These days it seems like almost every American has either been directly impacted by the increase in opioid-related deaths or knows someone who has. My own experience is indirect but demonstrated to me the far-reaching impact of opioid deaths. My daughter’s brother-in-law died of an opioid overdose in February 2017. Both my son and daughter knew Travis for many years before my daughter married his brother, my now son-in-law. He was the little brother of their group. The tag-along. The sweet kid who you bought ice cream for or raced through Walt Disney World for one last ride on Space Mountain before closing. His death was devastating to his immediate family and close friends and triggered shock and guilt for both my children that continues to this day.
My family is not alone in this experience. Given the statistics, it is not an overstatement to refer to U.S. opioid-related deaths as a “crisis.” From 1999 to 2017 more than 700,000 people died in the U.S. from a drug overdose. Of this number, almost 400,000 were due to an overdose involving an opioid. In 2017, around 68% of the more than 70,200 drug overdose deaths involved an opioid. According to the Centers for Disease Control, on average 130 people in the U.S. die daily from an opioid overdose.
More and more discussion at conferences and in articles suggest that employers are on the front lines of the opioid crisis, and, therefore in the best position to take action. Arguably, employers have a vested interest in addressing the crisis. U.S. employers provide health benefits to more than 178 million people. According to the Kaiser Family Foundation, employer health plan expenditures on opioid addiction increased by more the 800% since 2004 to $2.6 billion in 2016. Emergency room visits attributable to opioid-related incidents doubled between 2005 and 2015. In the same time period, inpatient stays attributable to opioid-related events increased by 84%. In addition to health plan expenditures, it is estimated that, on average, employers lose $10 billion per year from lost work and lower employee productivity due to the crisis. In short, the opioid crisis is having a direct and significant impact on employers' bottom lines.
Unions are beginning to include the opioid crisis in negotiations. According to a March 21, 2019 article in the Detroit Free Press, Rory Gamble, a United Auto Workers (UAW) international vice president and director of the UAW Ford Department, identified combating opioids as a key priority for the collective bargaining talks scheduled for summer 2019.
In April 2018, the United States Surgeon General, Jerome Adams, spoke to the National Business Group on Health and asked employers to assume a direct role in combatting the opioid crisis. Among recommendations made by the Surgeon General was that employers include the opioid reversal agent naloxone (also commonly known by its brand name, Narcan) in their onsite first aid supplies. The Surgeon General stated,
"For a heart attack, we train employees how to do CPR until the paramedics arrive. Why is that not the case with naloxone and Narcan? We need to make these emergency treatments as ubiquitous as knowing CPR and calling for a defibrillator when someone is having a heart attack, or using an EpiPen when someone's having an allergic reaction."
Notwithstanding the Surgeon General’s appeal to employers in April 2018, providing access to naloxone in the workplace is a decision to be made by each employer.
In late 2018, the National Institute for Occupational Safety and Health (NIOSH) published a fact sheet, titled “Using Naloxone to Reverse Opioid Overdoes in the Workplace: Information for Employers and Workers.” The publication is addressed to employers that are considering implementing a naloxone program to prevent overdose deaths in the workplace.
In Publication 2019-101, NIOSH encourages employers to consider the following factors before adopting a workforce naloxone program:
NIOSH suggests that employers take the following steps to establish a workplace naloxone program:
Statistics are not readily available regarding the percentage of U.S. employers that currently include naloxone as part of their emergency response interventions.
One insurer, Blue Cross and Blue Shield of Massachusetts, instituted a pilot program in late 2018 under which it provides free opioid overdose reversal toolkits to select large employers in industries with high opioid overdose rates. Each kit contains two doses of naloxone in nasal spray form. Each kit also has a surgical mask, gloves and instructions for administering naloxone. Blue Cross Blue Shield also provides support in naloxone administration so employers can train their employees in the administration of naloxone. The pilot program could provide prototype by which employers can adopt workplace naloxone programs with a degree of confidence.
Given the scope of the opioid crisis and the heavy toll on employers and employees alike, employers should consider a risk/benefit analysis to determine whether to provide naloxone as part of their emergency response interventions in their workplaces.
Lori Jones is the chair of Thompson Coburn’s Employee Benefits practice.
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