Prescription Drug Impact in the Workplace Tess Benham
Prescription Drug Impact in the Workplace Tess Benham, Sr. Program Manager, National Safety Council Dr. Denise Fields, Pharm. D, Sr. Clinical Consultant, Express Scripts Tamara Watson, Master Trooper, Indiana State Police
Conflicts of Interest • Tess Benham has no conflicts of interest to disclose. • Dr. Denise Fields is an employee of Express Scripts, but this will not influence today’s presentation. • Master Trooper Tamara Watson has no conflicts of interest to disclose
Learning Objectives • Understand the impact of prescription drug abuse on Indiana businesses and workplaces. • Identify strategies for educating your workforce. • Identify challenges to and resources for implementing a prescription drug abuse training program in your workplace.
Setting the Stage Results from a Survey of Indiana Employers Tess Benham, Senior Program Manager, National Safety Council
Survey Background Overall Objectives: The purpose of this research was to understand current attitudes and behaviors around prescription drug policies and procedures among Indiana employer Methodology: Online survey invitations were sent to HR and safety professionals. Sample: Sample was a combination of NSC contacts and SHRM members in Indiana. Timing: Survey was fielded May 13 th through August 20 th, 2015.
Survey Background (continued) Qualified Respondents: • 50+ total employees in organization/company (all locations) • Make or share in determining organization practices for hiring practices, training, benefits programs or employee policy Statistical Significance: • Results analyzed at the 95% level of confidence • Margin of error, +/- 6. 9%
Participant Demographics # of Employees 50 to 99 employees Job Title/Role Human Resources 11% 56% Environmental Health Safety 100 to 499 employees 500 to 1, 000 employees Over 1, 000 employees 42% 11% 23% Risk Manager 5% Training & Staff Development 5% Owner or CEO 4% Other 7% 36% (n=201 - Total) S 1 How many employees work in your organization or company, taking into account all units and locations? (Your best estimate is fine) 29. Which of the following best reflects your job title?
Participant Demographics (continued) Industry 39% Arts, Entertainment, and Recreation Manufacturing Health Care and Social Assistance 11% Transportation and Warehousing 10% Finance and Insurance 6% Construction 5% Professional, Scientific, and Technical Services 5% Educational Services 5% Retail Trade 3% Utilities 3% 2% Wholesale Trade 2% Mining, Quarrying, and Oil and Gas Extraction 2% Public Administration 2% Real Estate and Rental and Leasing 2% Agriculture, Forestry, Fishing, and Hunting 1% Information 1% Accommodation and Food Services 0. 5% Waste Management and Remediation Services 0. 5% (n=201 - Total) 32. Which of the following categories best represents the industry to which your company or business unit belongs?
Participant Demographics (continued) 79% have HQ in Indiana 77% in their field 10+ years 71% have no emp. covered by union regs or contracts 68% senior-most for location or organization 65+ have employees at multiple locations (n=201 - Total) 36. Where is your headquarter location located? 30. If applicable, how many years have you worked in your field? 34. Are any of your employees covered by union regulations or contracts? (n=201 - Total) 31. Which statement best describes your personal level of responsibility within your organization for health and safety issues? 35. Do most employees at your organization work…?
Scope of the Problem
Most Indiana comp. impacted by RX abuse… Observed Workplace Issues Observed an Issue (NET) 80% Use of Rx painkillers at work 59% Positive drug tests result for prescription 41% Absenteeism or missed work 41% Family member affected 40% Impaired/ decreased job performance 35% Borrowing or selling Rx drugs at work 23% Complaints to HR/ negative morale 19% Near miss or injury related to Rx drug usage 19% Arrest (on/off job) Overdose None 10% 5% 20% (n=201 - Total) 6. Keeping in mind that all information will be kept strictly confidential, which of the following are you aware of having occurred in your workforce? Please include any occurrence, even if it is few in number.
… and feel it is a problem… Agreement with Statements Strongly Justifiable reason to fire % Strongly/Somewhat 37% 39% Bigger problem than illegal drugs 18% Harming safety 46% 14% Lowering productivity 12% Is a problem 11% 64% 46% 32% 16% Moral/ ethical failure 29% 45% 32% 44% 39% 28% Decreasing morale 5% 26% Causing near misses or injuries 6% 24% Making it hard to hire 6% 23% 39% Increasing Worker’s Comp. 5% 23% 28% Making it hard for keep 3% 18% 76% 31% 30% 21% (n=201 - Total) 5. Please rate your agreement with each of the following statements about the impact of prescription drugs on your organization. Misuse or abuse of prescription drugs is…?
…but everyday concerns eclipse the problem. Level of Concern - Issues Major Concern 74% 68% 51% 46% 42% Ability to hire Benefits Costs Aging of the Worker comp Illness / workforce / costs absenteeism (n=201 - Total) 1. How concerned are you about the impact each of the following issues may have on your organization? 29% 25% 23% RX drug misuse Illegal drugs Workplace violence
Underlying beliefs a barrier to org. change. Agreement with Statements … a justifiable reason to fire an employee. …a moral or ethical failure. 24% 55% 76% Agree 45% Do not agree (n=201 - Total) 5. Please rate your agreement with each of the following statements about the impact of prescription drugs on your organization. Misuse or abuse of prescription drugs is…?
Behaviors of Indiana Employers
Most cover drug tests, but few address abuse. Topics Covered by Organizations Written Policy None of these 5% Drug testing 84% Employee use of drugs without a prescription 60% Return to work policies for employees undergoing substance. . . 58% Employee use of prescription drugs at work 53% Employee responsibility to notify supervisors of prescription. . . 48% Performance improvement plan for employees who have faile. . . Unsure/Don’t know (n=201 - Total) 10. Which of the following topics are specifically covered in your organization’s written policies? 34% 4%
Policy Best Practices • Address non-medical use of prescription and over-the-counter medications in the policy • Include prescription medications in drug testing panel and policy • Provide guidance to employees on when it is okay to use medication at work and if they should report this use • Be able to assign employees to alternate work tasks while on medication • Provide information about how to access employee benefit and assistance programs
Most conduct drug testing… Conduct Drug Testing Yes (NET) 87% Pre-employment 79% When need is indicated 63% At random intervals On a fixed schedule 39% 3% No (n=201 - Total) 20. Does your organization require drug testing for your employees ? 13%
…but few test for opioids… Substances Tested For Cannabinoids (Marijuana, THC) 93% Opiates (Codeine, Morphine, Heroin) 91% Amphetamines (including Methamphetamine). . . 91% Cocaine 91% Barbiturates (Seconal, phenobarbital, etc. ) 77% Benzodiazepines (Xanax, Ativan, Klonopin, Valiu. . . 64% Phencyclidine (PCP) 61% Methadone 57% Synthetic Opioids (Oxycodone, Hydrocodone, . . . 52% Methaqualone (Quaaludes) 43% Propoxyphene Other Don’t Know/Not Sure (n=174 - Require Drug Testing) 22. What substances are tested for? 31% 11% 26%
…the most frequently abused drug in Indiana. Upon admission to treatment in Indiana, top drugs of choice reported are: • Alcohol • Opioids • Polysubstance abuse • • Opioids Cannabis Benzodiazepines Alcohol
Most take advantage of an EAP. Use Employee Assistance Program (EAP) Level of Usage of EAP Yes (net) Annonymously assist 79% Develop plan to assess/ treat Identify employees with abuse issues Other No 76% 87% 29% 12% 22% 3% 12% (n=201 - Total) 18. How confident are you in your EAP providers’ ability to handle substance use, misuse or abuse issues? 2% Increasing Staying the same (n=176 - Have EAP) 19. s that rating based upon…? Decreasing
Most want to return employees to work. . . Organizational Approach to Employee Misuse/Abuse of Drugs or Alcohol 63% 33% Returning them to their position after appropriate treatment Dismiss them 2% 1% 1% Ignore the problem Ensure they have careful supervision for the rest of their careers Relocated them to positions of lesser responsibility (n=201 - Total) 9. Which of the following, would you say, best reflects your organization’s approach to an employee who is found to be misusing or abusing drugs or alcohol?
…but can’t identify who needs help. . . Very Confident can Identify Warning Signs 38% 35% 26% HR Supervisors Employees (n=201 - Total) 8. How confident are you that your Human Resources department, supervisors and employees can correctly identify behavior that is a warning sign of misuse or abuse of prescription medication?
…because very few offer any training. Offer Training Do not Train; 71% (n=201 - Total) 11. Does your organization currently offer training around workplace usage of prescription drugs? Train; 29% • 29% train supervisors • 13% also train employees
Prescription for Indiana Employers 1. Recognize prescription drugs have big impact on your workplace 2. Put strong policies in place 3. Expand drug testing panels to include opioids 4. Train supervisors and employees how to spot signs 5. Treat substance use problems as a disease 6. Leverage EAP to assist employees to return to work
Strategies for Training your Workforce Dr. Denise Fields, Pharm. D, Senior Clinical Consultant, Express Scripts Tamara Watson, Master Trooper, Indiana State Police
Where to start Forming your team Identifying your resources Developing policies and procedures Engaging employees in awareness and education
Forming your team Internal Executive leaders Clinical Experts Labor relations Law Enforcement Legal Community Resources Human Resources Health/wellness vendors Benefit leaders Facilities Safety/Risk Management
Identifying your resources Do you know or have clinical experts, community leaders, vendors or law enforcement contacts that would be willing to volunteer/assist? Can you get approval to pay employees for an hour of non-productive time? How is your benefit plan for employees designed?
Developing Policies and Procedures Company Stance Law Enforcement Relationship Drug Testing Disciplinary Action Benefit Design Medication Security Safety & Risks Education & Training
Engaging employees • General awareness education can be an early/initial activity, even as policies are still being developed. • Consider when and how often general awareness education should be done: • Onboarding • Annually or semi-annually • When an event occurs
Awareness effort considerations Who will be educating your workforce? Who should your audience be? What content should be included? What presentation style will work best?
Who should educate your population? Clinical • Physician • Pharmacist • Paramedic/First Responders • Law Enforcement • Local Coordinating Council Community Vendors • Employee Assistance Program (EAP) • Health and Wellness Partners
Consider your audience • Create different education programs for your management/supervisory level employees from your general pool of employees • Consider not having management present at your general employee meetings • Educate your audience not only as employees in a work setting, but also touch on effects of Rx Drug Abuse on their community and family
Presentation Delivery • Make it interactive – Use audience polling questions/system – Incorporate games or competitions • Remain non-judgmental • Ensure it is relatable – Use real life examples – Tie it in to community or workplace
Have you ever heard or said…. . “Just take a few of my leftover…” “My sister will never miss one or two of these, and I have a huge headache…” “I was just borrowing a couple of pills from an old bottle of medicine in the cabinet. . . ” “I store all these in case someone needs them sometime…” “Dad will never notice they are gone. . . ” “We just have not had time to go through all these drugs since grandpa passed away…”
What to include Why are prescription drugs an addiction issue? What are the signs and symptoms? What are some issues specific to the workplace? What resources are available? What are the potential legal ramifications?
Why Prescription Drugs? • Provide statistics on Prescription Drug Abuse – Compare US vs state vs county/local statistics – Review statistics available for specific job types • Describe some of the cultural/social drivers • Explain the supply chain • Describe the business plan
Reasons Adults Abuse Drugs Job Loss Pressure to Succeed or meet a deadline Desire to Fit In Death of a Loved One
Why Pharmaceuticals? • • Easy to obtain Cost effective – especially with insurance! Perceived as safer Easier to conceal Generally odorless Dosage Consistency Everyone’s doing it!
Recognizing the signs and symptoms – Describe the physical and emotional signs/symptoms employees could exhibit – Explain the focus for disciplinary action(s) should be on job performance • Reinforce that supervisors, managers and co-workers should not attempt to diagnose – Gives examples of physical evidence left behind – Review slang words or terms related to Rx drug abuse – Educate supervisors/managers regarding drug testing limitations • Qualitative vs quantitative testing • What does a preliminary “non-negative” result mean?
Job performance issue examples Reduced productivity or work quality Absenteeism and tardiness Bizarre and/or disruptive behavior Concentration problems Erratic work habits Concerns about possible substance use Interpersonal conflicts; confrontations with coworkers and/or customers • Violence at home or at work, including threats of suicide or workplace violence • •
Supervisor Guidelines • • Know your employer policies and procedures Be aware of legally sensitive areas Recognize potential problems Document in a systematic and fair manner Act in a confidential manner Refer to appropriate resources Reintegration into the workplace
Work place specific issues • Company policy and procedures – Drug testing – Disciplinary action • Dangers in the workplace – Safety risks – Financial risks – Corporate brand/image risks • Security of medications at work
Resources available National Experts • SAMHSA • National Safety Council • Centers for Disease Control (CDC) • National Institute on Drug Abuse • Law Enforcement • Church programs • Social workers/Support groups Community • Healthcare facilities/providers Vendors • Employee Assistance Program (EAP) • Pharmacy Benefit Manager (PBM)
Legal Ramifications – Relationship with law enforcement – Perpetrator and victim can be same person – Legal vs not legal activities – Felonies vs misdeamoners – Felony Impact
Felony Consequence Examples • • • Disenfranchisement (expressly permitted by the Fourteenth Amendment, as noted by the Supreme Court)…. ”losing your right to vote” Exclusion from obtaining certain licenses, such as a visa, or professional licenses required to legally operate (making some vocations off-limits to felons) Exclusion from purchase and possession of firearms, ammunition, and body armor Ineligibility to serve on a jury Ineligibility for government assistance or welfare, including being barred from federally funded housing Deportation (if not a citizen) It is legal to discriminate against felons in hiring decisions as well as the decision to rent housing to a person, so felons can face barriers to finding both jobs and housing Many banks refuse service to convicted felons Some states consider a felony conviction grounds for an uncontested divorce
Challenges and Opportunities Awareness and Education Outdated/insufficient data in the workplace Outdated DOT testing panels Access to Care – Local resources Changing your benefit plan (make physical therapy more convenient and just as cheap as a $4 Rx) • Lifestyle education to equip and motivate employees to make better lifestyle choices (so that they don’t need medications) • • •
Resources • National Safety Council – www. nsc. org/rxpainkillers • NSC Prescription Drug Employer Kit – www. nsc. org/rxemployerpolicy • Bitter Pill – www. in. gov/bitterpill/workplace-risks. html • Department of Labor E-Laws Drug Free Workplace Advisor – http: //www. dol. gov/elaws/drugfree. htm
Thank you Questions… Learn more at Bitter. Pill. IN. gov
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