benefit management side.

Sam: And I am Samantha Naes with CN Video. We handle corporate video production.

Sam: Last summer I have this bush in my front yard that has these thorns on it, the real prickly, worse than a rose bush. And uh, decided I was going to pull out the nippers and trim back this bush. And I go out there and I’m barefoot and I accidentally stepped on one of the branches that I had dropped and one of the thorns shot up my heel and I had a friend with me and I said, can you help me get this out? And I’m laying down on my belly with my foot up in the air and he’s got tweezers and he’s trying to pull this thorn out of my foot and I’m just screaming because it hurt. And he said, Sam, I’m sorry, I’m only making this worse. Why don’t we take you to the urgent care and see if they can help you. We hopped in the car, I hopped on one foot and we got into the urgent care and she said, Oh, I’m going to have to give you a shot to numb your foot. So she gave me a shot, which was probably worse than the thorn in my foot, but it did numb my foot. And so she’s digging around and apparently the thorn had broken and a little piece of the tip was stuck down in there and she had to, you know, really cut in and get it out of there. But I didn’t feel anything. It was numb. And she said, you want to make sure, because the numbness is going to wear off so you want to make sure and take some Tylenol or something because it’s going to start to hurt later.

Sam: And I said, okay. And I’m not one, I don’t like to take medicine, I don’t even keep Tylenol in the house. I’m like, okay, we’ll stop and get some Tylenol. And she said, actually, do you want a prescription for? And I recognize it. I don’t remember what it was. What are some of the Common…Yeah. It was like an Oxycodone or something like that. And she said, do you want a prescription for that? And the thought that was going through my mind was, oh my God, how bad is this going to hurt? Right. She kind of scared me a little bit and I said, will Tylenol won’t be enough? And she said, well it might, it probably will, but just in case, do you want this prescription? And I said, no, no, no, no, I don’t think I need it.

Sam: And so we left and as we’re exiting I kind of leaned over to the person I was with and I said, did you find that odd? And he said that they were just going to give you a prescription for that that easily. And I said, yeah. It was almost like she was kind of recommending it. And he said, I did find that a little bit odd, but I didn’t give it much thought until I actually a with Natalie and rod where you guys were talking about kind of how these problems begin. It’s actually kind of scary and Tara you were kind of talking a little bit about kind of the process of opioid addictions and how that happens.

Natalie: Absolutely. So last April I attended a SHRM STL meeting and one of the speakers there was talking about opioid addiction in the workplace. And how it’s really come on the surface now of how more and more employers are expected to have narcan accessible at the workplace because overdoses are actually happening in the workplace.

Sam: Oh at work.

Natalie: At work,

Natalie: which is really scary.

Sam: So in order for an overdose to happen at work, somebody would have to be taking this type of drug in the office, like going into the restroom.

Natalie: Exactly one example was on a construction site, they found somebody who had overdosed on heroin in their car, on lunchbreak

Sam: Construction sites. So this person may have been operating heavy equipment.

Natalie: Yes, I know it was a very eye opening lecture that they spoke on. It was very interesting.

Natalie: My Dad went through some stuff. We had said he had had some previous back pain and yes, they put a lidocaine patch on it and they were like, oh sure, sure, sure, because he was just really uncomfortable. And so next day we realized they’d put a fentanyl patch on him and we did not know that. We did not Okay that. And with that you have to actually take it down a couple of steps. You know, you can’t just like rip the thing off. And my dad’s not a person that is into taking any type of painkillers. That’s never been something he liked. And it’s amazing though because he was had some medical things he was dealing with, how quickly they put that on him and that something of that magnitude you would think they would ask you or the family. But let’s just say someone else, that wasn’t anti pain medications and stuff. Next thing you know, you may have just given someone an addiction that they never wanted cause you never know who’s going to be susceptible to it. So, and I think that’s part of the problem of how this all begins.

Rod: When Oxycontin, hydrocodone and all that came out there were stating that this was less addictive, safer to use for the members and the physicians got out in the community, were writing more and more prescriptions for that. But if that employer has a prescription drug card program, there’s ways of identifying some things ahead of time. You can take some review of the reporting. You can see if there’s propensity of any of your employees of doing that or if you have identified that somebody is taking an excessive amount of… Now this is if it’s legally prescribed, right. If they’re purchasing it in the street, it’s not going to have a record of that, but usually those that get to it on the street probably had a prescribed and developed an addiction to it and then maybe we’re cut off, whether it be through the physician, through the employer, and then maybe had gone to the street so that could lead to that which is prevalent. Right.

Sam: It feels like I’m hearing more and more about it on television. You’re hearing more and more about opioid addictions. Feels to me like really the statistics are getting higher and higher.

Jerry: Well the National Safety Council says that in 2016 the majority of preventable overdose deaths, 69% were attributable to opioids and that the preventable opioid overdose deaths increased by 29% in 2016 and that’s a 544% increase since 1999 so the problem has really grown, and

Sam: Hold on a second, I’m not clear on what your statistic is saying. So in 2016 you’re saying there were preventable,

Jerry: Preventable deaths from drug overdoses.

Sam: So how many drug overdoses, did we have?

Jerry: The total, the total number in that year was just under 38,000 nationwide.

Sam: Okay. But you’re saying such a high percentage, we’re actually preventing

Jerry: preventable,

Sam: When you say preventable. What does that mean?

Jerry: Well, I think preventable means that if it were used in accordance with the prescription, it would not have occurred. But what you have is people are using these drugs outside of the prescribed use and over time you build up tolerances. So you then increase the amount you take to get the same amount of pain relief or high.

Sam: So here’s kind of, when I hear preventable deaths and you say by preventable you mean they weren’t following the recommended doses, how does that happen?

Rod: Well, more and more today is with any standard surgery or even going in for dental work, the physicians are prescribing these opioids and uh,

Sam: But I know when I get a prescription, they say this is for 30 days and this number of pills and you take two a day for this number of days and everything adds up. So how do you end up, shouldn’t you run out of pills?

Natalie: Absolutely, and I mean they’ve now had those new bottles they’ve been trying to do where it’s got a timer on it or like a thing that it won’t unlock until your next dosage.

Rod: a lot of times what they’ll do is just go right back to the physician, ask for a refill so that I’m still in pain and I’m still experiencing this. They may authorize another refill now in the past they you should just be able to fax it in like any other prescription, but you’ve got to have a written prescription so they’ve tightened it down. So for the person to go through that they’re going to have to go back in and see that physician.

Natalie: And Rodney, didn’t then they also shorten the amount of days they could…

Rod: They’re eliminating to like seven days where they used to be able to write a 30 days.

Jerry: Missouri is the only state that has no law that requires physicians to be able to access information for patient a for all of patient A’s prescriptions before writing a prescription.

Sam: So in Missouri, you could just go to a different doctor, tell them you need this prescription and they can’t look up whether or not you’ve gotten this prescription from another doctor.

Jerry: Right, they rely entirely on what the patient tells the doctor.

Sam: Who is that protecting? Why on earth do we do that?

Jerry: There’s one legislator and he happens to be a very high in the House Republicans and so he can more or less determine what goes to the floor and what doesn’t go to the floor and he has blocked legislation that would require disclosures from physician to physician to a central clearing house, so then a physician could look it up in the clearing house what prescriptions a patient is already taking.

Sam: And Missouri is the only state that has this issue?

Jerry: It’s the only state.

Natalie: Wow.

Rod: If this person has a prescription drug card program and they’re getting their prescription with that drug card, the employers receiving, or should it be receiving reports that they can see who is having what filled, how often, if they’re going to multiple physicians, if they’re going to multiple pharmacies, so they do have access to it, even though there’s not legislation at this point, if the patient is using that prescription drug card program and if an employer is looking at their reports as they should be able to do that to identify

Tara: is that, is there anything with hippo with that?

Jerry: It’s too big ifs because you have to have first the plan that requires that kind of information that are collected and then second and employer that is looking for that and most employers don’t use all the data they get, they’re overwhelmed.

Rod: I know that’s true to some extent, but you may have a third party administrator or somebody else that is proactive. If they’re looking at quarterly reports, there’s identifiers that we look at to identify it for them.

Jerry: And then the, the other problem with that is it’s after the fact, what the legislation does is at the time of prescribing, and it’s directly the physician is getting access to this information before prescribing. And so it has a much higher preventative effect.

Sam: I mean you talked about this construction worker, you know, and things happening in the office. Can you tell if a coworker is having a problem with this? Are there warning signs?

Natalie: I guess it just depends on how it affects them and how, you know, what is their job? They’re not someone that has a role where they’re going to be communicating with people on a regular basis. And even still, it may not

Rod: and to what extreme they’re taking it. Do they use more than a day?

Natalie: Uh Huh.

Sam: So you don’t, you know as like a coworker or a manager you don’t really know like unless you’re drug testing. Yeah.

Jerry: Well the symptoms are also symptoms of many other things are the problem. So what you have things like mood swings, nausea, anxiety, heightened anxiety. And those can accompany a lot of other things so they don’t necessarily stand out.

Natalie: That’s a good point Jerry because like again, people, it’s not like alcohol. You can usually smell it on someone or something of that sort. And you know these days people would say take vitamins, they take medication. So you’re not necessarily like, oh you took a pill. What is it?

Sam: So we have, I mean other obvious problems here to individuals and you know, you’re hearing a lot about opioid related deaths and things like that. What about healthcare and government costs? Other problems that are a Rod you had,

Rod: You had over in 2014-2016, over 500 billion in costs on that. If you’ve got traditionally medication for a member for an employee’s going to be about $1,500 to $1,900 a year on average. If you’ve got to treat addiction, then you’re jumping up to $19,000 to $30,000 a year to put that person…

Sam: Is treatment for addiction typically covered under your health insurance.

Jerry: For the most part the answer is yes because of Obamacare, which requires that not just physical conditions but mental conditions must get equal treatment in the plans.

Natalie: Yeah. It can be tricky too, especially if this happens frequently where someone has to go through multiple bouts of you know, rehabs and things of that sort so and maybe they don’t sometimes too they don’t always want to tell an employer because maybe they don’t want to risk losing a job.

Sam: Could they, I mean if they have problem with an addiction and they’re reaching out for help? Jerry, the the attorney, can an employer say, Ooh, opioid addiction.

Jerry: Well what the Americans,

Sam: oh, it’s a podcast. I did the slit throat with my hand gesture

Jerry: the Americans with Disabilities Act specifically excludes from disability, illegal drug use. So you’re talking most of the time they’re not being used in accordance with prescriptions or their street drugs. They are not covered by the Americans with disabilities act.

Sam: So they could be fired.

Jerry: Yes, you can be fired

Rod: if it’s a productive employee and all though, this is where I’m talking about going back to, even though it’d be retrospectively with reports, you can see if there’s any use and you can see trends and you can then at that point work with that patient because it could be compliant with what the physician is prescribing for them. And so it could be an issue that maybe it’s a work comp issue, maybe it’s a, uh, an ongoing physical disability that may multiple surgeries. You’ve got to find out a little bit more what’s taking place now the addiction, it can come no matter what form. But if you have that data, you can then at least format and work with a, an idea of how to treat it and what direction to go. If you cut it off. And in the same SHRM meeting, they’re talking about an example, a construction worker that had been receiving opioids through the physician did come up, you know, you’ve been abusing it, you need to stop this with the physician.

Sam: Is it a program that put them on to back them off of it or is it,

Rod: no, usually if it’s like a work comp, they’ll say here, you know, they’ll work with the physician, work with the employee and say, when they said, then here we’re stopping you that we’re stopping this prescribing of the opioids. And that patient then went out and found it on the street because if you buy legal drugs on the street they’re $75 $80 a pill, where as heroin and all is available and it’s in pill form. It’s not like you have to shoot up before it’s available, like $5 a pill. So access to see if you’re for the illegal versus the legal, no, fine. So you may drive them that direction.

Sam: and now you’re in trouble.

Tara: The scariest part of that conversation was when you brought up the phentenol, just the tiniest amount, and they had said that the EMT or somebody who had just touched it ended up overdosing in a different story, which was terrifying.

Natalie: It’s such a mind with this drug. Wow.

Jerry: Yeah. So if we can circle back just because the employer has the right to terminate doesn’t mean that’s the prudent choice. And many employers, if there is a drug issue, the first reaction will be some form of treatment. And now what’s interesting from the Americans with Disabilities Act perspective, is once someone has gone through treatment and let’s say is clean than it is discrimination that’s prohibited by that law. If you discriminate on the basis of that person having had, so having a history of drug abuse or having prior treatment for drug abuse.

Sam: So good news for the person, if their employer is supportive and they’re able to get into a program and get clean, yes, they can go on with a perfectly good career and,

Jerry: Yes, and it’s often good news for the employer because the employee has a heightened sense of loyalty to the employer for having given the employee a second chance, when he didn’t really think he was going to get one.

Sam: And if it’s covered under the medical benefits, then it’s not really costing the employer anything to encourage the employee to get into this program or, I’m seeing some faces around the table when I say that.

Rod: There are still benefit costs associated with it and with any medical procedure, whether it be a premature child, a heart attack, or whatever, you’re driving the cost up when you look at renewals for the next year. However, as you said, if you treat it and deal with it as a disease or whatever you’re doing under the medical that they come through it, you’ve got them be more productive and loyal.

Sam: Tara, you were talking about Narcan.

Tara: Yes, so in that meeting he had said that it’s available to anybody. You can get it at Walgreens or CVS and he had gone on-

Sam: Oh anybody can buy this,

Tara: Anybody can buy it.

Sam: Well, first of all, let’s clarify, I think most people know about what is Narcan?

Tara: Narcan is… If somebody is overdosing, it’s the drug that you would give them to reverse that.

Sam: And is this is it a shot, or a pill, or a drink ,or what?

Tara: I believe it’s like a pen that you would-

Sam: Like an Epi?

Tara: Exactly. That you would stick in somebody.

Sam: Okay.

Tara: Anyway, so he was saying that you can get it at any CVS or Walgreens, but that it’s such an issue that people should have it in their glove boxes.

Sam: It’s almost like today’s version of knowing CPR. You know how to save somebody who’s having some Narcan on, but is there a chance that like what if they’re not overdosing and you think they are or are there people that are allergic to Narcan and or you don’t administer it properly or you give them too much, are there,

Rod: Well that comes into the legal,

Jerry: There certainly are liability issues. Anything that’s done in the workplace that causes an injury ends up in the workers’ compensation system, which is basically a no fault system, but for example, if you have a customer and you think the customer is having an overdose and you misapplied Narcan or something, there certainly could be civil liability. So I would think that if you’re going to have Narcan, you would only have trained people that administer it, and that they are trained specifically to recognize when it’s appropriate to administer. Yeah.

Sam: How do you get this type of training, because it feels like offices with a large number of people, or businesses where you could have customers; I can definitely see the benefit, Tara, that you were talking about, so people actually having this, but how do you get trained?

Jerry: All the EMTs have the training. So if you call 911 there’s a slight delay, I understand, but it’s probably no more than five minutes. And you’ll have a trained person who knows how to and when to.

Sam: So your first thought should be “call 911”. How do you know if someone’s overdosing? What does that look like?

Jerry: Find him passed out on the floor frequently.

Rod: Maybe convulsions.

Sam: Yeah. So you would probably, you know, “are you okay? Are you okay?” And they call 911, yeah. I don’t know that I would feel comfortable giving someone a shot of, you know, if I just saw somebody passed out…

Natalie: You never know too. They may not initially realize the severity of what’s going on with them. And so they may not say it’s opiates or heroin, whatever it is, you know? So they may not be quick to give that up to someone. Especially what if it’s the person that you have this big issue with at work and you’re like…

Sam: They fall to the floor and they go, “it’s my heroin problem, Oh never mind, It was just gas, sorry.” you know?

Natalie: So you know,

Sam: Oops!

Natalie: So I… Great calling 911 and letting EMTs, so that way people are more likely to be more forthcoming.

Jerry: And just because someone passes out doesn’t mean it’s a drug overdose.

Natalie: No. Right.

Sam: Right.

Natalie: Blood sugar? Yeah. Yeah.

Jerry: Epileptic seizure?

Rod: Could be.

Natalie: So, I mean I think that would be one of the last things that would come to my mind, at this point in time, you know.

Sam: But anymore… It’s so common now.

Tara: And I think that’s what was alarming about it was like if it’s this accessible is [right] it such a huge problem that it needs to be this accessible?

Sam: What can we do in the workplace? How do we help solve this problem? I mean we can’t control, I mean there’s obviously, you know, write your politicians and you know, things like that. But we really can’t control what the doctors are doing and what the employees are doing, whether they’re following the prescriptions are not. What can we do in the office to try to help solve this problem.

Natalie: There are some things you can do with your benefits plan. I mean, if someone is again using this through their medical benefit and their pharmacy benefit, you can put restrictions on it, which a lot of changes have been made in the industry to actually restrict people’s ability to just be over prescribed on these. And when you’re setting up your pharmacy plan and say, will you guys notify me of this or that. And you know, making sure that those kinds of triggers and alerts,

Rod: Educational pieces.

Natalie: Absolutely.

Rod: But you also don’t want to, you know, you can educate the employees as they go in and talk with their physician, let the physician know if they’ve got an addictive personality or addictive situation or family history. But also you want to be aware of maybe not knee jerking this to the far extreme, cause it does have an appropriate place for pain management. So there are those that is very efficient and inexpensive way to manage short term pain. So that is something I want to be aware to when you’re setting up that design for them.

Jerry: Many employers do training for their employees. In fact, if there are an employer with a drug free workplace policy, which is there a number of employers that work with federal agencies or with federally funded projects have drug free workplace policies. Part of that is the educational piece and the education is broad enough to give training for people who maybe they’re not personally involved with opioids but have children and all the loss in productivity that comes from family members that are having problems, then affecting a parent who’s the employee is astronomical.

Sam: Do we have a horror story for the week?

Rod: You can always talk about a day in years past my wife who’s going in for drug testing and the night before it had a uh, Poppy seed muffin and went through the drug testing and found positive for the opiates because of the poppy seeds.

Natalie: That happened to your wife,?

Tara: So that’s not a myth.

Rod: Happened about 20 years ago.

Natalie: There was a Seinfeld on that,

Sam: Did she not get the job. They told her she just,

Rod: Did not get the job.

Sam: Wow. Yeah.

Rod: This person was far, far away from taking any drugs.

Sam: And I’m guessing there wasn’t a whole lot she could do about it. I mean they just know she didn’t have the job. Oh…

Jerry: That would be a misuse of the drug testing by the employer. [Yeah.] There has to be a medical review officer and part of what a medical review officer does is takes the results, discusses them with a person that has a positive result to see if there is either ,a false positive that would be a false positive, or some explanation that’s legitimate for the drugs showing up in the system.

Sam: Leave it to Jerry, the attorney, to suck the fun out of our weekly horror story.

Natalie: I thought it was just a Seinfeld episode that that happened, so I’m like, wow, it’s actually happened to somebody real, yeah.

Christine: Thanks for listening to SuperManager by CN Video Production. Visit our website at cn-video.com for additional episodes and lots of SuperManager resources, or give us a call at 314 VIDEO ME.