Opiates in the WorkforceJohnny Rogers

Manager Access/FFDMA Substance Abuse Counseling

The Prevalence of Opiate Abuse in Society

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1. Those who abuse prescription opioids are 40% more likely to use heroin than those

who don’t.

1. The United States consumes 80% of the world’s prescription painkiller supply, despite

not even making up 5% of the world’s population

2. From 1999 to 2017, more than 700,000 people have died from a drug overdose.

3. Around 68% of the more than 70,200 drug overdose deaths in 2017 involved an opioid.

4. In 2017, the number of overdose deaths involving opioids (including prescription

opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times

higher than in 1999.

5. On average, 130 Americans die every day from an opioid overdose. (CDC, 2018)

As Bad as you think it is, its much worse• From 1999-2017, almost 400,000 people died from an overdose

involving any opioid, including prescription and illicit opioids. (Centers for Disease Control, 2018)

• Opiate drugs are more abused than any other drug other than alcohol and marijuana.

• The majority opiate abusers (90 %) use opiates in pill form. (Buzzed, 2014)

• Suicides and drug overdoses kill American adults at twice the rate today as they did just 17 years ago.

• Opioids are a key contributor to that rise, according to a new review and analysis by a University of Michigan team.

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How Did We Get Here?• This rise in opioid overdose deaths can be

outlined in three distinct waves.• The first wave began with increased

prescribing of opioids in the 1990s 3, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.

• The second wave began in 2010, with rapid increases in overdose deaths involving heroin.

• The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids – particularly those involving illicitly-manufactured fentanyl (IMF). The IMF market continues to change, and IMF can be found in combination with heroin, counterfeit pills, and cocaine. PLACE THE TITLE OF THE PRESENTATION HERE | 4

Steps Leading to the Current Epidemic • (Bisaga, 2018) The epidemic began with the medical

community, good intentions, relieve pain. • Physicians with little training in addictions advocated

that pain killers could be used safely without causing addictions.

• Prior to 1980’s opioids used for end of life care. • In the 1990’s opioids expanded to many medical

conditions. • Belief that potential for opioid addiction was low.

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What Happened Next.

• Once the user is addicted and finds access restricted, the user typically turns to alternative sources.

• Typically heroin or pills that are often counterfeit. • As addiction grows, administration switches to injecting. • The addicted individual seeks cheaper stronger opioids

such as fentanyl, and the risk of overdose escalates. • Most people who develop OUD will have a life long

condition. Bisaga (2018)• Many develop co-occurring disorders

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Case Study 1

• Supervisor observes erratic behavior, extremes in emotions, happy and engaging to angry and emotional.

• When interviewed, employee became highly agitated, angry, confrontational, broken thought pattern

• For cause testing revealed no illicit substances.

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Case Study 1• Considerations• No drugs found in employee’s system• Employee admitted to abusing Percocet, Valium, and

Alcohol. (Poly-drug use is common) • Employee completed treatment, returned to duty as an

armed Security Officer. • Did not end well, employee left work under the guise of

family emergency, killed in a car accident, Valium found in vehicle.

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Case Study 2 • A contractor female working in the mechanical

maintenance department was accepting medication self reports from personnel.

• Female employee took notes of the narcotics • After lunch, the employee would rummage through

lockers and steal the narcotics reported. • Female employee was chronically addicted, had her

husband doctor shopping for her. State Police were contacted. Employee was prosecuted.

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Case Study 3 • An employee working in the plant was injured at home. • Employee underwent surgery, therapy, and was

prescribed oxycodone while in therapy. • Therapy did not go well and prescription opiates

continued. • Employee became addicted and began acquiring

additional doses on internet, stealing, or from friends. • Employee contacted EAP and self admitted to using

narcotics while on duty in the work place. PLACE THE TITLE OF THE PRESENTATION HERE | 10

Case Study 3• Considerations• The employee was using narcotics while on duty,

jeopardizing his safety and the safety of others. • His coworkers and management observed signs

and symptoms of withdraw, but did not report. • Withdraw looks like the flu, diarrhea, shivering,

sweating, general malaise, abdominal cramps, muscle pains, dysphoria (feeling lousy)

• Signs were present but were not acted on. PLACE THE TITLE OF THE PRESENTATION HERE | 11

Case Study 4• Employee with severe pain issues is on several

narcotic medications. On this day, he is returning to work from a morning doctor appointment.

• He has just been prescribed Fentanyl. (transdermal patch) The employee reports the medication to his supervisor.

• The supervisor accepts the report and directs the employee to his first job assignment, working on a pump,

• Moments later the employee is found wondering incoherently inside the station.

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Case Study 4

• Considerations• Supervisor never considered the impact of the newly

reported medication. • Fentanyl, 80-100 times more powerful than morphine• Medication should have been reported to FFD or

Medical for consideration.

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Case Study 5

• Supervisor observes erratic behavior from a subordinate for a period of two months.

• Mood swings, happy, excited, rapid speech vs. sullen, depressed, detachment from peers.

• Employee had a reputation for eccentric behavior.• Supervisor grew suspicious when employee began

making excuses for leaving work, being tardy and absent, asking for money from coworkers.

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Case Study 5

• Considerations• Employee’s behavior was accepted as the new

norm. Changes in behavior were not readily noticed.

• For Cause testing revealed the presence of Heroin• For many months, the employee posed a clear and

present threat to the work place in performance as an armed Security Officer.

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Statistics

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Drugs in the workplace. Substance abuse permeates every aspect of life, that behavior doesn’t get put on hold during a normal shift on the job. (DrugAbuse.com)

• Survey by DrugAbuse.com determined how many people have used illegal drugs or alcohol while at work.

• According to the survey, 22.5% of people admit to using drugs or alcohol during work hours.

• One in four men admits to using drugs or alcohol in their place of work• One is five women say they have used drugs or alcohol in a professional setting.

Recreation Marijuana Use In The Workplace• Over one in five respondents say they have used

marijuana recreationally during work hours. • Five percent admit to using marijuana

recreationally on a daily basis • Thirteen percent of people say they use marijuana

at work more than once a month.

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What Substances Do People Use• Sixty six percent of people admit that they have used

alcohol during work hours• Marijuana was second most used during work hours,

22% admit to using recreationally at work. • Over 10% of people admit to using Oxycontin or

Vicodin at work outside medical need. • Codeine, Adderall, and Ritalin had approximately 8%

use in the workplace. • People are far more likely to get high at work than to

be drunk during work. PLACE THE TITLE OF THE PRESENTATION HERE | 18

Is It Possible That The Substance Abuse Is Unknown?• Only 38% the respondents said that no one they

knew used drugs or alcohol at work• One in 5 people knows that a few of their

coworkers use drugs or alcohol at work• Sixteen percent of people say they know many

coworkers who use illegal drugs or alcohol at work. • Random drugs tests loom as a constant threat to

people who use drugs, however, the real deterrent is behavior observation.

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Lessons Learned• Impairment from any cause must be reported and

documented. • Behavior’s reflecting drug influence are often down played or

ignored due to friendship or fear of getting involved. • People often fear being wrong, don’t want to get involved. • People often assume behavior is normal based on past

supervisors inaction. Don’t accept new norms. • Don’t expect Supervisors to be Cops or Counselors, only

document and report

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Behavior Observation, The Best Tool We Have

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