Back to Basics is a weekly feature that highlights important but possibly overlooked information that any EHS professional should know. This week, we examine how to handle impaired employees in the workplace.
Are your employees showing up for work impaired by drugs and alcohol?
Both surveys and drug testing are showing spikes in substance misuse. There’s a majority of adults in the workforce (61%) with a substance use disorder (SUD), according to government data cited by the National Safety Council (NSC).
Positive drug tests for marijuana are at a 25-year high, according to a private testing laboratory chain. Marijuana remains a controlled substance under federal law, but states continue to decriminalize medical and recreational use of cannabis.
Both the NSC and the federal government are offering employers new guidance and resources for handling workplace substance use and overdoses.
Unintentional workplace overdose deaths reached an all-time high of 464 in 2021, according to the NSC. Deaths on the job from drug overdoses have increased 536% since 2011, according to the group.
The NSC regularly surveys employers about their concerns about opioid misuse in the workplace. For now, other issues are getting greater attention. Employers are more concerned about hiring qualified workers and the costs of employee benefits and workers’ compensation than about alcohol and drugs (including workplace opioid misuse).
However, a recent NSC survey of employers found that:
- While 86% believe that even taking opioids as prescribed can impair workers’ job performance, only 60% have policies in place for keeping employees safe when workers take prescription opioids.
- Only half are “very confident” that they have the appropriate policies and resources in place to deal with opioid use and misuse in the workplace.
- Most (79%) are “not very confident” that individual employees can spot the warning signs of opioid misuse.
The White House Office of National Drug Control Policy (ONDCP) recently released employer guidance and resources to address problems posed by workplace substance use and overdoses. Substance use in the workplace is widespread, according to the White House employer guidance.
White House employer guidance, ‘toolkit’
The four “pillars” of the government’s Recovery-Ready Workplace program include prevention and risk reduction, training and education, hiring and employment, and treatment and recovery support. Workplace prevention involves employer actions, policies, and programs to reduce risk factors for substance misuse, such as work-related injuries and employer policies regarding the use of opioids for treatment of pain under insurance or health plans.
The ONDCP recommends that employers take several risk-reduction steps, including:
- Reducing the risk of injuries that require opioid prescriptions for pain treatment, such as ergonomic/repetitive motion injuries and overexertion (lifting heavy items), by reviewing and updating workplace policies, procedures, and practices.
- Examining how opioids are used to treat pain under health insurance and workers’ compensation plans, especially in the treatment of work-related injuries.
- Assessing whether a lack of medical or disability leave incentivizes employees to use opioids in a rush to get back to work after an injury.
- Identifying and working to address social factors that can foster substance misuse, such as excessive or unpredictable work hours or “toxic work environments.”
- Examining practices and policies around alcohol use during work-related social events and other work activities.
Topics recommended for worker education and training include SUD and recovery, the company’s substance use policies, and benefits like employee assistance programs (EAP) for addiction treatment.
The Recovery-Ready Workplace guidance also suggests that managers and supervisors communicate with employees about substance misuse and SUDs.
NSC toolkit
Earlier this year, the NSC launched the new workplace safety program Respond Ready Workplace to help employers combat the rise in workplace drug overdoses. The new program replaces an earlier “Opioids at Work Employer Toolkit,” unveiled in 2019.
Elements of the Respond Ready Workplace program include:
- Advocacy and education: The NSC provides educational materials to raise awareness about the opioid crisis and the value of naloxone treatment to mitigate the effects of an opioid overdose. According to the NSC, most employers are unaware of the increase in fatal workplace opioid overdoses.
- Employee training resources on the proper administration of naloxone, enabling workers to respond swiftly and effectively during overdose emergencies.
- Naloxone distribution: The program advises employers on how to obtain and incorporate overdose medications like naloxone into their workplace first-aid kits or in accessible locations.
“The opioid crisis has reached every corner of society, affecting workers in all industries and occupations,” Lorraine M. Martin, the NSC’s president and CEO, said at the time. “By equipping workplaces with naloxone and the knowledge to use it, we can make a tangible difference in saving lives, from the workplace to anyplace.”
This past spring, the U.S. Food and Drug Administration (FDA) approved an over-the-counter (OTC) naloxone nasal spray for the treatment of opioid overdoses. Narcan, a 4-milligram (mg) naloxone hydrochloride nasal spray, is the first naloxone product approved for use without a prescription.
Substance use among workers rising
Do 61% of working adults really have an SUD? You need to understand how federal agencies define substance use and how they collect their data.
Beginning with the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration (SAMHSA) changed its data collection methods for its National Survey on Drug Use and Health (NSDUH). The agency now uses a combination of in-person and Web interviews for its survey. Pre-pandemic surveys relied solely on in-person interviews.
The SAMHSA acknowledged that the demographics of people answering surveys on the Web differed from those of the people answering in-person surveys.
The agency’s definition of “substance use” is broad and includes alcohol, tobacco, vaping, marijuana, and other illicit drug use, as well as the use and misuse of prescription drugs.
Regardless of whether nearly two-thirds of workers have an SUD, preemployment and post-accident drug testing shows a clear spike in substance use.
Earlier this year, private laboratory testing chain Quest Diagnostics announced that the percentage of employees in the workforce who tested positive in 2022 for marijuana following an on-the-job accident reached its highest level in 25 years. The post-accident marijuana positivity of urine drug tests in the general U.S. workforce was 7.3%, an increase of 9% compared with 6.7% in 2021.
The increases in post-accident marijuana positivity correspond with legalization of marijuana in several states, according to Quest Diagnostics. However, Quest Diagnostics’ testing also shows a rise in positive tests for amphetamines.
Quest Diagnostics’ testing showed widespread increases in “test positivity” for amphetamines, cocaine, and marijuana across industry sectors. Marijuana positivity was highest in retail trade, accommodation, and food services at 8.1% in 2022. Over five years, marijuana positivity in the retail trade increased 131.4%, according to Quest Diagnostics. Quest Diagnostics Drug Testing Index (DTI) report and industry insights are available on the company’s website.
Workers’ first experience with opioids
Treating the pain from workplace injuries may be a “gateway” to opioid misuse. Opioids often are initially prescribed to manage pain from a work-related injury, according to the National Institute for Occupational Safety and Health (NIOSH). Workplace conditions, such as slip, trip, and fall hazards or heavy workloads, can lead to injuries that necessitate prescription opioid use. Some people who use prescription opioids for a work-related injury may go on to misuse them and/or develop a dependency, according to NIOSH. Prescription opioid misuse also can lead to heroin use.
There also are accidental work-related opioid exposures. First responders, law enforcement officers, and forensics laboratory technicians may all be at risk. NIOSH investigators conducted a Health Hazard Evaluation (HHE) of an incident in 2018 when several police officers suffered exposure to opioids. While the officers wore half-facepiece respirators with P100 filters, NIOSH investigators concluded they incorrectly donned their respiratory protection and that glasses, police radio earbuds, cameras, and hats worn by the officers prevented a secure respirator seal.
NIOSH recently released another HHE of occupational exposures to illicit drugs, including methamphetamine, at a regional crime laboratory and state toxicology laboratory performing toxicological testing for law enforcement agencies.
Marijuana decriminalization
The NSC argues that when voters or state legislatures decriminalize or legalize cannabis possession, they should also pass laws restricting marijuana-impaired driving and marijuana impairment at work.
The NSC believes the effects of decriminalizing recreational cannabis use include:
- Increased risk of injury on roads and in the workplace due to marijuana’s effect on cognitive dexterity, judgment, and reflexes. The effects can be similar to those from alcohol consumption and opioid use.
- Varying effects of cannabis use because of the ways the drug is consumed and an individual’s unique body composition. Tetrahydrocannabinol (THC), the psychoactive agent in marijuana, is stored in body fat.
- An increase in motor vehicle accidents involving THC in states following the passage of medical or recreational marijuana laws.
CMV driver testing requirements
Commercial motor vehicle (CMV) driver impairment can make the nation’s highways unsafe.
Accordingly, the Federal Motor Carrier Safety Administration (FMCSA) has preemployment, post-accident, random, reasonable-suspicion, return-to-duty, and follow-up drug and alcohol testing requirements for drivers.
If a driver tests positive or refuses a drug test, the driver must be removed from duty. An employer then must provide the driver with a list of acceptable substance abuse professionals (SAPs) for treatment and the “return-to-duty” process.
Once a driver has completed the return-to-duty process and tests negative for drug use, an SAP must sign a return-to-duty report.
The return-to-duty report submitted to the FMCSA’s Drug and Alcohol Clearinghouse must include:
- The driver’s name, date of birth, commercial driver’s license (CDL) number, and state of issuance;
- The date of initial SAP assessment; and
- The date the SAP determined the driver demonstrated successful compliance with education and treatment requirements and became eligible for return to duty.
The Clearinghouse is a central repository of records of CMV drivers’ drug and alcohol violations to prevent drivers from concealing drug or alcohol violations simply by changing jobs or moving to another jurisdiction.
After returning to duty, a driver is subject to follow-up testing, which consists of a minimum of six unannounced, directly observed tests conducted during the first 12 months following the return-to-duty test.
Employers must query the agency’s Clearinghouse before hiring CMV drivers and must make annual checks of Clearinghouse records for all their current employees. Motor carriers first must get drivers’ electronic or written consent before querying the Clearinghouse database.
Clearinghouse records include records of driver drug and alcohol violations, as well as whether a driver has completed the return-to-duty process and follow-up testing after a positive test or refusal to test.