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Perspectives on the Opioid Crisis and the Workforce

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Perspectives on the Opioid Crisis and the Workforce Special Feature: Perspectives on the Opioid Crisis and the Workforce Reproduced with permission from Benefits Magazine, Volume 55, No. 7, July 2018, pages 28-33, published by the International Foundation of Employee Benefit Plans (www.ifebp.org), Brookfield, Wis. All rights reserved. Statements or opinions expressed in this article are those of the author and do not necessarily represent the views or positions of the International Foundation, its officers, directors or staff. No further transmission or electronic distribution of this MAGAZINE material is permitted. 28 benefits magazine july 2018 John S. Gaal, Ed.D., director of training and workforce development for the St. Louis– Kansas City Carpenters Regional Council, has spent the last two years researching the opioid crisis while he has seen its impact on the construction industry. Gaal offers his Perspectives on the Opioid own perspective on the matter and interviews four experts who recently participated in International Foundation panel discussions on opioids to get their views on how the opioid crisis started and efforts to treat and prevent the spread of opioid use disorder Crisis and the Workforce (OUD). John S. Gaal, Ed.D. John S. Gaal: As I’ve re- Hillbilly Elegy, refers to these phenom- Director of Training and searched the problem, ena as diseases of despair (Campbell, Workforce Development I’ve received input from 2017). St. Louis–Kansas City Carpenters a multitude of sources on Regional Council the opioids/heroin-relat- Mental Health, Chronic Pain St. Louis, Missouri ed crises. A recently re- and the Opioid Crisis [email protected] leased report from the state of Missouri Gaal: The opioids/heroin crisis has Joseph Ricciuti showed that nearly $13 billion per year negatively impacted people across all Co-Founder (approximately $35 million per day) spectrums within our communities. How Mental Health International is spent on economic issues related are the issues of chronic pain, depres- President and CEO to opioid use disorder (OUD) (HIDI, sion and mental health interconnected, SEB Benefits and 2018) in Missouri. Shockingly, Wyman and how has the medical profession’s re- HR Consulting Inc. (2017) asserts that opioids claimed sponse led to today’s state of affairs? Toronto, Ontario 64,000 lives in the United States during [email protected]. 2016 alone (or, in other words, approxi- Joseph Ricciuti: The opi- mately 170 people per day)—more than oid and heroin epidemic Jenny Armbruster car accidents or guns. Since many In- has become a national Director of Community Services ternational Foundation members are crisis in both Canada National Council for Alcoholism involved with the construction indus- and the U.S., but it didn’t and Drug Abuse (NCADA) try, it should be of interest that con- happen in isolation. Two St. Louis, Missouri struction workers are among the most other health care issues were quietly [email protected] vulnerable to opioid abuse, behind percolating behind the scenes—mental Paul Finch only food service industry workers health and chronic pain—and they Treasurer (March, 2017). Finally, when it comes fueled the demand for opioids, which British Columbia Government to a cyclical industry that tends to place created the crisis we have today. and Service Employees’ Union enormous pressures on a craftperson’s The prevalence of mental health is- Vancouver, British Columbia long-term ability to perform, Dasgup- sues has dramatically increased over [email protected] ta, Beletsky and Ciccarone (2017) posit, the last 50 years and more than doubled “the [opioid] crisis is fundamentally fu- in the last 20 years. The World Health Don Willey eled by economic and social upheaval. Organization projects that mental Business Manager . Overreliance on opioid medications health will become the second-leading Laborers’ International Union of is emblematic of a health care system cause of disability next to heart disease North America Local 110 that incentivizes quick, simplistic an- by 2020. Mental illness also has an ex- St. Louis, Missouri swers to complex physical and mental ponential effect on health care costs, [email protected] health needs.” J. D. Vance, the author of performance issues and occupational july 2018 benefits magazine 29 opioid crisis injuries. Approximately seven out of ten people with de- safety of working populations. It starts with leadership and pression are in the workforce, and depression is a chronic the will to prevent the sources causing opioid and heroin ad- disorder that is clinically linked to a number of other physi- diction from happening in the first place. cal disorders. Because of stigma, most don’t get professional help. One in three people with depression struggles with a The Impact of OUD substance addiction. Gaal: What is OUD, and what impact has it had on fami- Chronic pain, which can be caused by injuries, illnesses lies and the workforce? What are some effective evidence-based and complications from surgery, has also been on the rise, prevention and treatment methods for battling OUD? and 50 million Americans now live with chronic pain at any given time. Being saddled with chronic pain stymies the abil- Jenny Armbruster: It’s becoming increas- ity to work, exercise or enjoy life. ingly difficult to get through the day without The relationship between mental illness and chronic pain hearing at least one horrible piece of news is complex and comorbid. They can exist as a dual condition, about the country’s opioid epidemic. We have and disorders such as depression and anxiety can be present reached a point where virtually everyone both before and after the onset of pain. knows someone whose life has been affected— Pain causes sleep disturbances and, when chronic, can or taken—by this awful and seemingly intractable problem. trigger symptoms of depression. It is crippling and emo- OUD is a brain disease. Using an opioid, such as a pain- tionally draining, and the need to relieve its effects are often killer or heroin, creates changes in the brain over time. It urgent and desperate. The neurology that underlies chronic also takes time for these changes to heal once a person finds pain conditions and major depression are very similar. Some recovery and stops using. The fact that it is a brain disease researchers tend to view the relationship between chronic means that someone does not choose to become addicted. pain and mental health as an interaction between biological, Substance use disorder has no boundaries and can happen to psychological and social influences. anyone. Stopping is not just about willpower. When mental health issues and chronic pain include a Awareness of the dangers of misusing opioids has in- pharmacology treatment plan, there is a risk of drug depen- creased, but people continue to die. A record-high number dency and/or an adverse drug reaction, which creates a vol- of Americans died from fatal overdoses in 2016, with more atile environment for abuse and illegal use. When medica- lives lost to drug overdoses in 2016 than in the entirety of the tions such as opioids (like oxycodone) or benzodiazepines Vietnam War. The total for 2017 will be higher, and no end (like Xanax®) are properly prescribed and used, the chance is in sight. for addiction is relatively low, although it can still occur. Re- Loss of life is the greatest but not the only devastating im- liance and an oversupply of legally prescribed opioids and pact of the opioid epidemic. This crisis has also contributed a black market present a toxic recipe to satisfy wants and to a smaller workforce, because OUD is most prevalent in needs. The risk is harmful addiction and a death warrant 18- to 30-year-olds, who represent the emerging workforce. by overdose. This creates a smaller pool of eligible candidates that will ap- There is plenty of blame to go around. Clearly the heavy- ply or be able to pass initial drug screenings. A 2016 survey handed marketing and promotional strategies of the phar- of men aged 25-54 who were not in the labor force, which is maceutical companies have influenced doctors to overpre- defined as not employed or looking for work, found that 47% scribe in the name of making a profit. But just as guilty are had taken a pain medication on the previous day. Misuse of organizations that fail to promote psychological health and opioids by working individuals impacts job performance and safety in the workplace. increases employer costs. The American Society of Addic- Research has shown that the work environment and tion Medicine has estimated that opioid abuse costs employ- chronic job stress are risk factors for mental and physical in- ers approximately $10 billion in absenteeism and presentee- juries and can contribute to substance use and abuse. These ism losses alone. issues can’t be ignored, and they underscore the need to im- Prevention of substance use disorders must begin early prove awareness and training to secure the mental health and with consistent education to young people. Parents and oth- 30 benefits magazine july 2018 opioid crisis ers also must receive messaging and education about the BCGEU recognized early on that employers were not pro- dangers of opioids and the connection between prescrip- viding the occupational health and safety (OHS) training, tion painkillers and opioids; two-thirds of people who use materials or psychological support that was required to cope heroin began by misusing prescription painkillers. Commu- with the scale of the crisis. nity interventions also are necessary to promote the safe use, One of our first actions was to canvass our membership storage and disposal of prescription medications. Physicians to explore and examine the scope of the crisis. The union in- should be having conversations with patients about the dan- vited members to share their stories with us directly and also gers of misuse and should prescribe low amounts of opioid with the general public, on our campaign website—https:// medications only as needed.
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