In addition to immeasurable human suffering, the issue of opioids in the workplace has not received the attention it demands.
A new report, Opioids in the Workforce, issued this morning at the Massachusetts Health Policy Forum, in partnership with RIZE Massachusetts, researchers from the Institute for Behavioral Health at the Brandeis University Heller School for Social Policy and Management, found that while many employers are concerned with opioid use disorder (OUD) in the workforce, there is no consensus on the best approaches and stigma remains a major obstacle to action. The breadth of this epidemic is moving many employers to take action, as the crisis increasingly affects their employees and business.
According to today’s report, which offers strategies and examples of employers who have implemented effective and innovative approaches, the annual impact of prescription opioid misuse on Massachusetts’ employers, employees and dependents is estimated at a minimum of $1.7 billion for increased heath care and OUD, criminal justice involvement and lost productivity in the workplace. The actual cost of this epidemic will likely continue to rise due to additional societal costs such as increased burden on the foster care system, first responders and caregivers.
The urgency of the opioid epidemic raises the possibility of and opportunity for implementing effective approaches to the prevention, identification and treatment of substance use disorder (SUD) throughout the Commonwealth, including the workplace.
This morning’s event featured a discussion of the new report with authors, Constance Horgan, ScD., Professor and Director at the Institute of Behavioral Health and Nancy Lane, PhD, Visiting Research Scholar, Institute for Behavioral Health, along with Monica Bharel, M.D., MPH, Commissioner of the Massachusetts Department of Public Health and J.J. Bartlett, President of the Fishing Partnership Support Services.
A second panel featured program and policy experts who discussed specific impacts of the opioid epidemic on employers and employees and innovative approaches underway to tackle the crisis. Panelists included: Rachael Cooper, Senior Program Manager and Subject Matter Expert, Substance Use Harm Prevention, The National Safety Council; David Chamberlain, Principal, Strategic Benefit Advisors; Kate Walsh, CEO & President, Boston Medical Center; Jeffrey W. Werner, Executive Director, New England Carpenters Benefit Funds; Kenneth Duckworth, MD, Associate Medical Director for Behavioral Health, Blue Cross and Blue Shield of Massachusetts.
“The opioid epidemic has taken a huge toll on the workforce. Employers are struggling with worker shortages, absenteeism, and increased costs and individuals are working to provide for their families while also trying to manage and treat their disease” said Julie Burns, Executive Director of RIZE Massachusetts. “From this report, we see that employers can be part of the solution and there is more we can do together to change the course of this terrible disease.”
In interviews with 36 stakeholders, including employee and industry groups, academics and researchers, benefits managers, health plans, providers, advocates and government leaders, Dr. Horgan and her team found that common themes included employers’ uncertainty regarding how to address the opioid epidemic, the need for workplace-specific solutions, and the prevalence of stigma around SUD and medication for addiction treatment.
“Employers can play a unique role in addressing the opioid crisis in Massachusetts,” according to Dr. Horgan. ”This study provides employers with examples of ways to implement and improve effective approaches.”
The report found that individual employers vary widely in their awareness of opioid use and addiction issues. The report found that this disparity is particularly evident in safety-sensitive occupations, such as the construction and fishing trades – industries most hard-hit by the opioid epidemic because of the physical demand and the high degree of stress in these occupations. According to a 2018 MA Department of Public Health report on opioid-related overdoses, the fishing, farming and forestry industries in Massachusetts have experienced an opioid overdose death rate of 144 per 100,000 workers, over five times the average rate for all state workers.
In response, the Massachusetts Fishing Partnership Support Services, a non-profit organization founded in 1997, has integrated a set of member programs that focus on preventing opioid exposure and addiction through training and education, access to insurance and treatment at specialized providers, and recovery coaching by navigators.
The construction industry is also disproportionally impacted by opioid use disorder. In 2016, The New England Carpenters recognized that it was spending “outrageous amounts” on out-of-state network SUD providers and that their employees were most likely not receiving effective care. The New England Carpenters Benefits Fund, which provides health benefits to its roughly 22,000 members, worked with Blue Cross Blue Shield of Massachusetts to remove all treatment limitations and prior authorization for in-network SUD care. As a result of their efforts, 25 to 30 members have now successfully completed the Extended Services program (which includes an additional 90 days of recovery home services through the Gavin Foundation, a Quincy-based recovery home provider), and there has been a significant decrease in out-of-network, out-of-state SUD care.
The report looks at three other major employer and industry programs – Boston Medical Center, Seafood Sam’s and General Electric — that could serve as models for other employers.
“At Boston Medical Center, we are committed to raising awareness and ending the stigma associated with substance use disorder” said Kate Walsh, President and CEO of Boston Medical Center Health System. “That’s why we worked with our employees to provide and promote the necessary benefits and other services for those suffering with this disease. By providing a workplace that supports treatment and recovery, businesses can end the stigma that prevents employees from seeking help. BMC has leveraged its experience to create a free online resource library (bmc.org/library) for other employers who are working to address substance use in their own organizations.”
Research conducted for the new report indicates that employer engagement is critical – and that employers need targeted tools and resources to structure employee benefits to better prevent and combat opioid use disorder. Employers have the unique opportunity to better harness their considerable purchasing power as payors of health benefits to develop comprehensive substance use disorder programs.
The report provides recommendations for structuring employee benefits to better prevent and combat opioid use disorder.
Recommendations include:
- Employers should work with health plans to use de-identified personnel data to better understand the incidence of opioid use disorder, control exposure to opioids and limit barriers to treatment.
- Employers need to be pro-active regarding opioid prescribing and the potential for opioid use disorder in the workers’ compensation population by identifying people at risk for developing OUD at the point of injury.
- Employee Assistance Program (EAPs) should direct employees and their dependents needing treatment to evidence-based providers.
- Employers can conduct pre-employment screenings and drug tests in coordination with clearly defined organizational drug-free workforce and drug testing policies.
- Employers should access toolkits developed by the National Safety Council, Boston Medical Center and the Society for Human Resource Management to provide better services and communicate with employees regarding opioid use disorder.
- Employers should strive to create a recovery-friendly workplace that allows employees to take time off for appointments and support groups that reduce stigma for employees returning to work from treatment.
The report also suggests that employers can do a better job reducing the stigma associated with OUD and SUDs: Specifically, stigma impacts employers’ recognition of SUDs in the workplace, limits the efficacy of SUD prevention efforts, and contributes to lower employee utilization of EAP services and evidence-based treatment. Studies suggest that stigma is a primary factor in employees’ delaying SUD treatment until symptoms significantly impact their daily functioning.
The report recommends targeted workplace anti-stigma interventions: Workplaces free of stigma, with resources for preventing exposure to opioids, and support for treatment and long-term recovery are a common goal for employers and employees alike.