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Employers have a role to play in combating the opioid crisis | COMMENTARY

Matt Eleazer, president of Bricklayers and Allied Craftworkers Local 1, Oregon, visits a construction site in Portland, Ore., on July 24, 2018. Eleazer says at least 10 of his approximately 650 members had recently struggled with opioid use disorders, some with lethal outcomes. (Heidi de Marco/KHN/TNS) ** OUTS - ELSENT, FPG, TCN - OUTS **
Matt Eleazer, president of Bricklayers and Allied Craftworkers Local 1, Oregon, visits a construction site in Portland, Ore., on July 24, 2018. Eleazer says at least 10 of his approximately 650 members had recently struggled with opioid use disorders, some with lethal outcomes. (Heidi de Marco/KHN/TNS) ** OUTS - ELSENT, FPG, TCN - OUTS ** (Heidi de Marco / TNS)

At a New York hospital, a custodial worker passed out in a bathroom stall. In Ohio, police found a municipal employee slumped over his steering wheel in an IHOP parking lot. These individuals overdosed on the job — demonstrating how the opioid crisis has reared its head in America’s workplaces. According to federal government statistics, the opioid crisis costs the U.S. economy approximately $500 billion annually. And, contrary to public perceptions, most drug abusers are gainfully employed. Lifesaving interventions in the opioid crisis could happen, therefore, not in courts, hospitals or family living rooms, but instead in office cubicles.

This past year I’ve worked with a digital health care start-up that provides technical support to improve medication adherence for a variety of diseases, including substance use disorder. In the course of my work, I’ve gained detailed knowledge about the convoluted landscape of private health insurance. In the United States, with no single payer, employers have an outsize role in the health and well-being of their employees.

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The uniquely American arrangement, whereby employers supply health insurance, has its roots in the post-World War II era. This historical development of the employer-employee relationship regarding health and wellness has profound implications for the interaction of employment and disability today, particularly when workers struggle with substance abuse.

Employers are governed by The Americans with Disabilities Act of 1990, which prohibits discrimination on the basis of disability. This groundbreaking law, the culmination of years of work, requires society to accommodate workers with disabilities. Although addiction was recognized as a disability, that classification threatened the ADA’s passage just as the war on drugs was reaching its zenith, and it was omitted from the final bill.

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With overdoses skyrocketing today, however, addiction is finally being recognized as a disease in need of treatment, rather than a behavior in need of punishment. And employers are recognizing the benefits of doing the right thing. More than 70% of employers acknowledge the negative impact of drug use in the workplace. Employers know that employees with substance abuse problems use more sick days and benefits, arrive tardy and are involved in more accidents on the job than their counterparts.

There are some resources to help. The Affordable Care Act guarantees addiction treatment as a benefit. The Family and Medical Leave Act of 1993 requires that employers provide job-guaranteed unpaid leave for personal and family illness — including time off for rehab. But these legal protections are often circumvented by stringent workplace zero-tolerance drug use policies that discourage or simply prevent employees from seeking the care they desperately need.

What would an alternative approach look like? To start, abandoning zero-tolerance policies might encourage workers to be honest with employers about their addiction struggles and to seek treatment. Studies on alcoholism in the 1980s demonstrated that 85% of alcoholics did not seek treatment, even where insurance-related barriers were eliminated, because they feared losing their jobs. But certain employer-sponsored policies to encourage alcoholism treatment did reduce the number of sick days used. Moreover, the inclusion of alcohol treatment in health care policies led to lower premiums. Similar efforts to encourage both coverage and utilization for workers addicted to drugs would ultimately provide a healthier and more productive workplace for employers, in addition to giving people struggling addiction access to the treatment they need.

Likewise, employee assistance programs (often run by unions) help employees get back to work after relapsing, and a strengthened labor movement would benefit workers struggling with addiction. A growing handful of employers have contingency management or supportive employment practices, which use frequent drug screens to identify workers who relapse. Rather than losing their jobs, however, these workers are directed to treatment. Such strategies assist workers struggling with addiction and help them become healthy (and better employees) over the long-term.

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There is an inherent contradiction in the way employers treat drug addiction: While 71% of employers understand addiction as a disease requiring treatment, 65% believe drug use is a justifiable cause for firing. Yet few would condone the firing of employees with cancer or diabetes — even when their diseases affect their work. With addiction at epidemic proportions, employers cannot escape the disease’s inevitable effects in the workplace. And the structure of the U.S. health care system, which makes employees dependent on employers for health care, should now address addiction as the chronic illness it is. If employers adjust the way they view and treat drug addiction — as a disease rather than as a moral failing — they could play a role in combating the opioid crisis on a humane level and diminishing the negative impacts of addiction in the workplace.

Leah Smith (leah.smith598@gmail.com), a 2020 graduate of Yale University, works as a communications and marketing associate at a Baltimore-based digital health care start-up.

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