How Should Employers Handle Drug Addiction at Work?

March 14, 2019, 5:20 PM UTC

You’ve probably heard the mind-blowing statistics: Every 13 minutes, someone in the U.S. dies of an opioid overdose. The total reached a record 72,000 deaths in 2017, the CDC reports, making prescription pain medications like Oxycontin, Vicodin, and the synthetic opioid fentanyl even bigger killers than diseases like diabetes. Addiction to pain pills is so widespread, across every U.S. age, race, and income group, that it’s nearly impossible to say how many Americans are quietly struggling with it. But the available research suggests that about two-thirds of opioid addicts have jobs. At least a few of them probably work for you.

The cost of this crisis—in lost productivity, mistakes at work, absenteeism, and plain human misery—has become so high that many employers are now intent on fighting it. (Want an estimate of addiction’s price tag at your business? Check out the National Safety Council’s online cost calculator.) The U.S. Surgeon General Jerome Adams last year started urging employers to join the battle, and the Chamber of Commerce Foundation has launched a campaign against opioid abuse, with information and case studies employers can use in their own efforts to tackle the problem.

Yet most companies clearly have a long way to go. A nationwide survey last November of more than 2,000 HR managers and employees, by insurer The Hartford, showed that only 24% of human-resources pros and 18% of employees felt “very confident” they could spot the signs of opioid addiction, let alone do anything about it. In companies with no formal policies and procedures about this, individual managers have to wing it, and the results are often not great.

Consider: In a poll of 737 bosses by rehab-center operator American Addiction Centers, 70% of managers reported feeling “guilty” about how they have handled their direct reports’ addiction issues—more than half of them because they wish they had addressed the problem sooner, instead of just hoping it would go away.

Experts in addiction and recovery say there are at least two ways that any employer could make a huge difference. First, although 90% of managers in the AAC survey said they’d approve time off for drug rehab (or have already done so for at least one employee), such a stigma attaches to addiction that most employees won’t admit they need help, and they certainly won’t request time off to go and get it. “Employees are worried about losing their jobs so, even in companies with really good EAPs [employee assistance programs], they won’t come forward,” notes Michael Cartwright, AAC’s cofounder, CEO, and chairman, who adds that only about 5% of people seeking treatment at his company’s centers were sent by their employers. “You need to create a culture of honest communication, where people aren’t afraid to speak up.”

It helps to start by making information about opioid addiction, and how to prevent it, readily available to everyone. Most people don’t realize, for example, that it’s possible to get hooked on painkillers after taking them—for an injury, say, or after surgery— for just four days, especially at high doses. “People need to be educated about this, in the same way we as a society have done with smoking,” says Cartwright. “Employers are in an ideal position to help by simply spreading the facts about opioids, and making sure employees know the risks.”

A second way employers can help: Keeping close tabs on prescriptions through their medical-benefits plans, and letting employees and health care providers know that more than a three-day supply of opioid painkillers won’t be approved without special scrutiny. The Surgeon General’s office reports that about 30% of large U.S. companies have already started doing this, but most employers are still “unwitting enablers” of opioid addiction, says Dave Chase, CEO of a Health Rosetta, a nonprofit aimed at making the U.S. health care system more cost-effective—and, not incidentally, less awash in addictive drugs.

Chase wrote an illuminating book called The Opioid Crisis Wake-Up Call that is packed with case studies of companies, including GM and IBM, that have successfully overhauled their medical plans. Benefits managers, take note: He suggests three litmus tests for whether your company is inadvertently adding fuel to the opioid addiction fire. The first warning sign, Chase says, is if “payment for primary care in your system is based on volume,” which encourages health care providers to write quick-fix prescriptions. Second, take a close look at “whether it’s easier [for employees] to get an opioid prescription than access to physical therapy,” which is usually a far more effective, and less hazardous, treatment for injuries. And third, Chase says, “you should be getting regular reports on opioid prescriptions. Typically fewer than 10% of doctors are prescribing most of the opioids out there. You don’t want them in your system. Weed them out.”

It’s a start.

Anne Fisher is a career expert and advice columnist who writes “Work It Out,” Fortune’s guide to working and living in the 21st century. Each week, she’ll answer your most challenging career questions. Have one? Ask her on Twitter or email her at