As Safety Directors understand, many workplaces have mandatory “drug of abuse” (DOA) screens in place, and while these are helpful in identifying alcohol, amphetamines, cocaine, marijuana, phencyclidine (PCP), and opioids, it is the opioid class that proves the most problematic for judging its appropriateness on the job.
This is because, in spite of the press exposure over the “opioid crisis,” most people chronically taking prescribed opioids are using them legally for chronic pain syndromes, such as osteoarthritis, rheumatoid arthritis, old orthopedic injuries, and chronic inflammatory conditions (such as fibromyalgia).
However, according to Rebecca S. Spicer and Ted Miller in the Journal of Primary Prevention, when problems arise from those improperly taking their drugs, using illicit street drugs, or abusing alcohol, the workplace can become the scene of inefficiency, insubordination and poor performance, work-related injuries, or even fighting. What are the differences that safety directors must recognize between use and abuse? Such a question, of course, depends on when a user crosses the line from moderation to inappropriate consumption. (Any use of illegal substances or alcohol are considered abuse—there is no moderation.)
Approximately 75% of substance abuse in the workplace is marijuana, and some abusers can mask their condition well. Abuse of other illicit drugs such as methamphetamines, PCP, and XTC, or of alcohol, however, are often fairly obvious and incompatible with workplace productivity and harmony. Some may hide it well, but eventually the abusers (including of marijuana) become hard to miss, due to the nature of the substances themselves (e.g., sedation, hyperactivity, emotionally inappropriate, and absenteeism). However, for opioid-users there can be a completely normal working environment unless their use turns into abuse or addiction.
Goal of Opioid Therapy: Function
The medical and ethical goal of opioids (and many other supplemental medications) is function. This is the target of therapy by physicians who manage chronic pain; contrary to what many people believe, their target is not the absolute elimination of pain.
While it is a truism that it may not be possible to make a person pain-free, a chronic pain sufferer should be able to be completely functional when there is a rational strategy for his or her medical therapy. By functional is meant that a person can work without performance issues and engage in the common activities of daily living. Such therapy depends on a balance of analgesia and side effects (e.g., sedation), finding that “sweet spot” that allows an employee to be completely functional without cognitive impairment. In other words, a functioning opioid user should give no indications that there is a problem except, perhaps, a positive drug screen; such functioning employees are usually forthcoming with this sensitive, privileged information to the responsible officers.
The Prevalence of Opioids in the Workplace
Successful opioid therapy is happening all around us. As the population ages, so does the prevalence of chronic pain in the elderly. Also, however, as the population ages, the retirement age also gets older, well beyond the standard 65. This creates an overlap of more people on opioids remaining in the workforce. Not only must a safety director be aware of opioid use and abuse, but also the opioid impact on the elderly. Of particular concern—in any age group—is any cognitive impairment that may accompany opioid use. As above, however, when the medical management is appropriate, there should be no safety concerns. A safety officer should still be attentive to even the most dedicated employees, because there can often be a need for adjusting one’s meds over time.
There are some vocations in which opioids and/or other medications are not allowed. Drivers, heavy machinery operators, even medical workers or first responders may either require extra scrutiny before passing muster or may even be declined for employment if there is any safety concern. (Alcohol is never appropriate in any capacity of employment.)
Function vs Dysfunction
Function vs dysfunction is the distinction between substance use under medical supervision vs abuse/misuse. For the functioning employee who is following a medically prescribed regimen that is supervised by his/her physician, there is little risk of dysfunctional behavior that interferes with a job description or the usual duties, procedures, or protocols. However, addiction—defined as craving and behavior aimed at obtaining it any risk—will always affect performance. If an addicted person’s first obligation is to the addiction, the job (and anything else) will be a distant second priority, at best.
The Warning Signals of Dysfunction
Abuse of substances can occur by one of three processes:
Recreational abuse: these persons have no prescription or use street drugs that cannot be prescribed (Schedule I or the illegal drugs). Alcohol is legal, and abuse is a problem in moderation until there are signs of addiction.
Misuse: these persons have legitimate prescriptions but do not follow the prescribed regimen. They over-take their medication, supplement ahead of schedule and run out early, and borrow medication from peers. Such behavior can be doctor-caused via undertreating a pain syndrome. This is called “pseudo-addiction.”
Addiction: when craving drives substance-seeking in spite of the risks to the individual. Any drug that causes euphoria or stimulates the “reward” hormone in the brain, dopamine, can cause addiction.
Warning signals that a person is abusing, misusing, or illegally seeking drugs because of addiction:
Absenteeism. According to the Journal of Workplace Behavioral Health, early substance abuse, in those still alert to the risks they are taking, would rather call in sick than be suspected of abusing alcohol or drugs.
Inebriation or acting “high.”
Sleeping on the job.
Out-of-office gaps in the workday. “The Phantom Employee”: normal out-of-office tasks may take much longer than expected and happen repeatedly.
Inappropriate conversation and/or behavior. Persons addicted to or improperly using substances have a distorted worldview and will often say inappropriate things, have wild swings in their volume, and engage in inappropriate provocations with fellow employees.
Sudden emotional swings and mood changes.
Insubordination, refusing to perform job duties, and continuous complaining.
Personal grooming begins to deteriorate.
Always out of money—borrowing frequently from co-workers.
Pin-point pupils (opioid abuse).
Nausea and vomiting, shakiness, etc., from withdrawal.
Workplace Safety When the Reality Becomes Unreal
Those in a position to monitor workplace safety will know their employees well and be on the lookout for any behavior signals that warrant investigation. When “business as usual” becomes unusual—due to an isolated employee—it is time to act, certainly.
However, pro-active education and a policy of support for those who are forthcoming with any substance-related problems can do a lot to reduce turnover from drug abuse and addition. Each employee represents an investment and it is cost-efficient—as well as ethical—to help such persons in need if the environment can be kept safe for all. Communication is the best way to protect the workplace safety.