New Causes for Concern The Rise of Opioid- Based Prescription Drug Abuse: Presented By:

Who is Psychemedics? The world’s leading drug testing company using hair since Our clients include Fortune 500 Companies, Police Forces & Courts, Schools & Parents, and International Programs. Richard Clay Vice President – National Accounts (877)

DURING THIS SESSION YOU WILL LEARN ABOUT: Prescription Opioids – what are they and how do they work? Signs of Abuse/Impairment Steps involved in developing and maintaining a drug free workplace The tools available to keep drug users from entering the workplace undetected

 Prescription drug abuse in the nation’s fastest growing drug problem and classified as an epidemic. (Centers for Disease Control and Prevention)  Between 1998 and 2008 the use of prescription medications rose 61%. (National Center on Addiction and Substance Abuse at Columbia University)  The use of Schedule II Opioids – some of the most powerful pain relievers available – increased by a staggering 380%! (National Center on Addiction and Substance Abuse at Columbia University)  The DAWN study reported a 111% increase in the estimated number of emergency department visits for nonmedical use of opioid analgesics from (from 144,600 to 305,900), and a 29 percent jump from  Results from more than 5.5 million drug tests reveal an 18 percent jump in opiate positives in the general U.S. workforce in a single year (2008 to 2009), and a more than 40 percent climb from 2005 to (http ://  Post-accident drug tests found opiates up to four times more often than pre-employment tests, suggesting that these drugs may be playing a role in workplace accidents. ( AN INCREASING PROBLEM

WHAT ARE OPIOIDS & HOW DO THEY WORK? Opioids (also called narcotics) are drugs that alleviate pain, depress body functions and reactions, and when taken in large doses, cause a strong euphoric feeling What Are the Signs of Opioid Use? Mental dullness Lethargy and drowsiness Going back and forth from alert to drowsy Cold, moist skin or "gooseflesh" Scratches frequently Slurred speech Constricted pupils that fail to respond to light If injected, needle tracks or scars Paraphernalia (syringes, medical droppers, bent spoons, metal bottle caps, foil packets)  The opioid class of narcotics include morphine, codeine, and heroin. Synthetic opiates are hydrocodone, hydromorphone (Dilaudid R ), oxycodone (Oxycontin R, Percodan R ), meperidine (Demerol R ) and propoxyphene (Darvon R, Darvocet R ) and methadone.  Effects: Narcotics increase pain tolerance. As a result, people could more severely injure themselves or fail to seek medical attention after an accident due to the lack of pain sensitivity.  Opioids are considered Schedule II drugs under the Controlled Substance Act because they have a strong potential for abuse or addiction.

 More people die in America every year from prescription drug abuse than die from heroin and cocaine combined.  Enough narcotics are prescribed every year to medicate each and every adult in America every day for a month.  According to the CDC (Centers for Disease Control and Prevention), over 20,000 Americans die each year of prescription drug abuse - 14,800, or 74%, due to misuse of opioid pain medications.  New Mexico has the highest death rate, followed by West Virginia, Nevada, Utah and Alaska.  The highest abuse rate is in Oklahoma, followed by Oregon, Washington state, Rhode Island and Kentucky.  The highest death rates tend to be in either rural or impoverished counties. “This problem crosses all walks of life, crosses all socio-economic classes. Crosses all races and gender, national origin, age.” - Dr.Thomas Frieden, Director of the CDC 2011 Centers for Disease Control and Prevention November /2011 Report

OPIOID USE IN THE WORKPLACE  The apathy caused by opioids can translate into an "I don't really care" attitude towards performance.  Driving: The physical effects as well as the depression, fatigue, and slowed reflexes impede the reaction time of the driver, raising the potential for accidents.  Although opiates have a legitimate medical use in alleviating pain, workplace use may cause impairment of physical and mental functions.  Unwanted side effects such as nausea, vomiting, dizziness, mental clouding, and drowsiness place the legitimate user and abuser at higher risk for an accident.  Injured employees prescribed opioids and given larger and larger doses may merely increase their tolerance for the drugs without achieving improvements in function or decreased pain, leading to more lost work days and increased workers’ comp costs. The Effect

Reasons for Increase in Prescription Drug Abuse Availability of online pharmacies increase ability to obtain prescription drugs. Technology has lead to better prescription forgeries that go undetected by pharmacies. Increase in the manufacturing of pharmaceutical medications including pain relievers, anti-anxiety medications and insomnia drugs. Increases in availability of medical insurance has led to increases in medical visits for the purpose of obtaining prescription medication for purposes of abuse. High volume practice schedules leave many physicians unaware of risk behavior in their patients. Abusers often visit multiple physicians to obtain prescriptions for opioid-based pain relievers increasing each user’s supply for sale or personal use.

Drug Abusers: Work less than 70% of the time and have more absences Are involved in accidents 3.6 times more than other workers Are 5 times more likely to file a workers’ compensation claim Use 8 times more hospital days and 3 times more sick benefits than other workers Are responsible for 80% of theft in the workplace Drug use in the workplace costs employers approximately $81 billion annually in lost productivity. - The U.S. Department of Labor RISKS OF HIRING A DRUG USER

WHAT CAN YOU DO? Don’t Hire a Problem! Implement The Most Effective Method For Identifying Repeat Drug Users Drug Testing Methods and their Window of Detection Hair Testing Identifies Historical Patterns of Substance Abuse

11 Prescription Lab Positive Count (VECTOR Total) Compared to MRO Positive Count *Prescription Drugs Displayed: Hydrocodone, Hydromorphone and Oxycodone 1,

12 Opiate Positive Rate(VECTOR Total) Compared to % Lab Total Positives *Drugs Displayed: Hydrocodone, Hydromorphone, Oxycodone, Codine, Morphine & 6-MAM *Based on 18,553 Positive Tests 55%

13 Positive Rate by Drug Breakout(VECTOR Total) Past 5 Years Including Current Year to Date *Total Lab Positives: 18,553

Summary – Expanded Opiates in Drug Tests Expanded Opiates drug positivity rate in the general U.S. workforce up 20% over the past 5 years. - Hydrocodone positives increased 59% during this time period. - Hydromorphone positives increased 66% during this same time period. Today, 2 nd only to marijuana (urine) cocaine (hair) in workplace positivity Random positivity, 2x higher than pre-employment Post-accident positivity, 3-4x higher than pre-employment - Quest Diagnostics Drug Testing Index 2011

Reducing Risk for Employers 1.Develop a drug-free workplace policy and make it visible in the workplace. 2.Screen potential employees for drug use using the most effective testing method to identify repeat drug users that includes the expanded opiate panel 3.Maintain a post-accident drug screening policy. 4.Train all supervisory personnel to recognize the signs of potential abuse and maintain standardized reasonable suspicion testing policies. 5.Document every incident in writing and enlist another manager as a witness when confronting an employee with a potential problem abuse. 6.Maintain a good Employee Assistance Program (EAP.) Remember drug addiction is a medical disability. Increased options for treatment increase likelihood of abusers seeking help.

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