Prescription Drug Impact in the Workplace

Tess Benham, Sr. Program Manager, National Safety CouncilDr. Denise Fields, PharmD, Sr. Clinical Consultant, Express ScriptsTamara Watson, Master Trooper, Indiana State Police

Conflicts of Interest

• Tess Benham has no conflicts of interest to disclose.

• Dr. Denise Fields is an employee of Express Scripts, but this will not influence today’s presentation.

• Master Trooper Tamara Watson has no conflicts of interest to disclose

Learning Objectives

• Understand the impact of prescription drug abuse on Indiana businesses and workplaces.

• Identify strategies for educating your workforce.• Identify challenges to and resources for

implementing a prescription drug abuse training program in your workplace.

Results from aSurvey of Indiana Employers

Setting the Stage

Tess Benham, Senior Program Manager, National Safety Council

Overall Objectives:

The purpose of this research was to understand current attitudes and behaviors around prescription drug policies and procedures among Indiana employer

Methodology:

Online survey invitations were sent to HR and safety professionals.

Sample:

Sample was a combination of NSC contacts and SHRM members in Indiana.

Timing:

Survey was fielded May 13th through August 20th, 2015.

Survey Background

Survey Background (continued)

Qualified Respondents:

• 50+ total employees in organization/company (all locations)

• Make or share in determining organization practices for hiring practices, training, benefits programs or employee policy

Statistical Significance:

• Results analyzed at the 95% level of confidence

• Margin of error, +/- 6.9%

50 to 99 employees

100 to 499 employees

500 to 1,000 employees

Over 1,000 employees

11%

42%

11%

36%

# of Employees Job Title/Role

(n=201- Total)

Participant Demographics

S1 How many employees work in your organization or company, taking into account all units and locations? (Your best estimate is fine)

29. Which of the following best reflects your job title?

(n=201- Total)

Human Resources

Environmental Health Safety

Risk Manager

Training & Staff Development

Owner or CEO

Other

56%

23%

5%

5%

4%

7%

Manufacturing

Health Care and Social Assistance

Transportation and Warehousing

Finance and Insurance

Construction

Professional, Scientific, and Technical Services

Educational Services

Retail Trade

Utilities

39%

11%

10%

6%

5%

5%

5%

3%

3%

Industry

(n=201- Total)

Participant Demographics (continued)

Arts, Entertainment, and Recreation

Wholesale Trade

Mining, Quarrying, and Oil and Gas Ex-traction

Public Administration

Real Estate and Rental and Leasing

Agriculture, Forestry, Fishing, and Hunting

Information

Accommodation and Food Services

Waste Management and Remediation Services

2%

2%

2%

2%

2%

1%

1%

0.5%

0.5%

32. Which of the following categories best represents the industry to which your company or business unit belongs?

(n=201- Total)

Participant Demographics (continued)

36. Where is your headquarter location located?30. If applicable, how many years have you worked in your field?34. Are any of your employees covered by union regulations or contracts?

79% have HQ in Indiana

77% in their field 10+ years

71% have no emp. covered by union regs or contracts

68% senior-most for location or organization

65+ have employees at multiple locations

31. Which statement best describes your personal level of responsibility within your organization for health and safety issues?

35. Do most employees at your organization work…?

(n=201 - Total)

Scope of the Problem

Observed an Issue (NET)

Use of Rx painkillers at work

Positive drug tests result for prescription

Absenteeism or missed work

Family member affected

Impaired/ decreased job performance

Borrowing or selling Rx drugs at work

Complaints to HR/ negative morale

Near miss or injury related to Rx drug usage

Arrest (on/off job)

Overdose

None

80%

59%

41%

41%

40%

35%

23%

19%

19%

10%

5%

20%

Observed Workplace Issues

6. Keeping in mind that all information will be kept strictly confidential, which of the following are you aware of having occurred in your workforce? Please include any occurrence, even if it is few in number.

(n=201- Total)

Most Indiana comp. impacted by RX abuse…

Justifiable reason to fire

Bigger problem than illegal drugs

Harming safety

Moral/ ethical failure

Lowering productivity

Is a problem

Decreasing morale

Causing near misses or injuries

Making it hard to hire

Increasing Worker’s Comp.

Making it hard for keep

39%

18%

14%

16%

12%

11%

5%

6%

6%

5%

3%

37%

46%

32%

29%

32%

28%

26%

24%

23%

23%

18%

Strongly Somewhat

Agreement with Statements

5. Please rate your agreement with each of the following statements about the impact of prescription drugs on your organization. Misuse or abuse of prescription drugs is…?

76%

% Strongly/Somewhat

64%

46%

45%

44%

39%

31%

30%

39%

28%

21%(n=201- Total)

… and feel it is a problem…

Ability to hire Benefits Costs Aging of the workforce

Worker comp / costs

Illness / absen-teeism

RX drug misuse

Illegal drugs Workplace violence

74% 68%51% 46% 42%

29% 25% 23%

Major Concern

Level of Concern - Issues

1. How concerned are you about the impact each of the following issues may have on your organization?(n=201- Total)

…but everyday concerns eclipse the problem.

Agreement with Statements

5. Please rate your agreement with each of the following statements about the impact of prescription drugs on your organization. Misuse or abuse of prescription drugs is…?(n=201- Total)

Underlying beliefs a barrier to org. change.

76%

24%

45%55%

… a justifiable reason to fire an employee. …a moral or ethical failure.

AgreeDo not agree

Behaviors of Indiana Employers

Topics Covered by Organizations Written Policy

10. Which of the following topics are specifically covered in your organization’s written policies?

None of these

Drug testing

Employee use of drugs without a prescription

Return to work policies for employees undergoing substance abuse treatment

Employee use of prescription drugs at work

Employee responsibility to notify supervisors of prescription drug usage

Performance improvement plan for employees who have failed drug tests or whose performance has declined related to drug

usage

Unsure/Don’t know

5%

84%

60%

58%

53%

48%

34%

4%

(n=201- Total)

Most cover drug tests, but few address abuse.

Policy Best Practices

• Address non-medical use of prescription and over-the-counter medications in the policy

• Include prescription medications in drug testing panel and policy

• Provide guidance to employees on when it is okay to use medication at work and if they should report this use

• Be able to assign employees to alternate work tasks while on medication

• Provide information about how to access employee benefit and assistance programs

Most conduct drug testing…

Yes (NET)

Pre-employment

When need is indicated

At random intervals

On a fixed schedule

No

87%

79%

63%

39%

3%

13%

Conduct Drug Testing

20. Does your organization require drug testing for your employees?

(n=201- Total)

22. What substances are tested for?

Substances Tested For

Cannabinoids (Marijuana, THC)

Opiates (Codeine, Morphine, Heroin)

Amphetamines (including Methamphetamine) (Adderall, Ritalin, etc.)

Cocaine

Barbiturates (Seconal, phenobarbital, etc.)

Benzodiazepines (Xanax, Ativan, Klonopin, Valium, etc.)

Phencyclidine (PCP)

Methadone

Synthetic Opioids (Oxycodone, Hydrocodone, Dilaudid, Fentanyl, etc.)

Methaqualone (Quaaludes)

Propoxyphene

Other

Don’t Know/Not Sure

93%

91%

91%

91%

77%

64%

61%

57%

52%

43%

31%

11%

26%(n=174- Require Drug Testing)

…but few test for opioids…

…the most frequently abused drug in Indiana.

Upon admission to treatment in Indiana, top drugs of choice reported are:• Alcohol• Opioids• Polysubstance abuse

• Opioids• Cannabis• Benzodiazepines• Alcohol

Yes (net)

Annonymously assist

Develop plan to assess/ treat

Identify employees with abuse issues

Other

No

87%

79%

29%

12%

3%

12%

Use Employee Assistance Program (EAP)

18. How confident are you in your EAP providers’ ability to handle substance use, misuse or abuse issues?

Level of Usage of EAP

Increasing Staying the same Decreasing

22%

76%

2%

(n=201- Total) (n=176- Have EAP)

Most take advantage of an EAP.

19. s that rating based upon…?

9. Which of the following, would you say, best reflects your organization’s approach to an employee who is found to be misusing or abusing drugs or alcohol?

Organizational Approach to Employee Misuse/Abuse of Drugs or Alcohol

63%

33%

2% 1% 1%

(n=201- Total)

Most want to return employees to work...

HR Supervisors Employees

38%35%

26%

Very Confident can Identify Warning Signs

8. How confident are you that your Human Resources department, supervisors and employees can correctly identify behavior that is a warning sign of misuse or abuse of prescription medication?

(n=201- Total)

…but can’t identify who needs help...

…because very few offer any training.

Offer Training

11. Does your organization currently offer training around workplace usage of prescription drugs?

Do not Train; 71%Train; 29%

(n=201- Total)

• 29% train supervisors• 13% also train employees

Prescription for Indiana Employers

1. Recognize prescription drugs have big impact on your workplace

2. Put strong policies in place

3. Expand drug testing panels to include opioids

4. Train supervisors and employees how to spot signs

5. Treat substance use problems as a disease

6. Leverage EAP to assist employees to return to work

Strategies for Training your Workforce

Dr. Denise Fields, PharmD, Senior Clinical Consultant,

Express Scripts

Tamara Watson,Master Trooper,

Indiana State Police

Where to start

Forming your team

Identifying your resources

Developing policies and procedures

Engaging employees in awareness and education

Forming your team

Internal

Executive leaders

Labor relations

Legal

Human Resources

Benefit leaders

Facilities

Safety/Risk Management

External

Clinical Experts

Law Enforcement

Community Resources

Health/wellness vendors

Identifying your resources

Do you know or have clinical experts, community leaders, vendors or law enforcement contacts that would be willing

to volunteer/assist?

Can you get approval to pay employees for an hour of non-

productive time?

How is your benefit plan for employees

designed?

Developing Policies and Procedures

Company Stance Drug Testing Disciplinary

Action

Law Enforcement Relationship

Benefit Design

Medication Security

Safety & Risks Education & Training

Engaging employees

• General awareness education can be an early/initial activity, even as policies are still being developed.

• Consider when and how often general awareness education should be done:• Onboarding• Annually or semi-annually• When an event occurs

Awareness effort considerations

Who will be educating your workforce?

Who should your audience be?

What content should be included?

What presentation style will work best?

Who should educate your population?

Clinical

• Physician• Pharmacist• Paramedic/First Responders

Community

• Law Enforcement• Local Coordinating Council

Vendors

• Employee Assistance Program (EAP)• Health and Wellness Partners

Consider your audience

• Create different education programs for your management/supervisory level employees from your general pool of employees

• Consider not having management present at your general employee meetings

• Educate your audience not only as employees in a work setting, but also touch on effects of Rx Drug Abuse on their community and family

Presentation Delivery

• Make it interactive– Use audience polling questions/system– Incorporate games or competitions

• Remain non-judgmental• Ensure it is relatable

– Use real life examples– Tie it in to community or workplace

Have you ever heard or said…..

“Just take a few of my leftover…”“My sister will never miss one or two of these, and I have a

huge headache…”“I was just borrowing a couple of pills from an old bottle of

medicine in the cabinet...” “I store all these in case someone needs them

sometime…”“Dad will never notice they are gone...”“We just have not had time to go through all these drugs

since grandpa passed away…”

What to include

Why are prescription drugs an addiction issue?

What are the signs and symptoms?

What are some issues specific to the workplace?

What resources are available?

What are the potential legal ramifications?

Why Prescription Drugs?

• Provide statistics on Prescription Drug Abuse– Compare US vs state vs county/local statistics– Review statistics available for specific job types

• Describe some of the cultural/social drivers• Explain the supply chain• Describe the business plan

Reasons Adults Abuse Drugs

Pressure to Succeed or meet a deadline

Desire to Fit In

Death of a Loved One

Job LossDivorce

CARING FOR AN AGING PARENT OR DISABLED CHILD

Why Pharmaceuticals?

• Easy to obtain• Cost effective – especially with insurance!• Perceived as safer• Easier to conceal• Generally odorless• Dosage Consistency• Everyone’s doing it!

Recognizing the signs and symptoms

– Describe the physical and emotional signs/symptoms employees could exhibit

– Explain the focus for disciplinary action(s) should be on job performance

• Reinforce that supervisors, managers and co-workers should not attempt to diagnose

– Gives examples of physical evidence left behind– Review slang words or terms related to Rx drug abuse– Educate supervisors/managers regarding drug testing

limitations• Qualitative vs quantitative testing• What does a preliminary “non-negative” result mean?

Job performance issue examples

• Reduced productivity or work quality• Absenteeism and tardiness• Bizarre and/or disruptive behavior• Concentration problems• Erratic work habits• Concerns about possible substance use• Interpersonal conflicts; confrontations with coworkers

and/or customers• Violence at home or at work, including threats of suicide

or workplace violence

Supervisor Guidelines

• Know your employer policies and procedures• Be aware of legally sensitive areas• Recognize potential problems• Document in a systematic and fair manner• Act in a confidential manner• Refer to appropriate resources• Reintegration into the workplace

Work place specific issues

• Company policy and procedures– Drug testing– Disciplinary action

• Dangers in the workplace– Safety risks– Financial risks– Corporate brand/image risks

• Security of medications at work

Resources available

National Experts

• SAMHSA• National Safety Council• Centers for Disease Control (CDC)• National Institute on Drug Abuse

Community

• Law Enforcement• Church programs• Social workers/Support groups• Healthcare facilities/providers

Vendors

• Employee Assistance Program (EAP)• Pharmacy Benefit Manager (PBM)

Legal Ramifications

– Relationship with law enforcement– Perpetrator and victim can be same person– Legal vs not legal activities– Felonies vs misdeamoners– Felony Impact

Felony Consequence Examples• Disenfranchisement (expressly permitted by the Fourteenth Amendment, as

noted by the Supreme Court)….”losing your right to vote”• Exclusion from obtaining certain licenses, such as a visa, or professional

licenses required to legally operate (making some vocations off-limits to felons)• Exclusion from purchase and possession of firearms, ammunition, and body

armor• Ineligibility to serve on a jury• Ineligibility for government assistance or welfare, including being barred from

federally funded housing• Deportation (if not a citizen)• It is legal to discriminate against felons in hiring decisions as well as the

decision to rent housing to a person, so felons can face barriers to finding both jobs and housing

• Many banks refuse service to convicted felons• Some states consider a felony conviction grounds for an uncontested divorce

Challenges and Opportunities

• Awareness and Education• Outdated/insufficient data in the workplace• Outdated DOT testing panels• Access to Care – Local resources• Changing your benefit plan (make physical therapy

more convenient and just as cheap as a $4 Rx)• Lifestyle education to equip and motivate

employees to make better lifestyle choices (so that they don’t need medications)

Resources

• National Safety Council – www.nsc.org/rxpainkillers

• NSC Prescription Drug Employer Kit– www.nsc.org/rxemployerpolicy

• Bitter Pill– www.in.gov/bitterpill/workplace-risks.html

• Department of Labor E-Laws Drug Free Workplace Advisor– http://www.dol.gov/elaws/drugfree.htm

Learn more at BitterPill.IN.gov

Thank you

Questions…