Prescription painkillers and the workforce

Bill Butler took pride in his ability to move heavy objects without assistance. However, the machinist experienced lower back pain. He was prescribed hydrocodone to relieve the pain and, after developing a tolerance, began taking methadone.

On July 12, 2006, Bill took too large a dose of methadone and died, leaving behind his wife and two sons. He was 33.

Bill’s brother Rex shares Bill’s story to educate others about the dangers of prescription painkillers. As an environmental and safety manager at Central Iowa Power Cooperative in Cedar Rapids, Butler counsels others about the drugs’ hazards.

“I truly believe that his death will save lives,” Butler said. “Life is too precious, and losses like this far too senseless.”

More than 16,000 Americans died from prescription painkiller overdoses in 2013 – quadruple the total in 1999 – according to the Centers for Disease Control and Prevention.

As part of a 2014 study, the Cambridge, MA-based Workers Compensation Research Institute examined 264,000 claims from 25 states. Researchers found that 65 percent to 85 percent of injured workers in most states received narcotic painkillers.

Opioids – a group of drugs that include oxycodone and morphine – are prescribed by doctors to relieve pain, but can affect safety, health and productivity, as well as increase workers’ compensation costs. The highly addictive drugs also can result in side effects such as confusion, drowsiness and nausea.

“There are more side effects related with opioid use than just addiction and death,” said Tess Benham, who manages the National Safety Council’s initiative to prevent prescription drug overdoses and deaths. “Employees using opioids should not be doing safety-sensitive work because of the impairment associated with opioid painkillers.”

In February, NSC polled 1,014 adults, 427 of whom reported having been prescribed an opioid painkiller within the previous three years. Nearly half of users participated in a potentially unsafe activity while using an opioid – 39 percent went to work, 35 percent drove a vehicle and 14 percent operated heavy machinery.

“Those are pretty telling figures on why employers should take action on prescription opioid use at work,” Benham said. “Their employees may have valid prescriptions, but these aren’t always safe drugs for workers to be using at work, depending on their job tasks.”

What can be done?

Workers need to be educated about the risks and hazards of using opioid painkillers, Benham said. Employers should implement a policy that defines which drugs are prohibited and the consequences of using them. She added that the policy should state that workers need to inform their supervisors if they are taking a prescription drug that can cause impairment and affect their work. But this requires a commitment from the employer.

“The caveat with that is employers need to be willing and able to accommodate those workers by either making sure they have leave they can use, giving them other job duties they can do, being accepting,” Benham said. “Because of privacy concerns, they shouldn’t be asking the employee, ‘Why are you taking it?’ It’s just enough to know they’re using a medicine that can be impairing. Safety should be paramount.”

The policy should be communicated at orientation, training and safety meetings. “Educating employees is critical. It’s not just tossing out a piece of paper and saying, ‘Read this,’” said Christine Clearwater, president of Drug-Free Solutions Group, a Delray Beach, FL-based consulting firm focused on substance abuse prevention in the workplace. “It’s educating them on drugs, how it affects them, their body, mind, workplace, family, community.”

An employer’s drug program needs to adapt to reflect changes in society and the workplace, Clearwater said. Employers should ensure their drug testing include monitoring of the most popular drugs, while NSC recommends that testing include – at a minimum – benzodiazepines, opiates, oxycodone, methadone, cocaine, amphetamines and tetrahydrocannabinol.

In addition, workers can act as their own advocates by asking their doctor for an alternative to a drug, Clearwater said. Alternatives may better relieve pain and have fewer side effects. According to NSC medical advisor Don Teater, M.D., non-steroidal, anti-inflammatory drugs – including ibuprofen and naproxen – are safer and cheaper than opioids, and taking this type of drug with acetaminophen can be more effective for pain relief.

“A lot of times, people – including employees – take for granted whatever the doctor says goes,” Clearwater said. “They can work with their doctors and ask, ‘Is there something else I can take that would accomplish the same thing that might not affect my ability to do my job or my safety?’”

A ‘comprehensive approach’

NSC launched an initiative in 2014 aimed at reducing injuries and deaths caused by prescription drug overdoses. The effort includes doctor education on prescribing lower doses for fewer days and offering effective alternatives to opioids. NSC also supports state prescription monitoring programs, which inform doctors if a patient is going to multiple pharmacies to obtain a drug.

The council’s position statement on opioids in the workplace recommends that employers use a “comprehensive approach.”

This includes:

• Supervisor training centered on identifying impaired workers
• Drug testing for all common opioids
• Insurance providers and pharmacy benefit managers that can identify inappropriate opioid use and report prescribers when appropriate
• Employee assistance programs that include treatment
• A clear explanation of drugs not allowed in safety-sensitive jobs

The prescription painkiller problem is very personal for Rex Butler, whose brother dealt with back pain for years. He believes employers need to take a more proactive approach on teaching workers about how prescription painkillers can be addictive and dangerous. Workers should take training seriously, use medications only for medical reasons and follow instructions.

“This is something that doesn’t discriminate in any way,” Butler said. “This is a very preventable tragedy that can be avoided with proper intervention and concern. There is no reason for people to lose loved ones to something as senseless as this.”