Rx Drug Abuse Tugs at the Employer’s Purse Strings

(Summer 2014) The pain of our county’s prescription drug (Rx) abuse epidemic is real. And it tugs at the hearts of the American public. Most know someone who is addicted to an Rx medication, who has died from an Rx drug overdose, or who is suffering at the hand of an abuser or addict.  From 2000 to 2012, just in Ohio, the death rate due to unintentional drug poisonings increased 366%, and the increase has been driven largely by prescription drug overdoses.

This dramatic rise in deaths in Ohio, and across the country, directly correlates to the increase in the amount of Rx medications distributed by doctors and pharmacies. The U.S. Centers for Disease Control and Prevention (CDC) reports that nearly 7 in 10 Americans take at least one Rx medication, more than half of us take two and 20% take five or more. In 2010, enough Rx opioids (i.e., painkillers) were prescribed to medicate every American adult around the clock for a month.

We take a lot of drugs.  When used appropriately, Rx medications can do a lot of good.  However, as the current epidemic demonstrates, not everyone uses these medications appropriately.  There is a cost to our nation’s use of Rx drugs, one that has to be paid. Often it’s the workplace that’s picking up the tab for both indirect and direct costs of misuse, abuse and addiction. One reason is that the population at the highest risk of abusing medications — 18-25 year olds – is of employment age. Another possible explanation is that two of the primary subsidizers of Rx medications – medical insurance and workers’ compensation – are tied to the workplace.

Losses directly tied to the bottom line are illustrated in these staggering facts:

• PRODUCTIVITY
  • The abuse of painkillers alone costs employers $42 billion per year in lost productivity. (This excludes the cost of insurance and workers’ comp claims.)
• HEALTH CARE
  • The majority of U.S. employers spend 16% or more of their total health care budget on pharmacy benefits.
  • An Rx drug addict, who shops around for doctors to prescribe Rx medications, costs his or her insurer (who will likely pass the costs along to the employer) an estimated $10 – $15,000.
• WORKERS COMPENSATION
  • 55 – 86% of all claimants are receiving opioids for chronic pain relief.
  • Pharmacy-only claims accounted for about 2% of workers’ compensation claims in 1990, grew 400% by 2001 and almost another 90% by 2010.
  • In the 2012 article “Opioids Wreak Havoc on Workers’ Compensation Costs,” author Keith Rosenblum, Sr., risk consultant with Lockton Companies, claimed, “Prescription opioids are presently the number one workers’ compensation problem in terms of controlling the ultimate cost of indemnity losses.”

According to a report released by Public Citizen, a nonprofit organization committed to “championing citizen interests before Congress,” there is one industry that is not feeling the pain of the Rx drug abuse epidemic – pharmaceutical companies. “While the overall profits of Fortune 500 companies declined by 53% [in 2001],” the report claims, “the top 10 U.S. drug makers increased profits by 33%. These companies had the greatest return on receipts, reporting a profit of 18.5 cents for every $1 of sales, which was eight times higher than the median for all Fortune 500 companies.”

There is some good news. Ohio, and the country as a whole, is making progress in decreasing the excessive prescribing of prescription medications.  In Ohio, the state’s Prescriber Education Work Group, convened by the Governor’s office, has developed two sets of opioid prescribing guidelines for medical professionals. One targets emergency and acute care facilities and the other offers guidelines for the treatment of chronic, non-terminal pain.  The State Medical Board of Ohio, Ohio State Dental Board, Ohio Board of Nursing and the Ohio Board of Pharmacy have all adopted these guidelines.

But there are things that can be done at the workplace, too, to help minimize the costs associated with Rx drug abuse. Employers, you can

1. Protect yourself by implementing a drug-free workplace policy that clearly and specifically tells employees what they are expected to do when prescribed a medication that could affect them at work. Because employees are afforded protections regarding medical issues under the Americans with Disabilities Act (ADA), use caution. Be sure your policy is not only very specific and directive but also written according to federal and state discrimination laws.
2. Pinpoint an Rx problem by making sure your drug tests identify commonly abused medications like OxyContin® and Vicodin®. Historically, traditional workplace drugs tests have not included these synthetic
3. Prevent problems not only by educating your employees about your policy around Rx drug use, but also about safe and responsible medicine practices. And be sure to train supervisors to identify potential problems and rely on the help of your workers’ compensation Managed Care Organization (MCO).
4. Prepare to assist an employee who admits to a problem. Because of the lethality of Rx drug abuse – particularly with pain medications – the stakes are high. Consider contracting with an Employee Assistance Program (EAP) to help employees (and you) quickly find affordable and available care. If you provide medical insurance, check now to see what allowances the employee has for drug treatment. Locate tax-supported treatment services in your community and establish a process for referring an employee who has a problem.

Granted, there are costs involved in proactively preventing and responding to Rx drug abuse. However, when considering the risks associated with employing an Rx drug abuser – including to safety, liability, public image and productivity – the costs seem minimal and justifiable.