Employee Assistance Program: Prescription Drug Toolkit and Fact Sheets

2021·1.7 MB·English

EMPLOYEE ASSISTANCE PROGRAM
Prescription Drug Toolkit and Fact Sheets
1
Employee Assistance Program (EAP) Prescription Drug Toolkit and Fact Sheets
Acknowledgments
This toolkit was prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA) under contract number S830700012I42001 with SAMHSA, U.S. Department of Health
and Human Services (HHS). Deborah Galvin, Ph.D., served as the Government Project Officer.
Disclaimer
The views, opinions, and content of this publication are those of the author and do not necessarily
reflect the views, opinions, or policies of SAMHSA.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied without
permission from SAMHSA. Citation of the source is appreciated. However, this publication may not
be reproduced or distributed for a fee without the specific, written authorization of the Office of
Communications, SAMHSA.
Electronic Access
This publication may be downloaded at http://store.samhsa.gov.
Recommended Citation
Substance Abuse and Mental Health Services Administration, Employee Assistance Program
Prescription Drug Toolkit and Fact Sheets. Publication No. PEP20-03-02-001. Rockville, MD:
Substance Abuse and Mental Health Services Administration, 2021.
Nondiscrimination Notice
SAMHSA complies with applicable Federal civil rights laws and does not discriminate on the basis
of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de
derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad,
discapacidad o sexo.
Originating Office
Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services
Administration, 5600 Fishers Lane, Rockville, MD 20857.
Publication No. PEP20-03-02-001. Released 2021.
Contents
Executive Summary .............................................................................................. i
The Scope of Employee Prescription Drug Misuse ..............................................1
Prescription Drugs in Combination with Illicit Drugs and Alcohol ..........................2
Workplace Awareness and Prevention .................................................................3
Employee Programs and Services for Prescription Drug Misuse and Addiction ...8
Screening for Prescription Drug Misuse ............................................................. 11
Fitness-for-Duty ................................................................................................. 16
Alternatives to Prescription Drugs ...................................................................... 18
Pain Relief Strategies.........................................................................................20
Return to Work ...................................................................................................22
Relapse Prevention ............................................................................................ 24
Employee Educational Materials ........................................................................ 26
Executive Summary
The Employee Assistance Program (EAP) Prescription Drug Toolkit and Fact
Sheets from the Substance Abuse and Mental Health Services Administration
(SAMHSA) provides guidance related to counseling, referrals, and follow-up
services that EAPs can offer employees whose substance misuse has affected
their workplace environment. The Toolkit also shares insight for employers
about preventing substance misuse and maintaining professional standards.
These materials describe the ways in which EAPs provide alternatives to
prescription drugs, workplace drug misuse and relapse prevention, information
on the dangers of combined drug use, screenings, and evaluations before
returning to work.
The Scope of Employee
Prescription Drug Misuse
Prescription drug misuse, including non-medical use, is a serious problem for employees
and workplaces in the United States. Employee Assistance Programs (EAPs) can connect
employees with confidential access to treatment and help them find providers. EAPs also can
help monitor employees’ progress after they begin treatment to support recovery and
successful job performance.
In 2019, 5.7 percent of full-time employed 18- to 25- The rate of opioid-related emergency department visits
year-olds reported misuse of pain relievers in the past more than doubled from 2008 to 2017.6
year.1
The negative associations often
accompanying substance misuse may
PRESCRIPTION DRUG MISUSE:
Taking a medication in a manner or dose prevent employees from getting the help
other than prescribed; taking someone they need to recover.
else’s prescription, even if for legitimate
EAPs can help employees by connecting them with
medical complaints such as pain; or
confidential access to treatment and helping them find
taking a medication to feel euphoria.2 providers.
References
The problem is most prevalent among
1 Substance Abuse and Mental Health Services Administration (SAMHSA).
18- to 25-year-olds.
(2020). Results from the 2019 National Survey on Drug Use and Health:
Detailed Tables. Retrieved from https://www.samhsa.gov/data/report/2019-
In 2019, 42 percent of full-time employed 18- to 25-year- nsduh-detailed-tables
olds reported illicit drug use in the past year.3 Employees 2 National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs.
in all age groups report some misuse of prescription Research Report Series. Retrieved from
https://www.drugabuse.gov/publications/misuse-prescription-drugs/overview
drugs.
3 Substance Abuse and Mental Health Services Administration (SAMHSA).
(2020). Results from the 2019 National Survey on Drug Use and Health:
Opioid pain relievers are the most Detailed Tables. Retrieved from https://www.samhsa.gov/data/report/2019-
nsduh-detailed-tables
commonly misused prescription drugs.
4 Substance Abuse and Mental Health Services Administration. (2020). Key
substance use and mental health indicators in the United States: Results from
According to the 2019 National Survey on Drug Use and
the 2019 National Survey on Drug Use and Health (HHS Publication No.
Health (NSDUH) data, approximately 9.7 million people PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral
Health Statistics and Quality, Substance Abuse and Mental Health Services
in 2019 misused prescription pain relievers in the past
Administration. Retrieved from https://www.samhsa.gov/data/
year.4
5 Hedegaard, H., Warner, M., & Miniño, A. M. (2017). Drug overdose deaths in
the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville, MD:
In 2017, opioids were involved in National Center for Health Statistics. Retrieved from
https://www.cdc.gov/drugoverdose/data/statedeaths.html
47,600 overdose deaths.
6 Healthcare Cost and Utilization Project (HCUP). (2017). HCUP Fast Stats.
Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from
From 2016 to 2017, there were significant increases in https://www.hcup-us.ahrq.gov/faststats/OpioidUseServlet?
location1=US&characteristic1=01&setting1=ED&location2
opioid overdose deaths in the Northeast, Midwest, and
=&characteristic2=01&setting2=ED&expansionInfoState
South census regions.5 =hide&dataTablesState=hide&definitionsState=hide&exportState=hide
1
Prescription Drugs in Combination

with Illicit Drugs and Alcohol
Employees engaging in the non-medical use of prescription drugs may be doing so in
combination with alcohol or other substances. It is important for Employee Assistance
Program (EAP) providers to screen for the use of all substances including medical and
prescription drug misuse.
It is important for EAP providers to understand how • Focusing on young adults ages 18 to 29 years old
prescription drugs are used in combination with illicit engaged in urban nightlife, a study found that nearly 25
drugs or alcohol, as well as the extent to which other percent reported prescription drug misuse in the past 6
months and, of those that reported past 6-month drug
substance use increases the risk of prescription drug
misuse, 91 percent also reported illicit drug use
misuse. EAP providers should assess those seeking
(compared to 68 percent of those who did not report
services about all substance use—illicit drugs,
prescription drug misuse in the past 6 months). The
prescription drugs (medical and non-medical use), over-
drug used most often in combination with prescription
the-counter medications, and alcohol—as all these drug misuse was marijuana. Of those that misused
substances, particularly if used in combination, can prescription drugs in the past 6 months, 59 percent
impact work performance and safety. combined that use with marijuana (which comprised
nearly 15 percent of the full sample).6
• As the dangers of opioid prescription drug misuse have
These data indicate that prescription drug misuse is
gained national attention, numerous regulatory
initiatives and recommended changes in prescribing often found in combination with illicit drug use and the
have led to stricter controls on opioid dispensing. While misuse of alcohol. When conducting behavioral health
these efforts have been credited with reductions in screening, it is important that EAP providers ask clients
opioid overdose deaths, there have been reports of about their full range of substance use, including medical
shifts among some users to heroin.1,2
and non-medical use of prescription drugs.
• According to the National Survey on Drug Use and
References
Health, approximately 404,000 people had misused
prescription pain relievers and had used heroin in 2019;
1 Volkow, N. D. (2014). Prescription opioid and heroin abuse. Witness appearing before
about 341,000 people had used heroin in 2019 but had the House Committee on Energy and Commerce Subcommittee on Oversight and
not misused prescription pain relievers.3 Investigations. Washington, DC: Department of Health and Human Services,
National Institutes of Health.
• Analysis of a nationally representative U.S. sample 2 Cicero, T. J., & Ellis, M. S. (2015). Abuse-Deterrent Formulations and the prescription
found that the odds of reporting past year non-medical opioid abuse epidemic in the United States: Lessons learned from OxyContin.
JAMA Psychiatry, 72(5), 424–430.
use of prescription drugs was 18 times higher among
3 Substance Abuse and Mental Health Services Administration. (2020). Key substance
individuals with an alcohol use disorder compared to
use and mental health indicators in the United States: Results from the 2019
those who did not drink alcohol.4 Adults ages 18 to 24 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001,
also had higher rates of binge drinking, alcohol use NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and
Quality, Substance Abuse and Mental Health Services Administration. Retrieved
disorders, and misuse of prescription drugs than those
from https://www.samhsa.gov/data/
25 and older.
4 McCabe, S. E., Cranford, J. A., Boyd, C. J. (2006). The relationship between past-year
drinking behaviors and nonmedical use of prescription drugs: Prevalence of co-
• Research that looked at problem use of prescription
occurrence in a national sample. Drug and Alcohol Dependence 84(3), 281–288.
drugs (defined as heavy non-medical use or non-
5 Simoni-Wastila, L., & Strickler, G. (2004). Risk factors associated with problem use of
medical use that met the criteria for a substance use prescription drugs. The American Journal of Public Health, 94, 266–268.
disorder) found that problem non-medical tranquilizer 6 Kelly, B. C., Wells, B. E., Pawson, M., LeClair, A., & Parsons, J. T. (2014).
use was associated with daily drinking.5 Combinations of prescription drug misuse and illicit drugs among young adults.
Addictive Behaviors, 39(5), 941–944.
2
Workplace Awareness
and Prevention
Employee Assistance Program (EAP) professionals can play a critical role in promoting
awareness of the problem of non-medical prescription use. In addition to providing
educational and counseling services, EAP providers may also become involved in other
workplace practices designed to prevent prescription drug misuse.
Employees who engage in prescription drug misuse may
Workplace Awareness
exhibit the following behaviors:
Workers may use prescription drugs to get high or to
• Lack of attention or focus
self-treat a medical condition with medication prescribed
for someone else or previously prescribed to them for a • Poor decision-making
different problem. Especially with pain relievers, they
• Decreasing work quality
also may take a larger dose than prescribed in hopes of
increasing the therapeutic effect. Collectively, these • Poor judgment
drug-taking behaviors are referred to as prescription • Unusual carelessness
drug misuse. These behaviors put workers at risk for
• Unsteady gait
potentially fatal adverse drug reactions. They also can
create workplace safety hazards. An employer may think • Excessive mood swings
their employees do not have prescription drug misuse • Drowsiness
problems; however, these problems often are referred to
• Appearance of being high, unusually energetic or
as a “hidden epidemic.” The sheer numbers of
revved up, or sedated
prescription medication users in all classes of U.S.
society pose substantial risks. While prescription pain • Increased absenteeism, including unexplained
absences or vague excuses for needing time off
relievers are the leading medications that are misused,
medications for anxiety, sleep disorders, depression, While none of these behaviors are a definitive indicator
and attention-deficit/hyperactivity disorder (ADHD) also of prescription drug misuse, such behaviors may warrant
are commonly misused. referral to the EAP. EAPs can play a critical role in the
prevention of prescription drug misuse in the workplace
The non-medical use of prescription drugs among
and should be ready to assess the potential for problems
employees can have significant negative impacts on the
with prescription drugs, along with other behavioral
employee, co-workers, and the workplace. The total
health conditions. Understanding how those seeking
economic burden of prescription opioid misuse alone in
help from the EAP use prescription medication (whether
the United States is $78.5 billion per year, including the
medically or non-medically and/or in combination with
costs of health care, lost productivity, addiction
other substances) is vital information for EAP providers.
treatment, and criminal justice involvement. It is
estimated that prescription opioid misuse increases
Preventing Prescription Drug Misuse
health care and substance treatment costs by $29.4
billion, increases criminal justice costs by $7.8 billion, EAPs are ideally positioned to provide educational
and reduces productivity among those who do not die of materials, training, and other resources related to
overdose by $20.8 billion (in 2015).1 That does not take substance misuse prevention—including the non-
into consideration the non-medical use of other types of medical use of prescription drugs. EAP professionals
prescription drugs.2 can work with management to educate them about
3
recognizing and responding to substance misuse issues, recommendations. Counseling professionals affiliated
including prescription drugs, so problems can be with the EAP will typically make an assessment,
addressed in uniform, effective, and business-sensitive recommend treatment options, and develop a treatment
ways. EAPs also provide behavior risk management, plan that stipulates return-to-work conditions. A well-
prevention, and early identification and intervention defined and managed treatment plan that stipulates the
services for those at risk for problems such as recovery and return-to-work criteria facilitates successful
prescription drug misuse. EAPs can deliver prevention transition back to work. (See Return-to-Work fact sheet
services designed to educate the entire workforce, as for more information.)
well as direct prevention messages to high-risk
Understanding the complexities of treating prescription
individuals, thereby encouraging them to seek help.
drug misuse and reflecting these considerations in drug-
free workplace policies is a continuous challenge for
What Are Types of Risk Management Activities to
organizations and important for EAP providers to
Address Prescription Drug Misuse?
understand. One key consideration is the need to
EAPs can conduct “brown bag” lunch meetings that
accommodate the potential for ongoing medication use
discuss the non-medical use of prescription drugs and
for a recovering employee. Employees who have
risk factors. This may encourage employees who are at
returned to work following a positive test are generally
risk, or whose family members may be at risk, to seek
restricted from taking any potentially addicting
early confidential counseling. EAPs can promote
medication as part of their Return-to-Work Agreement.
prescription drug “take-back” programs, post maps of
Such drugs would most likely be detected on monitoring
their locations, and provide information on how to
drug tests and result in a violation of the Return-to-Work
destroy unused medications. Resources, such as the
Agreement. However, even successfully rehabilitated
fact sheets included in this toolkit, can be distributed to
employees may experience medical conditions or
employees. EAP providers can create partnerships with
injuries requiring the limited use of such medications. A
supervisory staff to create re-occurring trainings as
procedure for the pre-approval and safe use of these
appropriate about the signs of prescription drug misuse
medications on a case-by-case basis needs to be
and the procedures they should follow within the context
established for monitored employees. The EAP can help
of their workplace policies if they suspect such use.
design this procedure.
EAP involvement in Recovery and Return-to-Work
Modifying Drug-Free Workplace
In addition to providing organizational resources and
prevention interventions, EAP providers may also be Programs (DFWP) to Address Non-
called on to manage the recovery and return-to-work
Medical Use of Prescription Drugs
process for employees who test positive for misused
prescription drugs. In some cases, to successfully return Employers are responsible for protecting the safety of
to work, and often as a condition of employment their employees. This responsibility includes developing
stipulated in a drug-free workplace policy, employees and enforcing a DFWP. Contractors or grantees who
who test positive for prescription drug misuse require the must comply with the Drug-Free Workplace Act of 1988
completion of a substance use treatment plan managed should pay special attention to elements required by the
by an EAP or treatment professional, and random or Act. Requirements vary, based on whether the
regular drug testing while in treatment (even if the contractor or grantee files as an individual or an
employer does not have a broader prescription drug organization. In the future, employer drug testing
testing program). Successfully returning to work is often requirements may be extended to detect certain
the goal for both the company and the employee. prescription drug use that could impair employees from
However, in some circumstances this process is highly safely performing their job duties.
regulated. For example, if an employee works in a
EAP professionals can play a critical role as workplaces
safety-sensitive position, the employer must comply with
consider modifying their DFWPs and policies to address
several mandatory regulations before the employee
prescription drugs. Below are the steps needed to
returns to work, including ensuring that the employee
update DFWPs to address prescription drugs and the
has been evaluated by a substance use counselor and
has successfully complied with the counselor’s
4
role that EAPs can play. For more information, go to • If applicable, the conditions that need to be met before
https://www.samhsa.gov/workplace/workplace- the employee can return to work.
programs.
EAPs can participate in these discussions and help
incorporate language to facilitate the identification,
Step 1: Define the employee’s role in making the
evaluation, treatment, and possible provisions to return-
workplace safe. Sometimes employees in the
to-work for employees who engage in prescription drug
transportation, nuclear, construction, moving, mining,
misuse.
and other high-risk industries are prescribed pain
relievers and other medications carrying warning labels.
Step 4: Obtain legal advice. It is advisable for an
If the warning label states, “Avoid driving or operating
attorney experienced in DFWP issues to review the
heavy machinery,” the medication may make a person
revised DFWP policy before it is finalized.
drowsy, dizzy, and/or lightheaded and may slow motor
skills and reaction time. A DFWP should state what Step 5: Train supervisory staff and educate
employees must do if they are prescribed medications employees. Conduct regular formal training to educate
that carry this warning label. Employees in safety- supervisory staff about the signs of prescription drug
sensitive positions should be responsible for discussing misuse and the procedures to follow for an employee
their job duties and requirements with their medical care that a supervisor suspects has a prescription drug
providers to avoid on-the-job impairment. misuse problem. Again, EAP professionals can play a
role in training employees and supervisors as needed.
Such discussions, documented in the medical record,
are important to lessen safety risks. The DFWP also Step 6: Review service coverage for behavioral
should spell out what steps will be taken if the employee health and/or EAP needs. The behavioral health
is suspected of using any of these medications without a portions of health insurance and EAP contracts should
prescription, in larger doses than prescribed, or more be evaluated to ensure that employees are covered for
frequently than prescribed. Those in designated drug- issues related to prescription drug misuse. EAPs should
tested positions should have updated information provide counseling services related to some co-
regarding appropriate use of prescription drugs and occurring behavioral health and substance use issues.
consequences for non-medical use. Prescription drug misuse should be included in these
services and employees should be made aware of the
Step 2: Decide if the company should add counseling services that the EAP can provide. EAPs are
prescription drug testing to traditional illicit drug expected to assess employees’ prescription drug use—
testing. This would involve organizational both medical and non-medical—to determine if the use
representatives responsible for the drug testing program
of prescription drugs contribute to workplace
and protocols to ensure that any policy changes comply
performance issues.
with applicable local, state, and federal laws.
Prescription Drug Monitoring
Step 3: Incorporate language that spells out new
Programs
provisions of the DFWP that deal with prescription
drug misuse. Make sure the policy details the complete
EAP professionals may want to familiarize themselves
course of action the employer will follow regarding non-
with Prescription Drug Monitoring Programs (PDMPs),
medical use of prescription drugs. Each employer must
as they can be a cost-saving tool for employers and help
develop their own policies regarding how suspected
reduce the diversion of prescription medications for
prescription drug misuse will be identified, evaluated,
unintended purposes. PDMPs are housed in different
and treated; the conditions for continued employment;
state agencies that may include regulatory boards and
work and leave options; and what medical certifications
health departments, as well as law enforcement,
are required. They must ensure the prescription drug
consumer protection, and substance misuse agencies.
use policy is clear, concise, and thorough. List
PDMPs collect, monitor, and analyze electronically
procedures or corrective actions the employer will follow:
transmitted dispensing data submitted by pharmacies
• For an employee suspected of prescription drug and, in some cases, dispensing practitioners.
misuse;
PDMPs produce a patient history and activity report for
• For an employee with confirmed non-medical use; and each patient. These reports provide the health care
5
practitioner with a list of all controlled substance
What Are Employers Allowed to Ask?
prescription drugs prescribed to the patient, the name of
the prescriber issuing each prescription, and the The Americans with Disabilities Act (ADA) protects the
pharmacy where each prescription was filled. EAPs rights of job applicants and employees to be assessed
themselves cannot access patient medical information on merit alone, while protecting the rights of employers
from PDMPs. Generally, PDMPs distribute data to to ensure that individuals in the workplace can efficiently
authorized medical professionals upon request; in some perform the essential functions of their jobs.6 The ADA
states, PDMPs distribute data proactively. The patient applies to all employees, not just those with disabilities.
activity report assists the physician in determining if a Medical information such as the non-medical use of
patient altered the quantity of drugs prescribed or forged prescription drugs is protected under the ADA, so
the physician’s name on prescriptions. The report also employers must be knowledgeable about ADA
flags doctor shopping that yields multiple doses of a regulations before making any inquiries of their
controlled substance. Information about each state’s employees or potential new hires. It is important that
PDMP may be found at EAP providers understand what the employer can and
http://www.pdmpassist.org/content/state-profiles. cannot ask at different stages of the hiring/employment
process.
So, why should EAPs be aware of PDMPs? PDMPs can
save employers money and reduce non-medical use of Pre-Employment Inquiries
prescription drugs. PDMPs reduce unnecessary and
According to the ADA, employers cannot ask potential
costly prescriptions for pain relievers and other addictive
new hires:
and controlled medications. They also can reduce the
physician visits and diagnostic tests required to get • Questions about their prescription drug history before
those prescriptions. PDMPs can help doctors identify they offer a job to the applicant.
employees who may need a referral to treatment and
Employers can ask potential new hires:
identify those employees who might be undertreated and
subsequently visit emergency departments to get relief • If they can perform all the job duties stated in the job
description.
via pain medication. PDMPs increase employee
readiness and productivity by reducing misuse and » The applicant is required by law to notify the
allowing patients to get adequate treatment. PDMPs employer of any prescribed drugs they may be
can also provide large cost savings in workers’ taking that have side effects which can affect their
compensation. The use of opioids increases the job duties. For many jobs, that includes drugs
where labels say, “may cause drowsiness” or
likelihood of long-term disability claims. Receiving more
suggest caution when using heavy machinery
than one week’s supply of opioids soon after an injury
(which includes driving).
doubles the risk of a worker’s disability a year later.3
After Job Offer; Before Employment Begins
EAPs can talk with management or health plan
Once a potential new hire completes the interview
administrators to request that doctors included in the
process and is offered a job, an employer can ask the
company’s health plan use PDMPs. States with PDMPs
employee:
save on health care benefits through reductions in (1)
admissions for inpatient and outpatient addiction • Health-related questions, including questions about the
treatment, (2) prescription drug overdoses and use of prescribed drugs.
associated health problems, and (3) prescription drug
» This can only be done if all employees at the same
costs associated with employer-funded purchases of
job status are required to answer the same
drugs diverted to abuse.4 One study estimated that using
questions. These questions can be asked even if
PDMPs nationwide could reduce health care costs by they do not relate to the job’s function.
$113 million.5
6