Compassion: A new treatment for addiction?
The email that showed up unexpectedly one day in February 2017 in the inbox of Roger Krone, the CEO of the large McLean, Va.-based national-security contractor Leidos, had a subject line that read, simply: “A father’s request.”
The employee who sent the email—John Hindman, a public affairs adviser—leapfrogged the normal chain of command in going straight to the chief executive of a 33,000-employee Fortune 500 company. But Hindman’s anguish over the death of his 30-year-old son, Sean, who’d died the previous September from an overdose after battling an opioid addiction, convinced the employee that it was worth any risk to plead with his boss to do something about the opioid epidemic.
“Roger is also a father, and it really hit him emotionally,” recalls Melissa Koskovich, the senior vice president for communication and marketing at Leidos who became the firm’s point person on its opioid efforts. The CEO reached out to Hindman that day and soon announced that—at a time when many companies were still denying or ignoring the extent of the drug crisis—Leidos would instead aim to be a role model for other companies. Six months later, Krone wrote in a letter to all Leidos employees that he’d accepted Hindman’s challenge to make a major response to the opioid epidemic that was inevitably affecting workers and their families, and that “it has to start with compassion and open dialogue.”
Leidos wasn’t the only company realizing as the 2010s came to a close that both the size and the scope of the opioid crisis called for a very different approach to drug abuse than the tack taken by most U.S. firms in the latter 20th century. That had been an era of aggressive drug testing, with many workplaces—especially those in safety-sensitive industries—adopting “zero tolerance” toward employees caught using illegal drugs.
Today, the buzzword is so-called “second-chance” approaches for employees suspected of falling prey to opioid addiction, with human resource executives now tasked with developing protocols around compassion, treatment and keeping workers on the job. Some of that stems from the understanding that many drug problems start with a doctor’s initial legal prescription for painkillers, such as OxyContin or Percocet, but can soon spiral out of control. In addition to treatment and recovery, HR leaders are also looking at changes in company health plans or enhanced training, aimed at stopping addiction before it starts.
As Leidos developed its new strategy on opioids, company officials realized that a simple change in the company’s prescription-drug plan—mandating that any first-time prescription for painkillers cover no more than seven days—could greatly reduce the chances that a pain patient would develop an addiction. Along with that one-week supply, patients get an education letter about opioid addiction and even a Deterra bag, which dissolves unused pills for disposal in the trash. Koskovich says fewer than one in 10 Leidos workers seeks to extend a prescription beyond the seven days.
“It’s a cost up front for the company,” Koskovich says of the disposal bags and the related education efforts, “but the employee benefits, and it saves money on the back end” in lower pharmaceutical expenses for Leidos. The firm has plowed some of those savings into anti-opioid efforts that have included a documentary film called Circle of Addiction, narrated by actor Jim Wahlberg, as well as new partnerships with anti-drug nonprofits.
Experts say smarter and more compassionate responses from companies and their HR executives to the opioid crisis—which, according to the U.S. Centers for Disease Control and Prevention, claimed an alarming 47,600 deaths due to overdose in 2017—are partly a belated realization that the workplace may be the best place to detect an addiction problem and intervene. That’s because the economic and psychological importance of holding onto a job often motivates people in the throes of addiction in a way that appeals from friends and family may not.
“The workplace is where you spend most of your day,” says James Reidy, an attorney at New Hampshire-based Sheehan Phinney Bass & Green PA and an expert on company drug-abuse policies. He says employees whose opioid problems become evident on the job “are running the risk of losing income and benefits—as well as their comforts and shelter—and if that person isn’t so much in the grip of addiction, they recognize they could lose it all.”
And yet, companies like Leidos with aggressive intervention strategies still seem like the exception rather than the rule. In 2018, the Hartford Financial Services Group surveyed 500 HR executives, along with 2,000 other employees, and found a disconnect: Some 67% knew, or expected, that opioid abuse was affecting their company, yet 64% admitted they felt unprepared to deal with the problem. Most survey takers also conceded a lack of knowledge about opioid addiction or how to identify a co-worker with a drug problem. And some 31% of people managers said a worker with an addiction problem is typically fired.
But a growing number of CEOs and their HR leaders are urging a radically different approach, not only to foster a more compassionate workplace but also because of the economic toll of firing experienced employees and hiring and training replacements.
“Business leaders need to also shift their mindset about how to respond to addiction in the workplace,” wrote Kirt Walker, CEO of Nationwide Insurance, recently in an op-ed for Fortune magazine. “While a one-chance-only policy may seem logical, it may actually be more costly than other alternatives in terms of training new workers and lost productivity.”
Unlike some major companies, Nationwide—headquartered in Columbus, Ohio, and an employer of 34,000 people—decided several decades ago that getting its most valued employees into drug treatment and counseling was preferable to a zero-tolerance policy. What’s changed, according to the firm’s HR leaders, is the extent of the opioid crisis—especially in its home state of Ohio, which, in 2017, had the second-highest overdose rate in the U.S. Kathleen Herath, Nationwide’s associate vice president for wellbeing and safety, says the firm has been not only fine-tuning its in-house procedures—such as better training for managers on identifying workers who may have a drug problem—but also sharing its best practices with other Ohio firms.
Chad Jester, Nationwide’s vice president of corporate citizenship, who runs the Nationwide Foundation, notes the firm’s key role in launching the Ohio Opioid Alliance, a coalition of businesses and nonprofits that aims to both share best practices and raise awareness. The insurance giant in 2019 donated $2 million to launch an ad campaign depicting how the drug crisis affects a fictional and seemingly idyllic town called “Denial, Ohio.”
“We are trying to be a conduit of great information and to extend the network,” says Jester, who has also worked with the National Safety Council to promote a free Opioids At Work Employer Toolkit and better data sharing among businesses. “That’s what awareness, education and prevention is all about.”
Modeling a New Approach
Indeed, as a consensus grows among employers for a more compassionate, second-chance-oriented response to the opioid crisis, there is also growing agreement among experts about what such workplace programs should look like. The newer approaches place an emphasis on worker education and honest dialogue, management training, smarter use of data, and working with insurers and doctors to head off addiction before it starts.
Here are some of the common threads:
Using big data. Increasingly, companies are looking at how to best collect data—typically through their health plans—on both the extent of the potential opioid-abuse problem in the workforce as well as ways to confidentially identify and reach out to individual employees who might have a problem.
First Choice Health, a firm in the Pacific Northwest that’s owned by doctors and hospitals to promote better and more efficient care, recently started offering more than 100 companies a service to identify high-risk employees—such as those who’ve been prescribed opioids and sedatives for 60 or more days during the prior three months—and connect them with counseling and other services.
Dr. John Robinson, chief medical officer at First Choice Health, says a computer code targeting opioid prescriptions and related claims “produced some eye-opening data” that’s helped create benchmarks to determine which companies have a problem. He says the data has cut down on over-prescriptions while steering workers into EAP programs. “It’s important to catch them,” he says, “when they’re ready to get help.”
New approaches to hiring. Richmond, Ind., is another community in the American Midwest hard hit by opioid abuse. Like other local employers there, Belden—a global manufacturer of security products—was struggling to fill vacancies with so many prospective workers failing drug tests.
Instead of automatically rejecting these applicants, Belden came up with a program called Pathways to Employment that—at an average cost of $16,000 per person—connects candidates with personalized drug treatment and, aided by repeated drug testing, eases them into the company before moving them into higher-paying safety-sensitive jobs when they’ve shown they’re free of addiction.
Innovative approaches to healthcare. Dave Chase, head of the reform-minded healthcare consultancy Heath Rosetta and author of the 2019 book The Opioid Crisis Wake-Up Call, says that 2% of the American gross domestic product is spent on treating lower-back pain—not with therapy or other effective treatments but by simply prescribing opioid painkillers. One out of six of those patients, Chase says, will become addicted.
“This is entirely a self-inflicted wound from our healthcare system,” says Chase, who notes the current fee-for-service regime has invited over-prescription of opioids. He’s worked with companies such as Rosen Hotels to change healthcare models to a value-based system that rewards better outcomes—and which has drastically slashed opioid prescriptions, curbing the risks of addiction.
Train managers on when and how to intervene. Experts such as Norbert Alicea, vice president for EAP and work/life services at Health Advocate, a Plymouth Meeting, Pa.-based firm that works with employers on healthcare solutions, says it’s important that managers learn both the signs that a worker might be having an opioid-related problem and then how to approach them, if necessary.
“An employee may come out like a bull in a china shop [if confronted], and you need to know how to deal with it or not deal with it,” says Alicea. Many firms, such as Nationwide or some of those advised by Alicea, assign the role of having a difficult conversation with an employee not to a line manager but a highly trained specialist, typically from the HR department.
Nationwide’s Herath says one such specialist in HR has become the point person for managing every employee who enters an opioid-recovery program. “She’s their lifeline,” Herath explains. “She talks them though their random tests and what they have to do. The model we created is that when someone needs help, we hold their hand and hold on.”
“The model we created is that when someone needs help, we hold their hand and hold on.”—Kathleen Herath, Nationwide Insurance
Alicia says the best approach in addressing an employee suspected of opioid use is to couch the situation as a work problem—that there are concerns about safety or the worker’s health—rather than confronting it as a drug problem. He also urges employers to think through every possible ramification, such as making sure there’s transportation to a doctor’s office to avoid the liability and safety risk of a drugged worker behind the wheel.
Experts agree that it’s complicated for many firms to develop a uniform, companywide policy around opioid abuse and recovery because many safety-sensitive jobs—such as truck driver or aviation worker—since 2018 have been covered by U.S. Department of Transportation regulations for opioid testing, with rigid protocols. But they also concur that finding strategies to get workers off opioids while keeping them employed are both cost-effective and humane.
“The good employers remember that human resources is a two-way street,” says Reidy, the New Hampshire employment attorney. Promoting wellness and recovery, he says, “is investing in these people, while losing these people could be a casualty.”
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