What You Need to Know About Prescription Painkillers and Safety Risks

The low number of employers who offer training about workplace usage of prescription drugs must increase dramatically.

• By Fred Kohanna
• Nov 01, 2016

A 37-year-old man was working on a metal roof when he slipped and fell 30 feet, smashing seven vertebrae. He was prescribed OxyContin, a popular painkiller, for his back pain. He had to take ever larger doses of the opioid to ease his pain and suffered cravings when he went without. At the peak of his addiction, each day he was taking 250mg of OxyContin, three 800mg ibuprofen tablets (an anti-inflammatory), three doses of Neurontin (an anti-epileptic med), two of Lyrica (a med to treat damaged nerves), plus Diazepam (to treat muscle spasms) and Ativan (an anxiety med), according to an article in the London-based newspaper The Guardian.

Abuse of opioid prescription medications has skyrocketed. Eighty percent of employers in Indiana have been impacted in their workplaces by prescription drug misuse and abuse, including opioid painkillers, according to a 2015 survey conducted by the National Safety Council (NSC) and the Indiana Attorney General's Prescription Drug Abuse Prevention Task Force.

What Aare Opioids?
Opioids are substances that act on the nervous system in a similar way to opiates such as morphine and codeine. The term usually indicates medications that are artificially made, rather than extracted from opium. Nearly two-thirds of employers (64 percent) said prescription opioid painkillers such as Vicodin, OxyContin and Percocet are a bigger problem than illegal drugs, according to the NSC survey.

Other key findings:

• Only 53 percent of employers have a written policy on using prescription drugs at work;
• Only 52 percent conduct drug testing that includes testing for synthetic opioids;
• 60+ percent of employers are not confident that their supervisors and managers, or co-workers, can recognize the signs and symptoms of prescription drug misuse or abuse;
• Less than 30 percent offer training on workplace usage of prescription drugs. When taken at proper doses, many prescription drugs are safe for employees to use while they’re at work. Employees who are addicted, though, might take huge doses and may very well be impaired all day long. The damage done: Abusing employees may miss deadlines, make errors, fall asleep, get into arguments, behave erratically, and get into work-related accidents. Urine tests for drugs are four times as likely to be positive for opiates after an accident, compared to tests of people who are applying for a job, according to an article in CNN Money.

The Challenge to Employers
Employers are facing a number of challenges in trying to combat employee abuse of prescription painkillers:

• Americans make up less than 5 percent of the global population but consume 80 percent of opioid prescription pills, according to an article in The Guardian.
• By 2022, about one-quarter of American workers are expected to be 55 or older, according to the Bureau of Labor Statistics (BLS). Baby boomers are staying in their jobs longer. In most cases, older and wiser workers are less likely to be injured on the job, according to BLS. But workers 65 and older have an incidence rate of slips, trips, and falls of 49.5 per 10,000 workers, about double the rate of workers younger than 45, according to BLS. "As people get older, their injuries are more likely to be severe," according to a research psychologist at NIOSH. And more-severe injuries can lead to more prescriptions for pain medication.
• Injured workers are frequently prescribed opioid pain medications. More than 25 percent of workers' compensation prescription drug claim costs in 2011 were for opioid pain medications, according to the NSC.
• Injured workers who take opioid prescription painkillers double their risk of being disabled a year later, and their lost-time workers' comp claims are 900 percent higher than those workers who didn't take painkillers, according to the NSC.
• Prescribing painkillers such as Vicodin, OxyContin, and Percocet is now commonplace. Prescriptions for opioid pain relievers shot up from 76 million in 1991 to 213 million in 2013—a 176 percent increase, according to the National Institute on Drug Abuse.
• Because painkiller prescriptions are written by primary care physicians or pain specialists, patients may perceive that they are receiving credible treatment, not realizing the risks of misuse or abuse, and assume that pills are safe to take for any reason and under any circumstance. Family practitioners and even dentists prescribe pain medications.
• Generally recognized and accepted standards exist for determining impairment from alcohol, but setting rules regarding impairment from prescription drugs is more difficult.
• Many employers ask workers in safety-sensitive positions to self-report prescription drug use, but unless there is an accident, most employers do not use effective measures to ensure that self-reporting is accurate or complete.
• Pain medication has improved. This means that more employees are working with chronic illnesses that once forced people out of the workplace. This also creates a greater opportunity for misusing or abusing legally prescribed drugs.

What to Do?
The low number of employers who offer training about workplace usage of prescription drugs must increase dramatically. Workers must be educated about the risks of opioids and statistics about the staggering rise in opioid overdoses, misuse, and deaths. They must understand the dangers of sharing opioids, and the fact that many opioid abusers obtain the drugs from friends and family, sometimes stealing them. They need to know how to safely store and dispose of opioid drugs and not to mix opioids with certain other types of drugs or alcohol.

Employees abusing opioids should be encouraged to make use of employers' employee assistance programs (EAPs). Seventy percent of all U.S. companies and 90 percent of Fortune 500 companies purchase EAPs, according to the NSC. But relatively few employees use EAPs because they don’t understand their value or fear negative ramifications if they seek help. Trained clinicians at EAPs can teach employees and managers about the warning signs of abuse and work with employers to get troubled employees the help they need.

Employees, supervisors, and managers must be educated to be more confident that they can spot the signs and symptoms of prescription drug misuse or abuse. Signs and symptoms depend on the specific drug, but the mind-altering properties of opioids commonly result in constipation, nausea, feeling high, slowed breathing rate, drowsiness, confusion, poor coordination, excessive mood swings or hostility, increase or decrease in sleep, and poor decision-making, according to the Mayo Clinic. Employees also may feign back pain in order to get painkillers. For that reason, the NSC recommends that employers expand their drug testing programs to include all common opioids and work with insurance carriers to identify inappropriate opioid prescribing.

Don't Overreact
As much as painkiller addiction is being described in the media as a crisis of epic proportions and a great unfolding tragedy, employees, supervisors, and managers must not fall prey to overreactions. Well-prescribed opioids at a stable dose that are well-supervised in most healthy people won’t cause sedation or other cognitive problems, states the American Pain Society.

"Not everyone who receives opioids gets addicted," said a Pennsylvania toxicologist in an article in the Pennsylvania Physician magazine. "But it doesn't take very long to get physically dependent." About one in four patients he sees are experiencing opioid toxicity or withdrawal.

This article originally appeared in the November 2016 issue of Occupational Health & Safety.