Opioid Misuse in the Workforce_ A sign of decreasing Resilience and BurnoutYou’ve likely seen the headlines in HR newsletters, social media, or even the evening news: The United States is currently in the midst of a public health emergency related to the opioid crisis. Although the stories related to heroin use and deaths related to overdose are riveting, we may be overlooking the disturbing impact prescription opioids, or prescribed narcotic pain medications, are having on our workforce.

In the US opioid use, abuse and treatment costs about $756 per employee per year.

The declaration of the opioid epidemic as a public health emergency in fall of 2017 accelerated our access to research and published outcomes. Healthcare systems, insurance plan carriers, pharmacy benefit managers, and professional licensing boards have all deployed mechanisms to control the supply of prescribed opioid pain relievers. The goal is to curtail the access to an excessive supply of prescribed pills—many of which have played a role in an individual developing a opioid use disorder (2.1 million individuals) or were diverted for misuse (11.5 million individuals).

What is Opioid Misuse?

  • use without a prescription of one’s own;
  • use in greater amounts, more often, or longer than prescribed;
  • use in any other way a prescriber did not direct;
  • Opioid misuse includes the misuse of prescription opioid pain relievers OR the use of heroin.

Opioid Misuse: An Under-recognized Threat to the Workforce?

In the 2016 National Survey on Drug Use and Health, individuals who misused an opioid prescription medication at least once during the past year reported the main reason they did so was to relieve physical pain (62%). This is not all that surprising a response, what is concerning are the next 4 most common responses for misuse:

  • To feel good or get high
  • To relax or relieve tension
  • To help with feelings or emotions
  • To help with sleep

Employers are becoming more aware of the utilization of opioids within their workforce. Rather than relying on random urine drug screens (which often fail to identify prescription opioid medications), they are reviewing claims data—both medical and pharmacy—to identifying concerning patterns, high utilization, and even individuals with multiple prescribers. Some employers feel they have a social responsibility to both their employees and the community to help curb the over-prescription of narcotic pain medications. After all, many employers are subsidizing their use through employer-sponsored medical and pharmacy plans.

A Cry for Resiliency?

Resilience is described as the ability to withstand, recover and grow in the face of stressors and changing demands. Burn-out could be considered the opposite—fatigue, frustration or apathy resulting from prolonged stress, overwork or intense activity. The World Health Organization named stress as the health epidemic of the 21st century and there are multiple studies linking workplace stress to several negative outcomes, including increased absenteeism, heart disease and substance abuse. Opioids are already being misused for reasons that could easily be associated with “self-medicating” to cope with stress. In fact, 2/3 of those who report abusing opioid pain medications are employed.

Could misuse of opioids for “self-medicating” of non-physical pain be a heralding sign of impending burnout in an individual?If present in a substantial portion of the workforce, could it be an early warning to a cultural burnout, declining population resiliency or a toxic work environment?  We do not have studies to date demonstrating a direct correlation and do not advocate asking your workforce directly if they have an opioid misuse problem. However, the potential connection should be enough to give one pause to consider other means to controlling opioid misuse beyond limiting access to prescription opioids (our current main strategy).

We have seen wellness programs evolve towards the more encompassing concept of wellbeing—taking note that stress (and health!) comes from physical, emotional, financial, career and community dimensions. As employers are refocusing their wellness efforts to the broader perspective of wellbeing—they must keep in mind that stress generated from poor health in one of the 5 dimensions of wellbeing may lead to a poor perception of self-health, self-medicating with mood altering substances, and declining resilience.

Don’t Wait Until You Have to Respond

Just as educating your workforce to the dangers of opioid medications (opioid-related overdose is a leading cause of death for employees under 50) and limiting excessive supplies of opioids are valid responses to the opioid epidemic, educating your workforce on stress and wellbeing can be a fulfilling response to a potential decline in resilience. Employers can take a proactive stance, assessing the health and engagement of their workforce, looking at the utilization of opioids, and educating on resources available within the health plan.

Reacting to the unexpected death of an employee who accidentally overdoses on pain medications over the weekend, or to the workplace accident that resulted from someone being under the influence of narcotic pain meds at work, is too late a response. So where do you start? Find out what your medical insurance or pharmacy plan carrier has developed to help your plan membership navigate this difficult topic. Take a more discerning look at your EAP to see if they have the capability of assisting in member education as well as directing individuals to appropriate resources in their community.

If you want to look more deeply at how your workforce utilization of opioids may be an indicator of their resilience and wellbeing— register for our webinar on April 11 or live event on April 26 to learn how we can be of help.

Jenny Love, MD, MPH, FAAFP, CPE

Jenny Love, MD, MPH, FAAFP, CPE

Health Management Director - Jenny leads the HCW health management platform and team to provide health management consultation and innovative solutions to help clients control healthcare costs. Her clinical knowledge and experience in physician leadership, population health, and healthcare systems contribute to her ability to champion and collaborate with physicians, insurers, third party service providers, and clients in developing health management initiatives for employers.
Jenny Love, MD, MPH, FAAFP, CPE