1. The Role of Employers and Employee Assistance Programs in Addressing Opioid Use Disorders Teri L Leasure, LCSW, CCS EAP Coordinator Mid Coast Parkview Health Services

2. Opioid use epidemic Prevalence of substance use disorders - 18.9 million adults classified with dependence or abuse, nearly 52% employed 1 Rate of opioid/opiate overdose is increasing. Tied to opioid/opiate use alone or in combination with other drugs or alcohol 2

3. Opioid use epidemic Drug overdoses (predominantly from opioids) now exceeds car crashes as the leading cause of unintentional death 2 Sale of prescribed painkillers and fatal poisonings quadrupled from 1999-2010 3 Opioids are powerful, highly addictive drugs that have the potential to cause impairment, workplace accidents, errors and injury, even when taken as prescribed Employer challenge: legal prescriptions prescribed by licensed providers for pain 3

4. Dependence vs Addiction 4 Different parts of the brain are responsible for the addiction and dependence to heroin and opiates. It is possible to be dependent on morphine, without being addicted to morphine. (Although, if one is addicted, they are most likely dependent as well.) This is especially true for people being treated chronically with morphine, for example, pain associated with terminal cancer. They may be dependent - if the drug is stopped, they suffer a withdrawal syndrome. But, they are not compulsive users of the morphine, and they are not addicted. Finally, people treated with morphine in the hospital for pain control after surgery are unlikely to become addicted; although they may feel some of the euphoria, the analgesic and sedating effects predominate. There is no compulsive use and the prescribed use is short-lived. 4

5. Impairment Warning Signs Multiple symptoms - not isolated Poor mood Decreased productivity Absenteeism and tardiness Physical changes - loss of interest in personal care, bloodshot eyes or pinned pupils, weight gain/loss, loss of coordination/ speech, withdrawal symptoms - intense flu-like symptoms 5

6. Steps to take - be proactive Expressing concern or feedback to an employee can be uncomfortable. Consider workplace drug testing policy - pre-employment, safety sensitive jobs (DOT) include on the job random testing Drug test doesn't prove impairment - proving an objective measure of unsafe impairment is difficult. Safety is key and should be the emphasis 6

7. Steps to take - be proactive Every company should have a written policy that prohibits use of drugs or alcohol during work hours and details employer action if an employees performance is being affected by use after hours. Policy should include process for notifying employer when employee is prescribed a medication that could impair work performance. 7

8. Steps to take - be proactive 1.Gather resources: EAP Community resources - treatment providers HR 2.Explore employer insurance coverage for treatment of substance abuse problems. Insurance coverage is widely variable 3.Take action - have a private conversation (or include HR rep), review specific concerns and company policy, provide resources. Let employee know if job is on the line. 4.Consult an attorney to be sure you are complying with state and federal laws 8

9. What is EAP? EAP is confidential Short-term assessment and referral to treatment Offered as an employee benefit even without health coverage Offers assistance to managers to help work through the problem 9

10. What is EAP? It's in the employer's best interest to identify opioid and other drug and alcohol abuse. Employer sponsored treatment is cost effective. 70% of all US companies and 90% of Fortune 500 companies purchase EAPs, because it improves the bottom line 5 Few employees use EAPs because they don't understand how they function and fear negative consequences. 10

11. What is EAP? 11 http://1drv.ms/1QgUl2a

12. Works Cited 1.Department of Health and Human Services (2011), National Survey on Drug Use and Health 2.Prescription Drug Abuse: Strategies to Stop the Epidemic (2013) Trust for Americas Health, pg. 4 3.Prescription Drug Abuse: Strategies to Stop the Epidemic (2013) Trust for Americas Health, pg. 4 4.http://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug- addiction/section-iii-action-heroin-morphine/10-addiction-vs-dependencehttp://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug- addiction/section-iii-action-heroin-morphine/10-addiction-vs-dependence 5.Goetzel, R. Z., Juday, T.R., Ozminkowski, R.J., What’s the ROI? Worksite Health. Summer 1999, 6(3), pp. 12-21 12

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