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When an opioid crisis hits your medical practice

By Lynne Curry  bio

The first time you saw “Bill” appear to nod off during a staff meeting, you pulled him aside after the meeting. When you asked if he was okay, he said he was. You gave him the benefit of the doubt because he’d worked for you for three years and been a good employee. You knew he’d recently gone through a divorce and thought maybe he’d had a hard time sleeping due to personal problems Then Bill blew up at a patient and when you brought him in a second time, he told you he’d been trying to get off the prescription pain killers he’d been using for back pain.

You gave Mary three weeks off after a car rear-ended her on her vacation in Maui. When she returned from work and said she could initially only work half days, you modified her schedule.  Because she’d always had great work ethic, the fact that she now abuses your flexibility surprises you. You can’t count on her arriving consistently at ten a.m. and she makes frequent math errors, appearing to have trouble concentrating.

Welcome to the opioid epidemic, it just found its way into your workplace.

Otherwise good physicians, managers, and employees, who are prescribed opioids or other prescription painkillers to relieve pain following an injury can start down a path to opioid dependency. Their managers and colleagues notice the effects—drowsiness, problematic attendance, depression, concentration problems, anxiety and mood swings—once dependency sets in. Those struggling with opioid dependency may pose a safety or liability risk to themselves or others because they don’t react as quickly or use sound judgment. They may embezzle because they need the money for drugs.

Not only are those in the medical profession not immune, they may have easier access to prescription opiates as detailed in “Drug Abuse Among Doctors, Easy, Tempting and Not Uncommon.”

Here’s what medical office managers need to know.

 1. Your turn may be next

If the problem hasn’t yet hit you, it may soon. According to the Centers for Disease Control and Prevention, nearly two million Americans abuse prescription opioids. Physicians wrote enough opioid prescriptions in 2012 for every American adult to have their own bottle. According to Castlight Health’s research, one out of every three opioid prescriptions is being abused

 2. Physicians are self-medicating

According to Dr. Lisa Merlo, researcher at the University of Florida’s Center for Addiction Research and Education, as quoted in Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon,  while “physicians are about as likely as the general public to abuse alcohol or illegal drugs, they’re more likely to misuse prescription drugs.”

Merlo’s research, published in the Journal of Addiction Medicine, involved her interviewing fifty-five physicians monitored by the state physician health programs for alcohol and drug abuse problems. Sixty-nine percent or thirty-eight of those fifty-five doctors abused prescription drugs and most said they turned to drugs to relieve either stress or physical and emotional pain.

Although physicians and those with professional access to prescription opiates aren’t unlike others who turn to prescription drugs to copy with pain or life struggles, they have greater access to prescriptions through prescribing privileges, professional contacts or proximity to hospital and clinic supplies.

According to Hazelden’s Chief Medical Officer Dr. Marvin Seppala, this access can both foment and perpetuate addiction. “They’re often described as the best workers in the hospital,” says Seppala. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do. Physicians are intelligent and skilled at hiding their addictions.”

 3. The problem can show up in your best managers and employees

According to the Hazelden Betty Ford Foundation’s Patrick Krill, “The more professional stature you have, the less likely you are going to be forced into recovery, and the longer your addiction is likely to go on unchecked.”

Ruby Shoes details the true story of corporate sales professional Michele Zumwalt who received a shot of the opioid Demerol for her headaches, and soon learned she’d get headaches if she didn’t get her shot. Said Zumwalt, “I didn’t know I was addicted, but I just knew that it was like you were going to ask me to live in a world without oxygen.”

Zumwalt says her addiction went unnoticed. “I could show up at Xerox and put on a presentation, and I was high on Percodan.  …I mean, fully out of it. I don’t know how many I had taken, but so many that I don’t remember the presentation. And do you know that people didn’t know?”

How to head off problems

 1. Educate your employees

Prescription drug abuse sneaks up on those who ordinarily would never think of abusing drugs. After all, doctors prescribe pain killers, and opioids soften the edges of post-surgery or injury pain, and to those battling chronic pain who seek to avoid surgical intervention.

According to Gregory DeLapp, chief executive of the Employee Assistance Professionals Association, fifty-five to eighty-five percent of employees out for seven or more days on work-related injuries receive at least one opioid prescription.

Some employees use as few pain killers as possible. Others, battling more pain, or at-home boredom, take more than necessary.

Provide your employees suffering from workplace-related or other injuries with education and counseling so they know the risks they face if they let themselves become used to opioids. For many, it’s an easy slide from using to using legally prescribed and necessary painkillers to inappropriately abusing opioids.

 2. Educate your managers and supervisors

Managers and supervisors need to understand the potential signals of opioid abuse and learn what to say if they have concerns. While managers and supervisors cannot be expected to informally diagnose a problem, they need to know how refer the employee to alcohol and drug testing. A sample statement might be, “Because of what I am observing right now, I am concerned about you. Based on my observation, we need a professional to evaluate the situation.”

 3. Offer help

Encourage employees to tell you if prescription painkillers have created a problem for them by making it clear you are willing to work with good employees who intend to kick the problem.

It’s hard for colleagues who see their coworker as a friend to view them as a potential addict. So it’s important to give all employees the information that problems don’t get better on their own and ask that they confidentially tell their human resources officer or manager if they suspect another employee has a problem and needs help. 

 4. Provide drug testing

Keep your workplace safe. If you suspect an employee has a problem, arrange for testing. Despite our country’s opioid epidemic, according to the testing firm Quest Diagnostics, only thirteen percent of the roughly 6.5 million workplace drug tests include screening for prescription painkillers.

 5. Implement a policy

To be able to fairly and effectively handle problems, your workplace needs a guiding policy more detailed than “please don’t use drugs or alcohol at work.” Your policy needs to outline the circumstances under which a manger might have “reasonable suspicion” concerning an employee’s potential drug abuse and the procedures to follow to have the employee tested.

If your company’s drug testing policy predates December 2016, it may contradict OSHA requirements. Effective December 1, 2016, OSHA’s new rule requires employers to drug test after a workplace accident only when the employer has a reasonable basis to believe that the incident was likely to have been caused by the employee’s impairment and the employer believes that the drug test may determine whether the employee was impaired at the time of the incident. “This doesn’t preclude an employer’s ability to test any employee involved in a workplace accident,” notes former attorney turned HR consultant Richard Birdsall.

You may also want to reconsider your company’s policy if it’s zero tolerance, as it may cost you employees you want to keep. You can instead make termination discretionary and require counseling for employees who fail drug tests. Your policy also needs to clarify the permitted use of necessary prescription drug use while working.

 6. Check the legalities

Finally, because an employee’s drug use or abuse may overlap into legal areas such as the Americans with Disabilities Act and HIPPA, consult your attorney when handling any particularly thorny problem.

Lynne Curry, Ph.D., SPHR, author of Beating the Workplace Bully and Solutions and Regional Director of Training and Business Consulting for the Avitus Group, consults with medical clinics and hospitals to provide employee training, physicians’ retreats and to provide other  solutions for workplace challenges. Her company’s services include HR On-call (a-la-carte HR), investigations, mediation, management/employee training, executive coaching, 360/employee reviews and organizational strategy services.  You can reach Lynne @, via her workplace 911/411 blog, or @lynnecurry10 on twitter

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