THE OPIOID CRISIS: CONSIDERATIONS FOR EMPLOYERS

Prescription Drugs & The US Workforce National Employer Survey Prescription Drugs & The US Workforce

Profiling Respondents Firmographics & Workforce Organization Size Sites Pacific Mountain West North Central West South Central East South Central East North Central South Atlantic Middle Atlantic New England 15% 8% 7% 9% 18% 5% 16% 17% Region Industry Industrial (Manufacturing (20%), Transportation & Warehousing (4%) Construction (2%), Mining & Oil & Gas Extraction (2%), Utilities (1%)) 30% Public & Social Services (Health Care & Social Assistance (9%), Education (8%),Public Administration (7%), Accommodation & Food Services (3%)) 28% Professional Services (Prof., Scientific & - Technical Services (10%), Finance & Insurance (7%), IT (4%), Real Estate (2%)) 25% Retail & Wholesale (Retail Trade (7%), Wholesale Trade (2%)) 9% Other (Non-Profit (4%), Arts, Entertainment & Recreation (3%), Agriculture (1%), Biotech (1%), Waste (>1%)) 10% This survey is based on a geographically representative sample of US businesses, with a good mix of industries and company sizes. All represent organizations with 50 or more employees, and all are based in the US. While 23% of the businesses are global, all responses are focused on US operations. Q1. How many employees work within your organization, taking into account all locations within the U.S.? Q27. Which of the following categories best represents your industry? Q30. Which of the following best describes the location(s) of the organization where you currently work? Q31. In which state is your work location? Base: 501 (All Respondents)

Profiling Respondents Professional Profile All respondents are HR decision makers who are involved in, or ultimately responsible for, decisions about their workplace’s strategy and policies with regards to: health and safety, healthcare benefits, employee policy and/or drug and alcohol policy (highlighted in blue). The majority of respondents are in a HR role. Professional Responsibilities Job Role Years In Role * Other job roles include: HSE, risk management, staff training & development. Q2. Please indicate your involvement in each of the following decisions within your organization. Q3. Which of the following best describes your job function? Q26. How long have you been in your current role? Base: 501 (All Respondents)

Key Learnings & Considerations

Prescription Drugs & The US Workforce National Employer Survey Prescription Drugs & The US Workforce

7 In 10 Employers Have Felt The Impact Of Prescription Drugs Understanding The Issue 7 In 10 Employers Have Felt The Impact Of Prescription Drugs

Employers Understand The Health Risks But Not The Business Impact Understanding The Issue Employers Understand The Health Risks But Not The Business Impact “Employers understand prescription drug abuse as a health issue but do not understand its business impact” Employer Concerns Employee benefits costs Ability to hire qualified workers / fill skills Worker compensation costs Illness/absenteeism Aging of the workforce Workplace violence Prescription drug misuse Illegal drug use/sale by employees Perspective on Prescription Drugs a sign of addiction a disease that should be treated as one a justifiable reason to fire an employee a bigger problem for than illegal drug abuse a signal that an employee cannot be trusted a moral / ethical failure harming the safety of my workforce lowering the productivity of my workforce a threat to my company’s reputation increasing my worker’s compensation costs decreasing employee morale causing more near misses or injuries making it hard to hire qualified employees a problem in my workforce making it hard to keep qualified employees “Employers focus more on HR challenges than prescription drug misuse” Substances of Concern Alcohol Marijuana Opioid pain relievers Anti-anxiety medications Heroin ADHD stimulants “Employers are more concerned about alcohol and marijuana than opioids although opioids still a concern to many”

Preparing For The Issue Over A Quarter Of Employers Feel Unprepared For Dealing With Prescription Drug Misuse Overall employer preparedness to deal with prescription drug misuse 72% Prepared 28% Unprepared More so large organizations with 1,000+ employees – 80% More so smaller organizations with less than 1,000 employees – 33% Organization size More so organizations with union contracts/regulation – 79% More so organizations without union contracts/regulation – 33% Workforce under union contract/regulation The less prepared organizations are smaller and are less likely to have employees operating machinery, tools and vehicles. This is a consistent national pattern with no noteworthy differences by region or industry. More so if any employees operate machinery, tools or vehicles – 76% More so if no employees operate machinery, tools or vehicles – 24% Workforce operating machinery, tools or vehicles

Policies & Processes Significantly Improve Preparedness Preparing For The Issue Policies & Processes Significantly Improve Preparedness …Take Workplace Initiatives Training (95%) Drug Testing (84%) Has An EAP (75%) … Cover Issues In Written Policies Employee use of medical marijuana (86%) Performance improvement plan for those who fail drug tests (85%) Return to work policies for impairing medications (84%) Employee responsibility to notify of prescription drug usage (84%) Return to work policies for substance abuse treatment (82%) Make accommodations for impairment due to prescription medications (81%) Employee use of prescription drugs at work (81%) Drug Testing (78%) Employee use of drugs without a prescription/illicit drugs (77%) … Have Confidence In Workplace Processes (Q9: % Somewhat & Very Confident) Processes for helping with recovery (83%) Management ability to identify impairment/addiction (83%) Workers’ ability to identify impairment/addiction (82%) Procedures for managers to follow (81%) Insurance and benefits to deal with issue (78%) Appropriate policies to deal with issue (77%) All employers who take any of the initiatives tested (training, drug testing, EAP), cover any one of the issues tested in written policies, or have confidence in their workplace processes, are significantly more likely to consider their organization prepared to deal with prescription drug misuse. For instance, 95% of those who offer relevant workplace training about prescription drug usage and misuse feel prepared to deal with the issue.

Training About The Subject Is The Strongest Driver Of Preparedness Preparing For The Issue Training About The Subject Is The Strongest Driver Of Preparedness Drivers of Overall Preparedness Who can identify signs of prescription drug abuse? Underutilized Primary Driver HR Decision Makers (me personally) HR Department Supervisors / Managers Individual Employees Training around workplace usage of prescription drugs All other policies and programs Every policy tested in this survey significantly improves overall preparedness to deal with prescription abuse in the workplace. However, employers offering training on the subject have a significantly higher correlation with overall preparedness. At the same time, this is the least implemented initiative, used only by 24% of employers. When charted against primary usage, it is the one item which drives preparedness like no other, and it is highly underutilized. It also has other clear benefits, such as improving the ability of co-workers to spot warning signs.

Employers Who Have Experienced An Incident Have More Policies In Place Responding To The Issue Employers Who Have Experienced An Incident Have More Policies In Place Topics Covered By Written Policies Drug testing Employee use of drugs without a prescription/illicit drugs Return to work policies for employees undergoing substance abuse treatment Employee use of prescription drugs at work Return to work policies for employees taking impairing medications Interactive process to make accommodations for employee impairment due to prescription medications Performance improvement plan for employees who fail drug tests/performance declines from drug usage Employee responsibility to notify supervisors of prescription drug usage Employee use of medical marijuana Those employers who have experienced a negative incident related to prescription drug usage are significantly more likely to have relevant policies in place. This could suggest all or some of the following: That it takes something to go wrong for employers to get adequate policies and processes in place; That those employers most exposed to the risk of incidents are also best prepared; That some organizations don’t recognize the challenge, and are both unaware and unprepared to deal with potential incidents.

Insurance Coverage Of Alternative Treatment

Responding To The Issue Alternative Treatment Options Of Interest Physical Therapy Is Most Used And Most Popular Total Interested -OR- Already Covered 89% 82% 69% 68% 67% 65% 51% Physical therapy is the most commonly covered form of treatment currently covered by US employers. It is also highly attractive, with nine out of ten employers mentioning that they either are interested or already cover it. Among those who do not currently offer it, 84% are interested in it – the highest of all options. Interest is consistent across regions, except that West South Central-based employers are significantly less interested in Yoga (37%). Base: 501 (All Respondents) Q22. Assuming you were given evidence that the following would be more effective in treating pain than prescription drugs, how interested would you be in having your plan cover these alternative treatment options at a cost similar to prescription copays?

There Is Significant Interest In Alternatives To Prescription Drugs Responding To The Issue There Is Significant Interest In Alternatives To Prescription Drugs 88% Are interested in their insurer offering alternative treatment options 62% Are likely to request that their insurer offers alternative treatment options 57% Expect their insurer to be responsive to offering alternative treatment options The 30% Who Are Interested But Unlikely To Request Physical Therapy Is the most commonly covered treatment (31%) and the most attractive for those who do not offer it (84%) less concerned about opioids (23% versus 66%) and other drugs less concerned about prescription drug misuse (25% versus 66%) less likely to recognize the health and business impact of prescription drug abuse less interested in specific alternative treatment options less likely to expect the insurer to be responsive (17% versus 75%) Cognitive Behavioral Therapy Is the second-most most commonly covered treatment (14%) and the second-most attractive for those who do not offer it (79%)

Real Costs of Substance Use https://www. shatterproof Easy to use tool Computes costs of substance use Specific to industry, state and employee population https://forms.nsc.org/substance-use-employer-calculator/index.aspx

Methodology Combines latest data on employment costs with data from the National Survey on Drug Use and Health to calculate how much substance misuse in your workplace costs Data Sources National Survey on Drug Use and Health 3-year average of data (2012-2014) Bureau of Labor Statistics Fully loaded hourly wage data by industry – August 2016 Hospital claims data This tool combines the latest research on employment costs with data from National Survey on Drug Use and Health (NSDUH) to calculate how much substance misuse and abuse in your workforce costs employers

Prevalence of pain medication, alcohol and substance use disorders prevalent by industry sector Finance, insurance, real estate Wholesale durable Other services except public administration Agriculture Manufacturing durable Transportation, utilities Education, health, social services Public administration Lower than average Wholesale nondurable Professional management Mining Retail Information, communications Average Entertainment, recreation, food Construction Higher than average This tool combines the latest research on employment costs with data from National Survey on Drug Use and Health (NSDUH) to calculate how much substance misuse and abuse in your workforce costs employers. Occupations where people are more likely to become injured have higher rates of SUDs and pain medication misuse disorders. Service occupations, except protective services Construction, extraction Production, machinery, operators Transportation, moving All 1.0% or more with pain medication use disorder. Workers with a substance use disorder are more likely to be male, unmarried, and have a lower income. Overall US Workforce Pain med use disorder Any substance use disorder Male 53% 61% 67% Married 54% 28% 33% Between 18 to 34 years 34% 66% 55% Family income below $20K 12% 24% 18% Prevalence of SUDS by industry Any SUD Pain Med Alcohol Entertainment, recreation, food 15.3 1.6 12.1 Construction 15 1.3 12.4 Mining 10.3 1 9.6 Other services except publ. admin 8.7 1 7.1 Professional, mgmt., admin 10.3 0.9 8.6 Retail 9.8 0.9 7.9 Manufacturing, durable 8.4 0.8 7.5 Overall average all occupations 9.4 0.8 7.9 Wholesale, nondurable 10.6 0.7 9.4 Information, communications 9.7 0.6 8.2 Manufacturing, nondurable 8 0.6 6.7 Transportation, utilities 7.5 0.6 6.6 Education, health, social services 6.4 0.5 5.4 Public administration 5.7 0.5 5 Wholesale, durable 8.7 0.4 8.1 Agriculture 8.6 0.4 7.5 Finance, insurance real estate 9.1 0.3 8.1 Higher prevalence Younger, male-dominated workforce, easy access to alcohol Construction, entertainment, recreation and food service have twice the rate of SUDs and AUDs Pain medication misuse highest in entertainment, recreation, food services, construction and mining

Unscheduled Leave Workers with substance use disorders miss 50% more days than their peers. Workers with pain medication use disorder miss 3x’s more work – 29 days. Costs of missed work vary by industry ranging from $187 to $3,941 per employee annually. Employees with pain medication misuse disorders miss much more work and their absence is associated with much greater costs to employers. Highest costs in information and communications ($27,500/employee), durable goods manufacturing ($14,800/employee), professional services ($6,000) and education, health and social services ($5,000). Highest costs for employees with any substance use disorder are Information and Communication ($3,941), professional services ($2,600).

Job Turnover Employees with untreated or active substance use disorder had higher turnover rate 36% as compared with 25% for general workforce. Excess job turnover per capita costs range from $512 to more than $4,000 annually. Turnover costs are highest in high-wage and higher-skilled industries Costs higher in higher wage and higher skilled industries: Information and communications, mining, manufacturing, wholesale

Excess Healthcare Use Workers and family members with a current SUD consistently use more health services and cost more than those individuals with no SUD. A worker with a SUD, the cost of employee’s health care in 2014 was $2,198, primarily from excess emergency department use. Pain medication use disorders cost twice as much, at $5,586. Emergency use is 4x’s that of workers with no SUD and twice the rate of workers with other SUDs. This tool combines the latest research on employment costs with data from National Survey on Drug Use and Health (NSDUH) to calculate how much substance misuse and abuse in your workforce costs employers

Employer investment in treatment reduces missed work and job turnover Workers completing treatment and in recovery for 1 year fewer days of work and less likely to change jobs

Employer investment in treatment reduces healthcare costs Healthcare utilization returns to baseline for workers completing treatment and in recovery for 1 year

Resources Real Costs of Substance Use Calculator Shatterproof https://forms.nsc.org/substance-use-employer-calculator/index.aspx Shatterproof www.shatterproof.org/take-action-in-the-workplace-resources NSC Employer Survey Findings www.nsc.org/NewsDocuments/2017/Media-Briefing-National-Employer-Drug-Survey-Results.pdf

Questions Jenny M. Burke, J.D., M.S. Senior Director, Advocacy National Safety Council Jenny.Burke@nsc.org Surgeon General estimates $120b spent annually on substance use-related health care services in ‘16 ($370 pp in U.S.)