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Thursday, February 25, 2021

Epidemic at work? A doctor’s view on opioid epidemic

There is enough hydrocodone prescribed in the U.S. that every adult in the U.S. could get a six-week supply to take around the clock, every year. – Glen Hardesty, Texas Health Resources

Glenn Hardesty, an emergency physician employed by Texas Health Resources, talked to the Fort Worth Business Press about his experiences with the opioid epidemic in the Fort Worth area.

Hardesty is considered a local expert on the subject, having worked on the opioid epidemic as a sort of pet project for 15 years.

“What we find is that the opiate addiction has gotten out of control,” Hardesty said. “We started on a path of treating pain and making sure pain was appropriately treated without the guardrails of awareness of addiction and what to do with addiction.

“What we find now is the biggest killer of people between the ages 19 and 60 is no longer motor vehicle accidents, it’s overdose, and primarily from that – those opiates, prescription drugs,” Hardesty said. “It’s now become one of the biggest killers in America.”

Hardesty described the problem as a long-term quiet epidemic that people sort of stuck their heads in the sand about and avoided dealing with. One of the most dangerous things a physician can do, he said, is to prescribe narcotic analgesics, also known as opiates, liberally.

While some of these prescriptions are given to people with cancer and people who need legitimate pain control, some are not. And Hardesty says the public needs to separate those two groups when thinking about how to address the problem of opiate addiction and dependency.

“The patients we are concerned about are the ones that suffer from chronic pain of uncertain etiology,” Hardesty said. Except for patients who suffer major burns or certain cancers, narcotics aren’t supposed to be used for more than three weeks.

“What happens is people will have something and receive a prescription of pain medications and for some reason that I don’t think we can totally explain, they become addicted to them,” he continued. “And that addiction overrides all their other senses.”

People who are addicted will lie, cheat and steal to get the drugs they crave, Hardesty said. More work needs to be done to identify what makes these drugs so addictive to certain types of people but not others, he said.

He believes society needs to have a reasonable approach to dealing with the opiate epidemic in the culture because “we have a problem in our society with … painkillers.”

Prescribing patterns and habits for these types of drugs and “painkillers” need to be examined too, he said, adding that people have become accustomed to calling them painkillers but these drugs don’t kill, or get rid of, the pain, they simply mitigate it.

“Nobody has ever died from pain, but painkillers are a leading cause of death today,” Hardesty said. “There is enough hydrocodone prescribed in the U.S. that every adult in the U.S. could get a six-week supply to take around the clock, every year.”

Those dealing with the epidemic also have to consider that when someone who is addicted to prescription opiates cannot get them — whether they can’t afford them or a doctor won’t prescribe them — they can turn to illicit drugs such as heroin.

Hardesty noted these warning signs for people struggling with an opiate addiction:

They may begin to have multiple medical problems that center on pain and treatment of pain, and they may begin to have multiple doctors;

They may begin to ask friends for any extra on-hand pain medications because they’re “out” or their medicine has been “lost or misplaced;”

They may get very vague and evasive or lie.

He says that as a physician the first thing he would do is talk to a patient about the possibility of addiction, but he finds that anger and denial is the typical response.

Businesses forced to deal with epidemic

When it comes to businesses handling the opioid epidemic, Hardesty has some advice, though he acknowledges he is a physician and not a business owner. It’s also important, he said, to understand that opiate addictions cross all race, socioeconomic and gender lines.

“Recognition of the problem is first and foremost,” he said. Offering a type of closed-door employee assistance/treatment program and allowing people struggling with this problem to come forward are both very important.

While people who are addicted and people who are dependent on opiates often are not distinguished — since the goal for both is to get them off the drug — there are usually different tactics to help each type of addict, he said.

For people who had a major medical event and had to use the opiate and who have become dependent on that medicine because they do not want to go through withdrawal, “once they do get off, they’re off,” Hardesty said. Meanwhile, for people who are addicted to the opiate because they like the euphoric high, “it would be important to have an ongoing monitoring program,” Hardesty said.

It is in businesses’ best interest to have something in place for these types of individuals, Hardesty said, not just because it helps the employees, but because most of the time the money the addicts are spending on prescription drugs is coming from a workplace health plan.

That cost will affect the company “in health care expenditures,” he said. “So as an employer it would behoove you to go ahead and affect the problem ahead of the curve.” – Linda KesslerAfter a troubled youth himself, Phillip Cohen made it a practice to hire people at his woodworking business who have also struggled with addiction and mental health issues. But when an employee died from a drug overdose, he adopted a zero-tolerance policy.

“I think I have saved lives,” says Cohen, the owner of Cohen Architectural Woodworking in St. James, Missouri — an area hit very hard by the nation’s growing opioid epidemic. Opioids range from prescription pain medicine like oxycodone to illegal drugs like heroin.

Cohen still hires former drug addicts, felons and people who have been traumatized in life. One person, now a top employee, was hired right after he finished drug rehabilitation. Another used to sell illegal drugs. Still, Cohen says, if a worker fails a periodic random drug or alcohol test, “we’ll fire them on the spot.”

A report from the U.S. surgeon general last year said that 20 million Americans have a substance use disorder. The epidemic of drug use is forcing many small-business owners to think about what they would do if they suspect an employee is abusing drugs or alcohol.

Between 1999 and 2015 the number of overdose deaths from opioids and heroin quadrupled, the National Institute on Drug Abuse says. The government also reported more than 15 million adults with what’s called alcohol use disorder in 2015.

Over 70 percent of employers with 50 or more workers have employees affected by prescription drug abuse, according to a survey released this year by the National Safety Council. But more than 80 percent don’t have a comprehensive drug-free workplace policy.

Although Cohen understood the dangers of drugs and knew that some of his employees had a history of substance abuse, he wasn’t prepared when a worker overdosed in 2010, three days after the staffer attended a leadership conference.

“I didn’t care what people did at first,” says Cohen, whose workers use saws and other potentially dangerous machinery to build reception desks, cabinets and furniture for businesses, schools and health care facilities. But the devastating death of an employee prompted him to hire an attorney to write a tough drug policy that workers must read and sign.

“You have to draw the line somewhere,” says Cohen, who also brings in counselors and people who run support groups to help staffers who are struggling with personal problems.

Many small-business owners don’t think ahead and create a written policy on alcohol and substance abuse, says employment law attorney Shira Forman. That forces them to be reactive, trying to figure out what to do with an employee who shows up drunk, high or hung over, whose work is suffering or who causes an accident.

“It’s often not something that an employer knows how to deal with until they’re confronted with a scenario,” says Forman, who works at Sheppard, Mullin, Richter & Hampton in New York.

Having a policy in place doesn’t make it easier for a boss to confront a staffer believed to have a drug or alcohol problem. It’s hard on an emotional level, especially if the employee denies that there’s an issue and gets angry. And there can also be legal questions that must be considered before an owner broaches the topic.

Many owners seek help from a lawyer or HR professional. David Grant was taken by surprise when an employee at his public relations company told him that a co-worker had gotten drunk at a lunch with a client.

Grant turned to his human resources provider and a consultant on dealing with alcoholics.

“It was a world I don’t know anything about,” says Grant, whose eponymous company is based in New York. “I was aware of how litigious everyone is, so I did it by the book.”

Grant’s HR provider had created a substance abuse policy that he followed. He told the staffer she had a choice: go into rehabilitation treatment for a month or be fired. She chose treatment, which Grant paid for. He also warned her that she’d be dismissed if it happened again. And it did; a few weeks after she returned to work she was again drunk at a client lunch.

“I fired her instantly,” Grant says. He had to follow some painful advice from his consultants: “You can’t back off. You can’t be a nice guy.”

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