The Problem

Despite being pushed off the front pages by the pandemic and our nation’s recent economic woes, deaths from opioid use disorder (OUD) have soared to new levels over the past few years, having a profoundly negative impact on families, communities, and workplaces. According to the Centers for Disease Control and Prevention, drug overdose is a leading cause of injury-related death in the US, and in Missouri, the leading cause of death for those ages 18-44 years. In 2021, opioids were associated with 70% of all overdoses in the state, at the cost of 1,583 Missouri lives, according to Missouri Department of Health and Senior Services (DHSS) data.

Missouri Resident Overdose Deaths, 2016-2021

Source: Missouri Department of Health and Senior Services

The opioid class of drugs includes heroin, fentanyl, methadone, morphine, oxycodone, and many other prescription and non-prescription pain relievers. As the chart above illustrates, the types of opioids implicated in death from overdose are changing. Synthetic opioids, predominantly illicit fentanyl, surpassed prescription opioids and heroin as drivers of overdose-related morality rates in 2016. Much more potent than heroin, fentanyl and its analogues can take the form of powders, tablets, and liquids, which severely challenges efforts to stem opioid misuse. This enables contamination of a range of illicit drugs, including heroin and counterfeit pills, and has elevated the risk of overdose among low-frequency users and increased both fatal and nonfatal overdose rates.

Reporting from the Midwest Health Initiative demonstrates that opioid scripts per 1,000 in the commercially insured population in St. Louis have been trending downward, dropping by nearly 25% between 2018 and 2021, likely due to employer, pharmacy benefit manager, and public sector interventions. But this should not be seen as a signal that that all is well at the worksite.

Workplace Impact

According to the Substance Abuse and Mental Health Services Administration, approximately 66% of adults who misuse opioids are employed. OUD and other substance use disorders increase accidents, turnover, poor job performance, and health care costs. Each employee who recovers from a substance use disorder saves an employer $8,500 annually, according to the National Safety Council (NSC). The NSC Substance Use Calculator uses workforce size, industry, and location to calculate the costs of substance abuse for individual businesses.

Employer Action

The drug epidemic affects all genders, races, economic statuses, and age groups in both rural and urban communities.  In addition to workers themselves, any employee may have a partner, child, or family member that is struggling with a substance use disorder. Given the widening scope and continuing urgency of the problem, employers can review and update their strategies for combatting this serious disease. 

1. Ensure benefit plans provide supportive counseling and behavioral health services.
2. Train managers and workers to identify signs and symptoms of a substance use disorder and connect impacted persons to appropriate treatment and recovery supports.
3. Keep naloxone in the workplace and train employees on how to properly administer it. Naloxone reverses the effect of opioids and can save a life, if administered in time. It is available in most states, including Missouri, without a prescription.
4. Help employees find the treatment and recovery programs with the highest likelihood of success. Medication -assisted therapy (MAT) is a comprehensive approach that combines the use of medication with counseling and behavioral therapies to meet the unique needs of individuals.

Missouri DHSS has been working to combat unnecessary death and suffering due to substance abuse, including advancing the number of treatment resources and identifying MAT Treatment Centers statewide. For employers in other markets, SAMSHA has a search tool which delivers information on approved treatment programs by zip code. Use care in getting to the actual federal agency site if not using the link provided, as a lot of treatment centers have created “official-looking” sites that promote their own treatment center. 

Resources

Employers hold legal obligations when addressing any type of substance use disorder with an employee. The Americans with Disabilities Act (ADA) protects qualified employees with disabilities from employment discrimination and may apply to individuals in recovery from substance use disorders. Luckily, there are many resources to guide employers in their efforts, including:

• SAMHSA’s Drug-free Workplace Toolkit, for advice on complying with federal guidelines.
• SAMHSA’s Guide for Employers to Identify and Prevent Opioid Misuse, a comprehensive and valuable resource for employers seeking effective policies and practices.
• The Society for Human Resource Management has created a library of resources on the topic, including this article on employer treatment approaches to combat rising substance abuse post-pandemic.
• The Minnesota Department of Health’s Opioid Epidemic Response Employer Toolkit, which includes sample emails, social media, and other resources for communicating with employees about proper disposal of prescription medications and other issues related to opioid misuse.

When employers respond to the opioid epidemic, it benefits employees, the people that surround them, businesses, and society in general. The BHC hosted an educational program on this topic in August 2018 and looks forward to continuing to support employers in addressing this concerning public health issue. Please let us know how we can be a resource to your teams.

Warm Regards,

Louise Y. Probst,

BHC Executive Director