Drugs and Alcohol in the Workplace

Alcohol and drug use among employees and their family members can be an expensive problem for business and industry, with issues ranging from lost productivity, absenteeism, injuries, fatalities, theft and low employee morale, to an increase in health care, legal liabilities and workers’ compensation costs.

The impact of alcoholism and drug dependence in the workplace often focuses on four major issues:

  • Premature death/fatal accidents
  • Injuries/accident rates
  • Absenteeism/extra sick leave
  • Loss of production

Additional problem areas can include:

  • Tardiness/sleeping on the job
  • After-effects of substance use (hangover, withdrawal) affecting job performance
  • Poor decision making
  • Loss of efficiency
  • Theft
  • Lower morale of co-workers
  • Increased likelihood of having trouble with co-workers/supervisors or tasks
  • Preoccupation with obtaining and using substances while at work, interfering with attention and concentration
  • Illegal activities at work including selling illicit drugs to other employees
  • Higher turnover
  • Training of new employees
  • Disciplinary procedures

In addition, family members living with someone’s alcoholism or drug use may also suffer significant job performance related problems — including absenteeism, lack of focus, increased health-related problems and use of health insurance.

Alcohol Use

Two specific kinds of drinking behavior significantly contribute to the level of work-performance problems: drinking right before or during working hours (including drinking at lunch and at company functions), and heavy drinking the night before that causes hangovers during work the next day.

And it isn’t just alcoholics who can generate problems in the workplace. Research has shown that the majority of alcohol-related work-performance problems are associated with nondependent drinkers who may occasionally drink too much — not exclusively by alcohol-dependent employees.

While alcoholism can affect any industry and any organization, big or small, workplace alcoholism is especially prevalent in these particular industries:

  • Food service
  • Construction
  • Mining and Drilling
  • Excavation
  • Installation, maintenance and repair

Prescription Drugs

There is always a level of risk when using any drug including prescription or over-the-counter medications.

Drug reactions vary from person to person. If you are taking a drug you haven’t had before, you won’t know how it will affect you. It’s important to follow your doctor’s advice when taking prescription drugs and discuss any side-effects and how this might impact on your work.

The effects of prescription drugs such as benzodiazepines (e.g. Xanax®) can have an impact on your work and you should discuss these with your doctor. Long term use in particular may become problematic.

What can the workplace do?

Work can be an important and effective place to address alcoholism and other drug issues by establishing or promoting programs focused on improving health. Many individuals and families face a host of difficulties closely associated with problem drinking and drug use, and these problems quite often spill over into the workplace. By encouraging and supporting treatment, employers can dramatically assist in reducing the negative impact of alcoholism and addiction in the workplace, while reducing their costs.

Without question, establishment of an Employee Assistance Program (EAP) is the most effective way to address alcohol and drug problems in the workplace. EAPs deal with all kinds of problems and provide short-term counseling, assessment, and referral of employees with alcohol and drug abuse problems, emotional and mental health problems, marital and family problems, financial problems, dependent care concerns, and other personal problems that can affect the employee’s work. This service is confidential. These programs are usually staffed by professional counselors and may be operated in-house with agency personnel, under a contract with other agencies or EAP providers, or a combination of the two.. Additionally, employers can address substance use and abuse in their employee population by: implementing drug-free workplace and other written substance abuse policies; offering health benefits that provide comprehensive coverage for substance use disorders, including aftercare and counseling; reducing stigma in the workplace; and educating employees about the health and productivity hazards of substance abuse through company wellness programs.

  • Research has demonstrated that alcohol and drug treatment pays for itself in reduced healthcare costs that begin as soon as people begin recovery.
  • Employers with successful EAP’s and DFWP’s report improvements in morale and productivity and decreases in absenteeism, accidents, downtime, turnover, and theft.
  • Employers with longstanding programs also report better health status among employees and family members and decreased use of medical benefits by these same groups.

Some facts about alcohol in the workplace:

  • Workers with alcohol problems were 2.7 times more likely than workers without drinking problems to have injury-related absences.
  • A hospital emergency department study showed that 35 percent of patients with an occupational injury were at-risk drinkers.
  • Breathalyzer tests detected alcohol in 16% of emergency room patients injured at work.
  • Analyses of workplace fatalities showed that at least 11% of the victims had been drinking.
  • Large federal surveys show that 24% of workers report drinking during the workday at least once in the past year.
  • One-fifth of workers and managers across a wide range of industries and company sizes report that a coworker’s on- or off-the-job drinking jeopardized their own productivity and safety.

Some facts about drugs in the workplace:

  • Workers who report having three or more jobs in the previous five years are about twice as likely to be current or past year users of illegal drugs as those who have had two or fewer jobs.
  • 70% of the estimated 14.8 million Americans who use illegal drugs are employed.
  • Marijuana is the most commonly used and abused illegal drug by employees, followed by cocaine, with prescription drug use steadily increasing.

Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

Emerging Trends and Alerts

New drugs and drug use trends often burst on the scene rapidly. NIDA’s National Drug Early Warning System (NDEWS) reports on emerging trends and patterns in many metropolitan areas and states. NDEWS builds on the work of the former Community Epidemiology Work Group (CEWG).


Loperamide Misuse/Abuse

Posted on June 09, 2016

Loperamide is an over-the-counter anti-diarrheal medication that is available in tablet, capsule, or liquid form under brand names such as Imodium, Kaopectate 1-D, Maalox Anti-Diarrheal, and Pepto Diarrhea Control. Because it acts at mu-opioid receptors, which regulate movement in the intestinal tract, it is an opioid medication, and there are reports of its being misused by drug users to stave off opioid withdrawal or possibly even to get high.

Misuse of loperamide has been reported since 2003; it is not common, but it has been reported all over the country. Nationwide, the number of calls to poison centers involving the intentional abuse or misuse of loperamide increased from 87 in 2010 to 190 in 2014 (AAPCC annual reports; http://www.aapcc.org/annual-reports/ ).

Effects of Loperamide

When taken as recommended, loperamide is designed not to enter the brain; but instructions available on the Internet purport to show how taking loperamide in very high quantities and combining it with other substances may help it produce psychoactive effects that resemble the euphoric effects of other opioids or that mitigate cravings and withdrawal symptoms.

Users’ reports of these effects effects (if any) are conflicting, but physical consequences of loperamide misuse may be severe, including fainting, abdominal pain, constipation, cardiovascular toxicity (including racing heart and even cardiac arrest), pupil dilation, and kidney failure from urinary retention. Anecdotes and case reports indicated that the potential harm is high.

There were also reports of opioid withdrawal symptoms when users stopped taking loperamide, including severe anxiety, vomiting, and diarrhea.

FDA issued a Safety Alert about Loperamide on 6/7/16: Loperamide (Imodium): Drug Safety Communication – Serious Heart Problems With High Doses From Abuse and Misuse

More information on loperamide is also availabe from the National Drug Early Warning System (NDEWS) .


Fake Prescription Drugs Laced with Fentanyl

Updated May 05, 2016

Media reports and official alerts in several U.S. communities (including Sacramento, CA and most recently, Carroll County, MD) are warning of counterfeit pain and anxiety medications that actually contain fentanyl, an extremely powerful, potentially deadly opioid. The pills, which are disguised as common prescription drugs like Norco (hydrocodone), Percocet (oxycodone), and Xanax (alprazolam), are responsible for a growing number of overdose deaths and non-fatal overdoses around the country. Fentanyl is 25 to 50 times stronger than heroin, so even a small amount can cause an overdose. (The Drug Enforcement Administration reports that some of these pills are manufactured in China and smuggled into the U.S. via Mexican drug cartels.)

The fake pills are much cheaper than the real versions. The public should be aware that drugs obtained on the street, even though they look like a real prescription pharmaceutical, may be deadly. It is always unsafe to take a prescription drug unless it comes from your own prescription and is dispensed by a reputable pharmacy.


Surge in Fentanyl Overdose Deaths

Posted on July 09, 2015

A surge in overdose deaths related to fentanyl, an opioid 30 to 50 times more potent than heroin, has prompted Baltimore health officials to launch a public health campaign to raise awareness among drug users. Hundreds of people have overdosed on fentanyl across the nation since 2013, often as a result of using heroin that has been laced with the much stronger substance. A quarter of drug overdose deaths in Maryland now involve fentanyl, up from 4 percent in 2013. Opioid overdose can stop a person’s respiration, and fentanyl can have this effect very quickly. Other parts of the country such as Detroit and surrounding suburbs are also seeing major surges in fentanyl use and fentanyl-related deaths. In some cases users are unknowingly taking fentanyl in what they believe to be pure heroin, but a growing number of opioid users are deliberately taking fentanyl.

Fentanyl and other opioid overdoses can be reversed if the drug naloxone (Narcan) is administered promptly. In a growing number of states, naloxone is being distributed to injection drug users and other laypersons to use in the event of overdose. For example, Baltimore’s Staying Alive Drug Overdose Prevention and Response plan issues naloxone and training in its use.


Increasing Overdoses From Synthetic Cannabinoids (“Spice,” “K2,” etc.) in Several States

Updated May 08, 2015

Recent surges in hospitalizations and calls to poison control centers linked to consumption of synthetic cannabinoid products–sold under brand names like “Spice,” “K2,” “No More Mr. Nice Guy,” and others–are being reported in several southern and northeastern U.S. states and have prompted officials to issue health warnings. After a surge in synthetic cannabinoid exposures and poison center calls in April and May, 2015, the Maryland Poison Center issued an urgent notice about the dangers of these drugs . New York Governor Andrew Cuomo issued an alert after more than 160 patients were hospitalized following synthetic cannabinoid use in under two weeks in mid April, 2015.

Synthetic cannabinoids are chemically related to THC, the active ingredient in marijuana, and are sometimes called “synthetic marijuana” or “legal marijuana,” but actually the effects can be considerably more powerful and more dangerous than marijuana. Users can experience anxiety and agitation, nausea and vomiting, high blood pressure, shaking and seizures, hallucinations and paranoia, and they may act violently.

The Maryland notice lists several chemical compounds in materials from crime labs, including MAB-/AB-CHMINACA, FUBINACA, FUB-PB-22, and XLR11. Besides the brand names above, the New York State health alert lists other common names: Blonde, Summit, Standard, Blaze, Red Dawn X, Citron, Green Giant, Smacked, Wicked X, AK-47; recent reports have involved products with the names Geeked Up, Ninja, Caution, Red Giant, and Keisha Kole.

For more information on synthetic cannabinoids, see DrugFacts: K2/Spice (“Synthetic Marijuana”)


U.S. and British Columbia Issue Alerts on Fentanyl

Updated March 18, 2015

The U.S. Drug Enforcement Agency (DEA) has issued a nationwide alert about the dangers of fentanyl and related compounds (fentanyl analogues). Fentanyl, an opioid that is 50-100 times more powerful than morphine, is both abused on its own and commonly added to heroin to increase its potency. Fentanyl and fentanyl-laced heroin have been a concern for over a decade and have caused numerous overdose deaths among injection drug users in several U.S. cities.

Heroin is not the only drug that can be laced with fentanyl, however. Officials in Vancouver, British Columbia, Canada, recently issued public warnings about a wide range of fentanyl-laced drugs causing overdose deaths among users. They warn that fentanyl is now being concealed in non-injection drugs, including oxycodone and various “party drugs” in powder or pill form, as well as in marijuana (although no deaths have been confirmed from fentanyl-laced marijuana). Because of this new threat, British Columbia officials are urging all recreational drug users to “know their source.”


HIV Outbreak in Indiana Linked to Abuse of Opana

Posted on February 27, 2015

Health officials in Indiana have announced a fast-spreading outbreak of new HIV cases in the southeastern portion of the state that are linked to injection drug abuse of the powerful prescription opioid painkiller Opana. Injecting drugs and sharing injection equipment is one of the main routes of transmitting HIV. Also, a few new HIV cases in southeastern Indiana were transmitted sexually.

Officials advise that people in southeastern Indiana who have engaged in needle sharing or unprotected sex should get tested for HIV and then re-tested after 2-3 months, as HIV may not appear on tests immediately when the virus is contracted. To reduce risk of contracting HIV, avoid injection drug use, sharing or re-using needles, and having unprotected sex or sex with commercial sex workers.

Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

New OSHA Accident Reporting Rules Knock Out Most Employer Mandatory Post-Accident Drug Policies

DOT, NRC and CG Mandatory Drug Testing Rules Exempt;
Effective Date of OSHA Rules: August 10, 2016
By Theodore F. Shults JD, MS

First, a good question is: How does a new rule requiring employer electronic reporting of accidents to OSHA end up prohibiting most private employer post-accident drug testing procedures and policies?

Many employer drug-testing policies mandate drug and alcohol testing in the wake of a workplace accident regardless of fault, cause or suspicion that the employee was impaired or was using drugs. These polices vary greatly and can in some situations be viewed as designed to chill an employer’s interest in reporting an on-the-job illness or injury. Some state laws and courts have addressed these issues by defining post-accident testing as requiring reasonable suspicion.

Now OSHA has chimed in with a comprehensive restriction on post-accident testing. Effective August 10, 2016, OSHA’s Final Rule on Electronic Reporting of Workplace Injuries requires employers to implement “a reasonable procedure” for employees to report workplace injuries and that procedure cannot deter or discourage employees from reporting a workplace injury.

Regardless of the merit of OSHA’s new restriction on post-accident testing, how does this happen? Well it helps that the text of the final rule (29 CFR § 1904.35(b)(1)(i)) does not specifically address mandatory post-accident drug and alcohol testing. It is OSHA’s subsequent May 12, 2016 commentary accompanying the final rules that specifies that OSHA views mandatory post-accident testing as deterring the reporting of workplace safety incidents and that employers who continue to apply such policies will face enforcement scrutiny and serious penalties.

It is not a complete ban, but it might as well be. OSHA instructs employers to:

“limit post-incident testing to situations in which employee drug use is likely to have contributed to the incident, and for which the drug test can accurately identify impairment caused by drug use.”

So which drug test does OSHA recommend that can accurately identify impairment by drug use (other than a breath alcohol test)? That guidance has not been provided.

Fortunately OSHA has spared mandatory federal and state testing programs.

State Workers’ Compensation Law and Federally Mandated Drug Testing

OSHA points out in its preamble to the final rule that a few commenters raised the concern that the final rule will conflict with drug testing requirements contained in workers’ compensation laws. To wit OSHA notes:

“This concern is unwarranted. If an employer conducts drug testing to comply with the requirements of a state or federal law or regulation, the employer’s motive would not be retaliatory and the final rule would not prohibit such testing. This is doubly true because Section 4(b)(4) of the Act prohibits OSHA from superseding or affecting workers’ compensation laws. 29 U.S.C. 653(b)(4)”

I suspect that most law firms that provide employment guidance in states with voluntary drug testing rules are trying to figure out whether states with “voluntary drug-free workplace laws” are covered under the exemption of compliance with the state worker compensation law. It is worth noting that if an employer decides not to comply with the post-accident requirement of, for instance, Florida’s Drug-Free Workplace Act, they would lose the workers’ comp discount and legal protections the Act provides.

Fortunately, it is quite clear that compliance with the federal drug testing requirements of the DOT, CG and NRC preempt OSHA’s restriction on post-accident testing

NOTE: It is important to point out that the offending language in this final rule restricting post-accident testing is found in the rule’s preamble and not part of the black letter rule itself. Further, how OSHA will enforce the rule remains an open question, which will be reflected in its as yet unpublished enforcement guidance. Given the significance of this rule and the perfunctory opportunity provided to the industry to comment, as well as the fallout OSHA already is receiving, there is a reasonable chance that it may be rolled back or significantly amended.

Repost by permission from AAMRO, MRO ALERT publication