TRENDS IN DRUG USE BY JONATHAN BAKTARI, MD, US DRUG TEST CENTERS


America’s Opioid Crisis and Impacts on the Workplace


Introduction A disturbing trend has been emerging in the workplace, and it is driven by the use and abuse of opioid painkillers—now the most widely prescribed pain relievers and most highly abused prescription drug. Companies and organizations of all sizes


have an important role with promoting the health and safety of employees and managing risks in the workplace. Employers who have strong workplace policies, education, health benefit programs, and well-trained managers can help create safe and healthy environments in which both employees and business thrive. Employees’ rights to a safe and healthy


workplace are not only being recognized by federal enforcement agencies, but also by the courts. Employee rights and protections stem from employers’ obligations created by federal and state statutes. It’s time to stop pointing fingers and start looking at solutions to make a difference in the lives of opioid users in your workplace.


Background In 2006, a scientist at the Centers for Disease Control and Prevention (CDC) noticed “an uptick” in poisoning deaths. Prescription opioids were identified as a primary concern.1 Today we know that between 1999 and 2017, more than 700,000 people died from a drug overdose. Some of the latest numbers from the CDC show: • On average, 130 Americans die every day from an opioid overdose.2


• Around 68% of the more than 70,200 drug overdose deaths in 2017 involved an opioid.3


• Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug-overdose deaths.4


Tere are regional and state differences in overdose deaths reported. Te CDC says


38 datia focus Figure 1—CDC Policy Impact: Prescription Painkiller Overdoses spring 2019


that the latest numbers show that, in order, West Virginia, Ohio, Pennsylvania, and Kentucky are the states with the highest rates of deaths due to drug overdose.5 Frequently, doctors are blamed for


providing the opioids that are killing Americans. While it is true that doctors are a leading source of prescribed opioids, most people get the drugs that are abused from friends and relatives (Figure 1). Te source of these drugs is one thing,


the cause another. Why is this epidemic happening? In part, it can be explained by pain. Te National Institutes of Health has reported that “at least 116 million U.S. adults are burdened by chronic pain” and annual national economic cost associated with chronic pain is estimated to be $560–635 billion.6 Te response to chronic pain is where


part of the problem begins. According to a recent report by the CDC, “[m]ore than 11.5 million Americans, aged 12 or older, reported misusing prescription opioids in 2016.”7 As Figure 1 indicates, people who abuse


drugs primarily get them from friends or family members. But the CDC noted that “those at highest risk of overdose are as likely to get them from a doctor’s prescription.”8


Chronic pain can be a disease in itself. Chronic pain has a distinct pathology, causing changes throughout the nervous system that often worsen over time. It has significant psychological and cognitive correlates and can constitute a serious, separate disease entity. https://www.ncbi. nlm.nih.gov/books/NBK92510/


In 2016, the CDC issued guidelines to help educate physicians when issuing opioid prescriptions.9


Tose guidelines indicated


that in 2012 “health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a botle of pills.”10


Workplace Impact How does this impact the workplace? It would be foolish to think that it doesn’t. Tere are more statistics about opioid abuse than baseball. It has been reported that “unintentional overdoses due to nonmedical use of drugs or alcohol while at work increased 25.3%” in 2017.11


It was further reported that “this was the fiſth consecutive


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