Misuse is on the rise and can have serious consequences
We all want and expect employees to arrive fit for work and remain fit for duty throughout the workday. But the most recent statistics and best evidence suggest there is a rising problem with prescription drug use. The impact on our workplace and workforce manifests itself in countless insidious ways, both tangible and intangible.
The question is: How do you know if someone is unsafe or unfit for work due to prescription and non-prescription drug use? And is this really something you need to be concerned about?
Most of us put prescription drugs in a different category than illegal street drugs. We tend to stereotype prescription and over-the-counter drugs as legitimate and safe. And that is accurate — most of the time. Often the use of these medications is legitimate, or at least it starts out that way. But sometimes that use escalates and becomes abuse or out-of-control use. And the associated behaviours can pose a significant health and safety risk — both for the individual and his employer.
In 2002, the Alberta Alcohol and Drug Abuse Commission (an arm of the provincial health services in Alberta) completed the study Substance Use and Gambling in the Alberta Workplace. A total of 2,836 workers participated in the study and provided information about the prevalence, patterns, impacts and costs of substance use and gambling (755 employers and 88 union representatives were respondents).
That study identified 88 per cent of respondents as having used medications within the previous 12 months — the most popular being non-prescription painkillers (74 per cent) followed by cough/cold/sinus/allergy medication (59 per cent). It is important to note that both of these categories of medications can affect employees’ abilities to safely perform their duties, even when taken at recommended dosages.
Subsequent research and studies have expanded on this. Of significant concern is the fact that the emerging workforce — 18 to 24 year olds — has the highest incidence of prescription drug misuse or abuse. As of 2013, the Canadian Centre on Substance Abuse reported Canada ranked second in the world as the largest consumer of prescription opioids, outpaced only by the United States. Canada’s rate of use increased by 203 per cent between 2000 and 2010.
Dire outcomes such as addiction, overdose and death are associated with certain prescription drugs. The drugs of greatest concern fall into three categories: opioids (narcotics derived from opium, such as morphine, codeine and oxycodone); sedatives and tranquilizers, more commonly known as anti-anxiety agents (primarily benzodiazepines such as Valium or Ativan); and stimulants (such as Dexedrine, Adderall and Ritalin).
When these are appropriately prescribed and consumed, there are recognized therapeutic benefits. Misuse and abuse occurs when an overconsumption of a medication is used for the high that’s induced, either from the escalation of prescribed therapy or intentional misuse.
It is also important to note that non-prescription drugs such as Gravol (dimenhydrinate) and Tylenol #1 (codeine 8 mg) can be widely abused. These drugs, in combination with alcohol or other drugs, can have a significant effect on an employee’s health and ability to work safely.
Substance abuse is insidious and its effects on employees will appear gradually and increase over time. The most important way a supervisor, manager or HR professional can respond is to know their people and manage any performance that deviates from the norm.
How will you know there’s a problem?
In general, you will see an increase in absenteeism with an employee, especially on Mondays and Fridays, which may initially manifest as an increase in sick days. Tardiness — after lunch or breaks — is often accompanied by changes in behaviour. Leaving early at the end of the day is common. "Presenteeism" is also common and more challenging to identify.
It’s also important to be aware there may be a legitimate explanation. As with any performance issue, the key is to address it early, as soon as it’s noticed, and document any discussions. Allowing these types of behaviours to go on enables the employee to continue in her drug use, which will only increase the negative impacts on the workplace and the employee’s health and safety.
Changes in personality, behaviour and attire will become more noticeable over time. An employee who is normally an upbeat, diligent worker and appropriately dressed may become the complete opposite, over time. You may notice more secrecy, exaggerated expressions of work accomplishments, poor decision-making,
increased aggressiveness, irritability or belligerent behaviour, a preoccupation with matters outside of work and an ability to rationalize abnormal behaviour.
Some of the more common consequences or indicators of substance abuse issues will present in the workplace as lost productivity, poor morale, compromised safety, increased accidents and near misses, reduced effort, diminished quality of work, reduced trust, increased errors and increased workplace aggression or violence.
This could lead to reduced customer or client satisfaction, a negative business reputation, decreased competitiveness, high turnover, a reduced ability to attract talent, an increased use of sick time, higher health benefit costs, increased workers’ compensation or disability claims, increased insurance claims, increased overtime costs, replacement costs for damaged equipment or property, litigation and — in case it’s not obvious — decreased financial viability or a reduced bottom line. If left unaddressed, substance abuse problems can even bankrupt a company.
The role of others
An important and often missed opportunity to identify problematic substance use with employees is information from other employees. When there is a substance abuse concern, co-workers are the first to know.
Initially, they often cover and compensate for the employee with the substance abuse problem. But this will only last for so long, at which time the concern for health and safety — combined with frustration at the employee’s escalating and increasingly dangerous behaviour — will result in disclosure to a supervisor, manager or HR professional.
How they respond will set the stage for whether or not the workplace is perceived as proactive or ineffective in these matters. Enabling a substance abuse problem to continue can have disastrous consequences.
The role of the HR professional in addressing this challenging matter is crucial. In many organizations, HR becomes involved with substance abuse issues by default, usually after a crisis arises. The goal is to be proactive and have a program in place so that when a difficult situation arises, there is clear direction and a consistent process to follow.
The actual program should be multifaceted and include: a foundational position on substance use in the workplace — usually in the form of a drug and alcohol policy, training and awareness for supervisors and managers; employee education; access to professional assessment, treatment and rehabilitation or education; and structured return-to-work strategies.
In addition, HR and leadership should:
•know their people — take action when there’s a performance concern that may be related to substance abuse
•use substance abuse experts to assess an employee for health and safety risks, and provide professional recommendations on appropriate treatment or education
•know the available treatment resources specific to substance abuse and how to access them, and make this information readily available to employees
•have an employee assistance program (EAP) available as support for employees and supervisors or managers
•encourage self-referral and provide supports and incentives for employees to do so
•have a drug and alcohol program in place — ideally created with and by a group of employee representatives guided by a subject matter expert
•clearly define and explain to all employees the company’s position on drugs and alcohol impacting the workplace, including specific work standards and consequences for non-adherence
•provide education and awareness on the safety and health implications of substance abuse.
Employers have a responsibility to address this health and safety issue. For far too long, the impacts of substance abuse in the workplace have been ignored or resulted in individuals being fired and then moving on — to become a problem at another workplace. A responsible, proactive employer deals with this common workplace issue as with any other: With integrity, fairness and respect.