A World of Pain

Dec 10, 2019, 19:44 PM
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November/December 2019

By Emilie Shumway

As the opioid epidemic sweeps the country, recycling workers are especially vulnerable. Here’s how employers can help prevent opioid abuse on the front end—and what to do if it’s too late.

Feature Graphics 300 x 200The problem at PK Metals started when a scrap peddler began a side business in selling pills when he would bring in his scrap, Bill Rouse says. “We were able to isolate the dealer and remove him from our facility,” he says. “But we didn’t catch it until it was three employees too late.” As corporate quality, environment, health and safety manager at the company in Coram, N.Y., Rouse has seen the way opioids can infiltrate and devastate a recycling facility.

The opioid epidemic has grown dramatically since it first began in the late 1990s, with a notable spike in the last decade. In 2007, 18,515 people died of an opioid-related drug overdose; that number had more than doubled, to 47,600, in 2017, according to the Centers for Disease Control and Prevention. For the first time in history, a person in the United States is more likely to die of an opioid overdose than a motor vehicle crash.

As the opioid addiction crisis has spread, employers are starting to face it head-on. In a National Safety Council survey conducted this year, 75% of employers reported experiencing an issue with opioids in the workplace. In the recycling industry, “I think almost everyone has had issues,” Rouse says, “and if they haven’t, they’re just not looking.” 

Recyclers’ vulnerability

Though the opioid crisis has received increased attention over the past few years, little data exists on opioid use in specific industries. In 2017, Frank Manzo IV, policy director of the Illinois Economic Policy Institute (La Grange, Ill.), decided to dig into the stories he was hearing about opioid abuse in the construction industry. The evidence turned out to powerfully reinforce the anecdotes he was hearing. A construction worker in Ohio was 7.24 times more likely than the average worker to die of an opioid overdose in 2016, according to Manzo’s 2018 report, “Addressing the Opioid Epidemic Among Midwest Construction Workers,” co-authored by Jill Manzo.

Manzo’s report focuses on construction rather than recycling, and it centers on the Midwest, where—like Appalachia and the Northeast—the crisis has hit particularly hard, but it’s easy to see the similarities between the two industries. Construction is physically intensive, and construction workers have a higher risk of injury than office workers face. Recycling carries similar risks of injury, even when operating according to safety requirements. Scott Wiggins, ISRI’s vice president of EHS, notes the risk of ergonomic problems, especially for scrap pickers. “Tall, lanky people may have back problems from leaning over,” he says. Sometimes employees will try to adjust for the problem themselves by asking to move to a different position instead of telling employers they’re experiencing pain. Some may seek out medical attention.

Doctors are likely to prescribe opioids to an injured worker as pain relief, Manzo says, inadvertently introducing the risk of dependence and addiction. A common route to opioid misuse is a legal prescription, the NSC says. More than one quarter of chronic abusers, defined as those who took pills for at least 200 days in the past year, received written legal prescriptions for the drugs, while another quarter misused opioids legally prescribed to friends or family, the organization reports in one of its guides on the epidemic, “The Proactive Role Employers Can Take: Opioids in the Workplace.”

Jerry Sjogren, safety director of E.L. Harvey & Sons (Westborough, Mass.), noticed that injuries resulting in long-term use of prescriptions were a common gateway to opioid misuse for employees at that facility. Those who developed an addiction would decline rapidly following a surgery or other medical procedure. Without proper intervention, the effects can be devastating, even for a person who had no apparent addiction issues before developing opioid use disorder. “I’ve had to terminate people and just watch their lives crumble around them,” Sjogren says.

Understanding the disorder

Like other substance use disorders, opioid use disorder is listed in the Diagnostic and Statistical Manual of Mental Disorders. “People should realize that this is a brain disease,” says Beth Connolly, project director of the substance use prevention and treatment initiative at the Pew Charitable Trusts. “Physiologically, [opioid dependence] changes the brain, and these effects continue over time. That is why it is not a moral failing, but a chronic medical condition.”

Opioids decrease a person’s sensation of pain by blocking pain messages sent through the spinal cord to the brain, the NSC says. They increase the level of dopamine in the body, giving some people a sense of euphoria. Predisposition to addiction depends on a person’s brain chemistry in addition to a variety of risk factors, including preexisting mental health conditions like depression and anxiety, growing up or living in high-stress environments, and childhood trauma—though anyone exposed to opioids can develop an addiction.

It can be more difficult to identify an impairment caused by opioid use compared with an impairment caused by substances like alcohol and marijuana. Signs and symptoms can vary depending on the drug being used, the degree of abuse, and the user’s level of tolerance. States of intoxication and withdrawal from opioids will appear different, says Dr. Neeraj Gandotra, who specializes in addiction treatment and psychiatry at the Substance Abuse and Mental Health Services Administration. “Intoxication would look like pin-point pupils, impaired coordination, drowsiness, lack of concentration, and shallow breathing,” he says, while a person in withdrawal will be restless and uncomfortable, will experience chills or sweating, and will have dilated pupils. Because a person misusing opioids may simply appear tired or unfocused, early stages of addiction can be difficult to detect.

As the misuse increases, behavioral changes are likely to occur. Rouse says one employee caught the attention of his co-workers after becoming “very angry and irate—he was screaming on the phone all the time with his friends and family.” Another employee, he says, was in such a catatonic state that he fell asleep standing up. He also describes observing erratic energy levels, with affected employees fluctuating between a lethargic state and being “really hyped up.” Sjogren noticed changes in hygiene and appearance. The most common signs, according to the NSC, are a failure to appear at work and declining performance on the job.

How to Respond

If you suspect an employee is misusing opioids, be careful in your approach. “It’s not a good idea to accuse the person if they haven’t admitted to it and you don’t have hard evidence,” says Kathryn Russo, principal at Jackson Lewis (New York). Employers who confront employees and level accusations about drug use that prove to be false may run afoul of the Americans with Disabilities Act, which prohibits discrimination against people with disabilities. Employees who find themselves subject to a wrongful accusation at work, followed by a disciplinary action, are legally protected under the ADA, Russo says. It’s fine to take employees aside privately, voice concern about behavioral issues, and ask them if they’re OK or need assistance, she notes. Document and use concrete examples of performance or attendance problems to bolster your case for concern. If termination is necessary, emphasize these performance and attendance issues and exclude your suspicion of an opioid problem.

In some cases, employees may recognize they have a problem themselves and come forward to their employer. These cases can also create the potential for legal violations, says Michael Wong, a labor lawyer at SmithAmundsen. “If they find out an employee is on a prescription drug, the knee-jerk reaction for an employer is to ask what the name of the drug is,” he says. Such a disability-related inquiry would violate the ADA. You may be tempted to research that drug on your own and draw your own conclusions, without necessarily having all the information. “In doing that, you may again be violating the ADA by regarding that individual as being disabled and as having limitations based on the name of the drug that was given to them,” he says, “not [based on] what their doctor is actually saying their restrictions are, if any.”

The need to stand back and collect evidence of poor performance can be stressful, especially when employees are working in positions in which careless operation of equipment or oversight of operations could lead to dangerous circumstances. To protect yourself from these situations as much as possible, Wong recommends you have a drug policy in the employee handbook that includes specific guidelines for prescription drugs like opiates. For example, you can require a doctor’s clearance to return to some kinds of work following a medical leave, hospitalization, or even concerns over safety, Wong says. He recommends a drug policy that requires employees to review their job descriptions with their doctors before returning to work on a new medication. He also recommends employees be required to disclose to the employer if a medication could impact the employee’s ability to safely do his or her job. If the doctor prohibits operating heavy equipment or other types of work due to potential side effects, you must evaluate whether the employee is entitled to Family and Medical Leave Act benefits or whether the ADA process should allow the employee to work in a different, less demanding role until he or she recovers. Wong says each situation should be evaluated on a case-by-case basis.

Both Russo and Wong also endorse the use of drug testing, which is already required for some recycling employees by the U.S. Department of Transportation. To increase your chances of uncovering misuse, Russo suggests you expand your testing panel to include synthetic opioids, which could include prescription drugs like Vicodin and OxyContin. Pre-employment testing, random testing, and post-incident testing are some of the most common types of drug tests. Testing is not a perfect means of detecting opioid use disorder. If a tested subject can provide the medical review officer with verification of a legal prescription, the officer is likely to return those results as negative—as the subject is not illegally using the drug, Wong says. He adds that employers should discuss with their medical review officers how results are reported and whether—for positions where safety is a significant issue—the officer will report that while the result is negative, the employee is taking a prescription medication for which they may need to provide a doctor’s clearance.

Some recyclers, like Rouse, say they have success with “reasonable suspicion” drug tests, which you conduct based on factors like the employee’s appearance, speech, behavior, and work performance. While many employers have access to these tests, they may be hesitant to use them, Russo says. “Very often, unless supervisors are trained, they’re afraid… they don’t know what to say to the person, they don’t know what they’re looking for—they just don’t know how to do it,” she says. Both Wong and Russo recommend training supervisors on how to use reasonable suspicion and supplement the test with checklists. Russo provides such training across the country in person and via webinar. PK Metals has four employees trained to use reasonable suspicion as the basis for a drug test, and Rouse says the tests have been the most successful way of detecting opioid issues at the facility.

Where there’s a clear and alarming situation, Russo says, use your best judgment to prevent an accident from occurring. Prevent an employee who seems disoriented, confused, especially tired, or otherwise impaired from operating equipment or doing other work—even if you don’t know what’s going on. While an employee could conceivably pursue a discrimination claim, weigh the potential of more likely and more serious safety and legal issues if the impaired worker were to cause an injury. “Most employers would rather be faced with a discrimination lawsuit than a personal injury lawsuit,” she says.

Preempting the problem

While there are several ways of detecting and dealing with suspected opioid misuse, you can take a proactive role to reduce the chance your employees will develop a dependence on opioids.

Employee education can be key, several experts say. In up to one-third of cases, people who are prescribed opiate-based drugs for pain relief—which include common medications like Percocet, OxyContin, and Vicodin—don’t realize they are taking an opioid, according to the NSC. Bring in experts and hold companywide seminars to educate employees about these drugs’ potency and effects and empower them to ask questions about the medications they are taking. In many cases, there may be a serviceable alternative. “For types of pain related to common workplace-related injuries, including soft-tissue injuries and musculoskeletal problems, opioids are not any more effective than non-opioid alternatives such as Tylenol, Advil, or generic ibuprofen,” NSC’s report on opioids in the workplace notes.

Consult your health insurance providers about opioid addiction and ask what measures they’ve taken to ensure patients aren’t needlessly prescribed opiate-based medication, Manzo suggests. While doctors have cut back significantly on opioid prescriptions in recent years as awareness of the epidemic has spread, abuse of legal prescriptions is still a risk. Ultimately, medication is a personal and confidential choice a doctor and patient should decide together, but you can press insurance companies to account for how they’ve responded in the face of the epidemic and what alternative services they offer or cover for employees dealing with pain. You can select health plans that cover substance abuse treatment and mental health treatment. It also helps to provide at least two weeks of paid sick leave and encourage employees to use it when needed, Manzo says. His research found that employees who feel pressured to return to work quickly following an injury—either due to perceived employer pressure or the threat of losing money on unpaid sick leave—may turn to “popping a pill” as a way to endure the pain when returning to work too soon.

You can offer other resources outside the traditional insurance system as well. Manzo provides the example of a construction company labor union that negotiated for access to a physical therapy provider. The benefit allows any worker to access physical therapy for any reason, from a back injury to shoulder pain. “They don’t even need a doctor’s note,” he says. Russo also highly recommends all employers have an employee assistance program, which can provide assessments, short-term counseling, referrals, and follow-up services that are confidential and free to the employee. These can be helpful both for employees who think they have a problem with opioid use but are hesitant to seek help due to the stigma of the disease and for those who are looking for pain management alternatives.

Access to nonprescription means of dealing with pain—from mental health services that can help people manage chronic pain psychologically to acupuncture and physical therapy—may be key in reducing the likelihood that employees will be directed to opioid medications. While opioids are often the appropriate treatment for short-term and acute injuries, Dr. Gandotra says, long-term use for chronic pain increases the chance of developing an addiction considerably. “The treatment of a chronic condition with an addictive substance for an extended period of time is generally a very bad idea,” he says. He notes that people often have an expectation of complete pain relief; unfortunately, for those with chronic pain, this may be an unrealistic expectation.

For Bob Lenhardt, substance abuse counselor and co-founder of the HeartWell Institute, finding ways of reframing this expectation is central to his work of helping addicts recover. He has seen an increase in the number of opioid addictions in recent years and has found pain to be a primary factor that has led to the addiction, he says. Among other approaches, Lenhardt uses a mindfulness-based method of helping people cope with their pain, which he says can be very effective. “People have the same amount of pain, but their experience of pain has changed dramatically,” he says. “Their story about the pain has changed. It makes it a lot more tolerable.”

If employees seek out recovery and have their performance and attendance under control, be supportive and flexible, Dr. Gandotra says. As a chronic condition, opioid use disorder may take time to overcome. However, he notes, the longer a person stays engaged in treatment, the more likely they are to be successful. You can play an important role by being compassionate and offering a wide variety of resources. “Employee-sponsored treatment is more effective than treatment encouraged by friends and family,” the NSC report says. “Retaining an employee following successful treatment is good for morale and the company’s bottom line.”

Emilie Shumway is an editor/reporter for Scrap.

Recyclers are spotting possible opioid abuse at work and taking steps to prevent it—all while supporting workers who might need help.

  • 2019
  • Nov_Dec

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