In the midst of COVID-19, America’s other public health crisis — the opioid epidemic — is still raging on. Opioids have affected the lives of millions of Americans across the country for nearly three decades, and employers in all industries have felt the impact. Now social isolation, job losses, and safety limitations on inpatient treatment are all making things worse.
To employers struggling to keep their businesses afloat, substance abuse may now seem like a distant threat. But, because of all the immediate challenges, we believe it’s one that is worth preparing for sooner rather than later.
This article tells the story of why the opioid epidemic is a bigger-than-ever risk to America’s employers and shares advice from workforce health experts on what they can do now to mitigate it.
Without treatment, I wouldn’t be where I am today
“Without treatment, I wouldn’t be where I am today. I’ve been sober for eight years. I’m married, I work as an analyst in health informatics and I’ve had the pleasure of seeing many other people receive the gift of recovery,” says Josh, a thirty-something who is in recovery from an opioid use disorder (OUD).
He describes how challenging his last eight years of sobriety have been — requiring ongoing effort, discipline, and commitment. Intensive inpatient treatment for 30 days, inpatient extended care for up to three months, a year of living in a sober house, 12-step programs, cognitive behavioral therapy, and faith, were all important aspects of his recovery.
Convinced that recovery is almost always possible and that people in recovery are among the most engaged and committed employees (a claim borne out by research), Josh advocates for employers to support struggling workers. Calculations from the National Safety Council lend proof to the argument that recovery is good for business:
- Workers in recovery help employers avoid $1,626 in turnover and replacement costs
- Workers in recovery miss 5 days less
- Each employee who recovers from a substance use disorder saves a company more than $3,200 per year.
Impact of COVID-19 on substance abuse and recovery
Sudden lifestyle and work environment changes brought by the COVID-19 pandemic, however, have compounded the issues faced by individuals living with any substance use disorder.
Shatterproof, a national nonprofit that works to reverse the substance use crisis in the U.S., warns of the threat, “Not only from the virus itself, but also from the consequences of physical distancing on access to necessary treatment and recovery resources. We should anticipate potential relapses and dangerously reduced access to addiction treatment for those actively using who are ready to seek care for the first time.”
So what can employers do right now to help?
Sixty-seven percent of HR professionals admit their companies are affected by the opioid epidemic according to a 2018 survey. Yet, nearly the same number of HR professionals - 64 percent - reveal that they do not feel well-trained to help workers experiencing opioid use disorder (OUD). In addition, only a third of the employees surveyed felt their employers made addressing opioid addiction a priority and had resources available. To help HR teams, who are likely to be feeling overwhelmed during COVID-19, we have compiled some advice from HealthPartners experts.
Six things to discuss with your health solutions provider now to reduce the risk of opioid abuse:
1. Get clearer on the extent of substance abuse in your company
It’s hard for employers to address opioid misuse when, even though they suspect there may be a problem, they have little idea of how much it’s affecting their employees and their company. There are, however, plenty of data that can both help reveal negative trends and alert providers (though not employers, since individuals’ data are confidential) to people at risk. Ask your health plan to tell you what the data show.
2. Make sure opioid prescriptions are being monitored and controlled
This should include:
- Reviews of prescribers to identify outliers - Clinicians who prescribe higher-than-normal levels of opioids should be regularly reviewed to ensure medications are being prescribed appropriately.
- Programs to prevent multiple prescriptions - Health plan members with opioid prescriptions from multiple providers should be identified and referred to one doctor, one pharmacy and one emergency room. Electronic prescribing can also prevent “doctor shopping” and fraudulent prescriptions for opioids.
- Programs to limit coverage on the number of pills - At HealthPartners, for instance, payment is limited to eight pills a day for short-acting medicines and four pills per day for long-acting medicines.
- Programs to limit strength of pills - Coverage can be limited to opioids that have a morphine equivalent dose (MED) of 90 mg per day. MED is a tool to measure the potency of opioid medications. Higher doses should require prior authorization and documentation of monitoring.
3. Start reducing stigma so employees speak up
Stigma stifles cries for help: employees won’t speak up and managers fear lifting the lid on a problem they don’t know how to deal with.
“Some think people use opioids by choice – they don’t understand that substance use is a disease,” says Lori Lewis, who lost her son to an overdose. “They are not educated. I’ve started to sit down with people to understand why they think this way and educate them on what I know.”
One helpful tool for employers looking to reduce stigma around substance use and mental health in the workplace is HealthPartners MakeItOk.org campaign.
It features a list of useful materials in a toolkit, including videos, PowerPoint slides, brochures, discussion guides, FAQs, sample articles, online learning experiences, and tip cards. They’re great conversation-starters and awareness-builders that can easily be incorporated into lunch and learns, internal communication, and other all-staff training.
More useful tools specific to opioids can be found here: Opioid Employer Toolkit.
“Anyone can be affected by OUD, whether it is the employee, a family member or friend,” says Lewis. “Educate employees on the signs and symptoms and what they can do to address the problem.”
4. Leverage big data and patient-centered case management for prevention
Health plans should use artificial intelligence to scan patient and pharmacy claims data to identify people who may be at risk for substance misuse. Case managers can then reach out to those people through a confidential phone call or an email to assess their needs, provide education on treatment options, and make referrals easier.
Joan Bullemer (MA, LPCC, LADC), a health plan care coordinator on the HealthPartners behavioral health team explains how she helps people experiencing a substance use disorder:
“My goal as a care coordinator is to plant a seed that “we are here and this is how we can help. I love my work and I love helping others. It’s very rewarding. When you can provide this type of assistance, it opens the door. And when you mutually agree with a struggling person on what’s needed, and keep working at it, the outcomes are amazing.”
5. Provide virtual, confidential ways for employees to seek help and access care
When people are experiencing a crisis, opening up to others can feel impossible. An Employee Assistance Program (EAP), which is part of many insurance plans, provides employees with confidential phone and online support on topics like substance use disorders, emotional well-being and relationships, as well as concerns around finances, work and career.
COVID-19 has forced a shift to virtual behavioral health care. People are welcoming the convenience and it's proving effective. Beyond the ease of access, other benefits of accessing care virtually from the home are reported as feeling freer from stigma and a new opportunity for providers to get a glimpse of their patients' living conditions.
Digital behavioral health tools and apps can help people manage stress and anxiety wherever they are and whenever they need to.
HealthPartners’ 24-hour CareLine is staffed by registered nurses and behavioral health navigators who are available to provide phone support that can be life-saving.
6. Incentivize new and better treatments for pain (especially back pain)
Most of the adult workforce lives with pain. Eighty percent of all heroin users were introduced to opiates through prescription drugs, many of which were for pain. Prescription opioids are rarely the best answer to treat pain, according to Regions Hospital Chief Medical Officer and neurologist, Dr. Bret C. Haake.
Our experience of pain is strongly influenced by how good we feel physically and emotionally, how socially connected we are, how active, and how well we sleep. Not surprisingly, in the second half of 2020 people are reporting higher levels of pain than in pre-COVID times.
Employers can help employees prevent the onset of pain or make some common types of pain more manageable by providing:
- Easy access to physical therapy, which can also prevent problems from becoming serious (video visits are possible)
- Incentives to be physically active
- Mental health, sleep support and resiliency programs
- Assessment by medical spine specialists to support non-surgical treatments for back pain, for instance
Hope for a healthier future
“Meet your employees where they are at, treat them with dignity and respect, and don’t pass judgement on what you don’t know or haven’t experienced,” explains Lewis. “In my workplace, people are sincere and understand that it is okay not to be okay some days. The strongest people I know are in recovery. People have no idea what’s going on and what it takes for them to pull themselves together. Be aware that nobody’s life is perfect. Just being there to support someone can do wonders for that person’s health.”