Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery (Online)

This toolkit provides general information on the topic of opioids in the workplace. It should not be taken as legal advice. Please consult an employment attorney to discuss your workplace’s unique circumstances before implementing any policies relating to the topics described in this toolkit.

On October 26, 2017, a nationwide Public Health Emergency was declared by the U.S. Department of Health and Human Services in response to the growing crisis of opioid misuse and overdose. Individuals, families, and communities across the nation continue to face significant emotional, social, physical, and financial impacts.

In 2017, opioids contributed to more than an average of 130 deaths per day – a six-fold increase from 1999. Most of these deaths occurred in individuals between the ages of 25 and 55 – a group primarily of working age adults. The White House Council of Economic Advisors estimates that the total economic cost of the crisis in 2015 was $504 billion, 2.8% of that year’s GDP. Other unintended consequences of this crisis include compromised mental and physical health, as evidenced by an increase in the prevalence of conditions such as neonatal abstinence syndrome, infectious diseases, suicide, and depression. The safety of communities is also threatened with an associated increase in crime and violence, motor vehicle crashes, and child neglect. The causes of this crisis are multi-faceted and have been developing over the course of many decades.

A contributing factor to this crisis is the stigma that persists not only around opioids, but around prevention, treatment, and recovery services. The belief that addiction is a moral failing and fueled by personal choice has been widespread and long-held. This unfortunate and incorrect belief has deterred individuals from accessing services that are necessary to their recovery due to fear of judgment or reprimand. Additionally, this stigma supports the continued separation of addiction treatment from the traditional healthcare system. To reduce this stigma, there needs to be a cultural shift towards understanding addiction as a chronic disease requiring compassion and evidence-based medical intervention.

As the opioid crisis has progressed, a crisis around pain has been co-evolving. Despite there not being an overall change in the number of Americans reporting pain, the number of prescriptions for opioids quadrupled from 1999 to 2014. In the 1990’s, opioids gained popularity as a quick, effective, and first-line method of treating pain. Although opioids can be an effective component of certain conditions’ treatment plans, there are also risks. This was demonstrated through the increased incidence of opioid misuse, opioid use disorder, and opioid-related overdose deaths in subsequent years.

In response to the current opioid epidemic, the healthcare sector has placed a heavy emphasis on improving responsible prescribing of prescription opioids. In 2016, the Centers for Disease Control and Prevention (CDC) released guidelines for appropriately prescribing opioids to those who had not previously used them. These guidelines have been successful in reducing inappropriate prescribing, however systemic barriers to accessing comprehensive evidence-based pain management options, and knowledge deficits in healthcare about proper pain care have left limited options for many people with pain.

At the individual level, pain can be a lifelong challenge. At the population level, pain is a significant public health problem. The Centers for Disease Control and Prevention (CDC) reported that in 2016, an estimated 20.4% of US adults had chronic pain and 8% of adults had high-impact chronic pain. Some groups are disproportionately affected by pain as well as have less access to pain-related treatment. A higher prevalence of pain is associated with increasing age, poverty, rural residence, and unemployment. Today, a multi-sector approach has been taken to prevent opioid exposure and related overdoses as well as increase access to OUD treatment options. Progress is being made; however, this same approach must be applied to addressing an upstream cause of opioid use – pain. Opioids can be part of an effective treatment plan for certain conditions. However, comprehensive evidence-based pain management, including opioid prescribing and tapering, must be advanced in order to decrease opioid related harms while ensuring people experiencing pain are receiving appropriate care.

Provide Access to Inpatient and Outpatient Care

After a SUD is diagnosed, ease of access to timely, high quality treatment is critical to initiate remission. Treatment of SUDs is a highly individualized process that often requires multiple treatment approaches. The inclusion of a variety of treatment modalities in the health plan can help improve the likelihood of members recovering.

Care for SUD can be carried out in a variety of settings and types of facilities, typically identified by types of treatment, length of stay, and intensity of treatment. It is important for members to be placed in the most appropriate level of care for their condition, situation, and goals as determined by the American Society of Addiction Medicine’s (ASAM) Levels of Care. A member’s level of care is determined by a provider after a diagnostic evaluation and comprehensive assessment. The assessment could be done by a primary care provider, mental health professional, or treatment facility covered by the health plan. There is no right course to moving between levels of care. To ensure members will have access to the treatment that they require, the heath plan should cover all levels of care.

Coverage limitations, cost-sharing requirements, and utilization management should be especially considered when designing benefits for inpatient and outpatient treatment. Employers should critically evaluate the financial and health-related impact that these components would have on their specific employee population based on income, location, and other social characteristics. Additionally, employers should require their health plans to examine network adequacy for treatment at the various levels of care and administration of evidence-based modalities.

A return-to-work policy for follow up to a treatment episode for OUD is similar in concept to other chronic health conditions. This policy can set clear expectations for the employee’s workplace conduct and responsibilities upon their return. Employee capabilities will largely be determined by their prescribed medical release and possible restrictions. An agreement should be reached with employee and employer input and include the following designations, at minimum:

• Medical Release Form and Potential Restrictions
• Periodic Medical and Job Performance Evaluations
• Employer Accommodations
• Designated Length of Agreement

A well-constructed return-to-work policy can help support the employee in successfully reintegrating into the workplace. In some circumstances, employees returning to work after treatment of a SUD are protected under the Americans with Disabilities Act (ADA).