Credit: Joy Gendusa, Founder and CEO of PostcardMania – www.postcardmania.com

Abuse of prescription pain killers now ranks second as the United States’ most prevalent illegal drug problem, following marijuana.(1) While approximately 50 percent of Americans use one prescription drug for medical reasons on a regular basis,(2) an estimated 20 percent have used prescription drugs for nonmedical reasons in their lifetime.(3)

• In 2006, 16.2 million Americans age 12 and older had taken a prescription pain reliever, tranquilizer, stimulant or sedative for nonmedical purposes at least once in the year prior to being surveyed.(4)
• In 2000, 43 percent of those who ended up in hospital emergency rooms from drug overdoses, estimated at 500,000 visits per year, were there because of misusing prescription drugs.(2)
• From 1998 to 2000, the number of people entering an emergency room because of misusing:(2)
  • hydrocodone (Vicodin®) rose 48 percent,
  • oxycodone (OxyContin®) increased 108 percent and
  • methadone (a synthetic opioid) increased 63 percent.
  • More than 17 percent of adults over 60 intentionally or unintentionally abuse prescription drugs.(2)

There are three classes of prescription drugs that are most commonly abused:(1)

• opioids such as codeine (Darvocet®, Tylenol with Codeine®), oxycodone (OxyContin®, Percocet®), hydrocodone (Vicodin®) and morphine;
• central nervous system (CNS) depressants such as barbiturates (Amytal®, Butisol®, Tuinal®) and benzodiazepines (Valium®, Doral®, Xanax®);
• stimulants such as dextroamphetamine (Adderall®), methylphenidate (Ritalin®).

Is Your Company at an Increased Risk?

More than half the individuals who take prescription drugs non-medically report getting them from a friend or relative for free.5 Access to these medications is fairly easy due to the widespread use of prescription drugs. One study found that 50 percent of participants aged at least 18 years used at least one prescription drug— 7 percent took 5 or more.(2) The highest overall prevalence of medication use was among women aged at least 65 years, of whom 12 percent took at least 10 medications and 23 percent took at least 5 prescription drugs.(6)

Other notable risk factors include:(7)

• Past or present addictions to other substances, including alcohol;
• Younger age, specifically the teens or early 20s;
• Working in a health care setting, where access to drugs is easier.

The risk of prescription drug abuse may vary by employee age. The rate of nonmedical use of prescription pain relievers rose from 4.1 to 4.6 percent among individuals aged 18 to 25 between 2002 and 2007.8 In the 50-59 age group (not accounting for employment), illicit drug use has grown substantially from 2004 (3.8 percent) to 2007 (5.0 percent).(9)

Why Employers Should Care

• According to The National Institutes of Health, alcohol and drug abuse cost $246 billion in 1992, the most recent year for which economic data are available.(10)
• The average cost per visit for outpatient substance abuse treatment (by far the most frequent form of treatment) in 2002 was $26.72.(11)
• Savings from investing in substance abuse treatment can exceed costs by a ratio of 12 to 1.11
• Statistics on the impact of workplace prescription drug abuse are not available. Consequences may be similar to illicit drug abuse.
  • Full-time workers aged 18-49 who reported any current illicit drug use were more likely than those reporting no current illicit drug use to state that they had:(10)
    • worked for three or more employers in the past year (32.1% versus 17.9%),
    • taken an unexcused absence from work in the past month (12.1% versus 6.1%),
    • voluntarily left an employer in the past year (25.8 % versus 13.6%) and been fired by an employer in the past year (4.6% versus 1.4%).
  • According to results of a NIDA-sponsored survey, illicit drug-using employees are:(10)
    • 2.2 times more likely to request early dismissal or time off,
    • 2.5 times more likely to have absences of eight days or more,
    • 3 times more likely to be late for work,
    • 3.6 times more likely to be involved in a workplace accident and
    • 5 times more likely to file a workers’ compensation claim.

What Employers Can Do: Creating a Drug-Free Workplace

Testing: Private employers can determine their own need for employee drug testing while federal agencies must follow standardized procedures established by the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services.(12)

Table 1: Substances included in drug panels.
Source: US Department of Labor. Workplace drug testing.
Available at: http://www.dol.gov/asp/programs/drugs/workingpartners/dfworkplace/dt.asp. Accessed August 19, 2009.

SAMHSA guidelines require a 5-panel test which does not include prescription drugs. In addition to the substances listed in Table 1, testing can also be done for hallucinogens, inhalants, anabolic steroids and hydrocodones.(12) Nevertheless, if employers are interested in testing for certain prescription drugs, confidentiality then becomes an issue when determining who is using for medical vs. nonmedical reasons.

SAMHSA recommends 8 components for a comprehensive workplace program:(11)

1. Implement drug-free workplace and other written substance abuse policies.
2. Publicize drug-free workplace policies and reiterate that use of alcohol or drugs is never permitted in the workplace.
3. Communicate information about the health risks of alcohol and drug use through company websites and health and wellness initiatives.
4. Educate employees about the health and productivity hazards of drinking excessively and abusing prescription and illicit drugs through company wellness programs, Employee Assistance Programs and Work/Life programs.
5. Incorporate substance abuse information in workplace wellness strategies, such as learning about good nutrition, exercise, seat belt use, etc.
6. Offer health benefits that provide comprehensive coverage for substance use disorders, including aftercare and counseling.
7. Ensure that company wellness programs, Employee Assistance Programs and Work/Life programs provide education, screening and follow-up services for employees’ drug and alcohol problems.
8. Respect employees’ privacy. Employers may not know who among their employees is in recovery from alcohol or drug abuse. If company officials have this information, however, they must recognize and appreciate the delicate balance between wanting to help, and respecting an employee’s need and desire for privacy.

Additional Resources:

• The SAMSHA Drug Free Workplace Kit offers resources for employers, employees, HR managers and supervisors.
• The US Department of Labor provides safety and health publications, substance abuse basics, regulations and statistics regarding workplace substance through their Working Partners for an Alcohol- and Drug-Free Workplace program.
• SAMHSA Cost Savings for Employers contains 14 short issue briefs addressing workplace substance abuse from a variety of perspectives.
• Confidential assistance is available from the SAMHSA Workplace Hotline, 1-800-Workplace or helpline@samhsa.hhs.gov.

References:

1. The White House, Office of National Drug Control Policy. Prescription drug abuse prevention. Available at: http://www.whitehousedrugpolicy.gov/drugfact/prescr_drg_abuse.html. Accessed August 17, 2009.

2. Substance Abuse and Mental Health Services Administration (SAMHSA) Health Information Network. Prescription drug abuse statistics: trouble in the medicine chest, rx drug abuse growing. Available at: http://ncadi.samhsa.gov/govpubs/prevalert/v6/4.aspx. Accessed August 17, 2009.

3. National Institutes of Health. Medline plus: prescription drug abuse. Available at: http://www.nlm.nih.gov/medlineplus/prescriptiondrugabuse.html. Accessed August 17, 2009.

4. National Institute on Drug Abuse. Prescription medications. Available at: http://www.nida.nih.gov/DrugPages/prescription.html. Accessed August 17, 2009.

5. U.S. Department of Health and Human Services. Results from the 2007 National Survey on Drug Use and Health: national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2008. NSDUH Series H-34, DHHS Publication No. SMA 08-4343.

6. Kaufman D, Kelly J, Rosenberg L, Anderson T, A. M. Recent patterns of medication use in the ambulatory adult population of the United States. Journal of American Medical Association. 2002;287(3):337-344.

7. Mayo Clinic. Prescription drug abuse. Available at: http://www.mayoclinic.com/print/prescription-drug-abuse/DS01079/METHOD=print&DSECTION=all. Accessed August 17, 2009.

8. Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2007 NSDUH: national findings, SAMHSA, OAS. Available at: http://www.oas.samhsa.gov/NSDUH/2k7NSDUH/2k7results.cfm. Accessed August 18, 2009.

9. US Department of Labor. Working partners for an alcohol- and drug-free workplace: general workplace impact. Available at: http://www.dol.gov/asp/programs/drugs/workingpartners/stats/wi.asp. Accessed August 18, 2009.

10. US Department of Labor. eLaws: drug-free workplace advisor. Available at: http://www.dol.gov/elaws/asp/drugfree/benefits.htm. Accessed August 19, 2009.

11. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. 14 short employer cost savings briefs. Available at: http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17943. Accessed August 19, 2009.

12. US Department of Labor. Workplace drug testing. Available at: http://www.dol.gov/asp/programs/drugs/workingpartners/dfworkplace/dt.asp. Accessed August 19, 2009.