Heroin and the Workplace: How’d We Get Here

(Spring 2017) When you think of a heroin user, what images come to your mind?  Is it someone who is down on their luck?  Is it someone with stringy hair, who doesn’t look like they’ve showered for days and whose teeth are falling out? Or do you picture your coworker?  Whatever the image, it’s probably a safe bet that the image you pictured was not your coworker.  But should it have been?

Not to cast dispersions on your coworkers, but the stereotypical heroin user isn’t so stereotypical anymore.  In fact, a 2014 study published in JAMA Psychiatry found 52% of heroin users are female, 90% of users are white and started using heroin in their late 20s, and live in the suburbs.  And recent drug testing data from Quest Diagnostics report a 146% increase in workplace drug tests positive for heroin.  Let’s face it.  Heroin is no longer a junkie drug relegated to dark, dingy alleys.  It has made it into the workplace

But why?

To understand why heroin has crept into the workplace we need to look at the prescription drug epidemic.  Working Partners^® has written several articles about on this topic that can give you some background including

• “Dreamland – How’d we get here?”
• “Close cousins: The link between painkillers and heroin”
• “Don’t forget about adults, they misuse prescription drugs too”
• “American’s prescription drug abuse epidemic: “Quick-fix” mentality”
• “Refining prescription drug monitoring programs”

However, to summarize the chain of events that have led to the current situation, one needs to look at the factors leading to the prescription drug epidemic and the steps taken to curb the epidemic.

In the 1990’s, pain was identified by medical professionals as a fifth vital sign.  This meant that pain was given the same status as blood pressure, heart rate, respiratory rate and temperature.  The heightened awareness of pain also meant that physicians had a renewed focus on treating pain.  This, combined with a few medical studies on the safety of using opioids to treat pain, paved the way for pharmaceutical companies to increase their focus on developing painkillers to treat chronic conditions.

Fast-forward about a decade and you get another element that compounds the situation – patient satisfaction surveys.  A 2012 report, surveying 155 doctors, found that over half of the doctors said their pay was linked to results from patient satisfaction surveys.  Almost 50% shared that they believed the pressure to get positive patient feedback led to inappropriate care.  Put into the context of treating pain, this led to an uptick in the number of painkillers being prescribed to treat patient pain.

As more people were prescribed painkillers, including codeine, Vicodin^® and extended-release opioid-based ones such as OxyContin^® and hydrocodone, the more these medications were misused, abused and sold illegally.  The resulting dependence and addiction on these medications led to an increased demand for these medications, which provoked the rise in doctor shopping (going from doctor to doctor to get prescriptions for pain medications) and pain clinics.

As deaths from opioid overdose increased, states, legislators and pharmaceutical companies took steps to reduce the availability and abuse potential of opioid drugs:

• States began cracking down on physicians operating pain clinics and implemented prescription monitoring databases to reduce doctor shopping.
• Legislators passed bills restricting how doctors could prescribe certain medications, e.g., the number of refills allowed to a patient.
• The makers of these medications, including Purdue Pharma, maker of OxyContin^®, took steps to make their drugs harder to abuse (e.g., reformulated pills turn into a gel when crushed vs. turning into a powder that could be snorted for a quick high).

The efforts to reduce the availability and abuse potential of prescription opioids have worked.  These drugs have become harder and more expensive to get both through legitimate means, i.e., prescriptions, or illegal means, e.g., purchasing the drug from a dealer.  However, as supply dwindled, people’s addiction and need for the drugs did not.  So, your coworkers who became dependent on painkillers after being prescribed the medications to treat back pain or recover from surgery, find themselves turning to the next best and cheapest alternative they can get their hands on – heroin.

What can businesses do?

While it was once unfathomable that a heroin user would be in the workplace, that is no longer the case.  But, that doesn’t mean businesses are left helpless.  A 2013 report indicated that almost 80% of heroin users began by using prescription opioids first.  Education to prevent the misuse of prescription opioids can help prevent behavior that could lead to addiction and start an employee down the path toward heroin.

In addition to educating employees, businesses can implement expanded opioid drug testing.  The basic 5 or 9-panel drug test does not detect the commonly abused prescription painkillers.  By including an expanded opioid testing panel, employers can test for the spectrum of opioid drugs that are currently being abused.  This could enable a business to identify an employee misusing or abuse opioid drugs before the use turns into addiction and take steps to refer the employee for an assessment and treatment if needed.

And speaking of drug testing.  Even if a business is doing expanded opioid drug testing, it is important to do more than just pre-employment testing.  “Drug testing gives your program teeth,” said Joe Reilly, president of National Drug Screening. “Going beyond pre-employment testing and including random testing, reasonable suspicion and post-accident testing can cause an employee to think twice before misusing or abusing a drug.”

Beyond management including supervisors need to be vigilant by being knowledgeable of the signs and symptoms of opioid abuse and acting when there’s a questionable situation.  Symptoms of abuse include

• noticeable elation
• marked sedation or drowsiness
• confusion
• slowed breathing
• withdrawal (which can present with headaches, sweating, fatigue, nausea and vomiting, and anxiety)

While exhibiting one of these symptoms does not automatically mean someone is abusing opioids or heroin, noticing a pattern of these symptoms could be cause for a reasonable suspicion test.

Of course, the bottom line is that businesses have a comprehensive drug-free workplace program can help the situation.  By implementing all five components of a drug-free workplace program – policy, employee education, supervisor training, drug testing and assistance – businesses will be positioned to deal with the issue if heroin, or any other drug that finds its way into their workforce.  Because while heroin is making its way into the workforce, it is important not to take your eye off the ball.  Remember heroin is just one drug, there are other commonly abused drugs like alcohol and marijuana that are just as likely to find their way into your place of business.