While there has not been an overall change in the amount of pain that Americans report,(1,2) the volume of prescription painkillers prescribed in the U.S. has quadrupled since 1999.(3) Changes in the way providers are prescribing painkillers is fueling this epidemic. An interesting facet of this problem is that there is wide variation in which painkillers are being prescribed from state to state. A variation which cannot be easily explained by differences in health issues that may vary from state to state.
Deaths from prescription painkillers have also quadrupled since 1999, leading to the deaths of more than 16,000 people in the U.S. in 2013.(4) For example, over a 9 month period in a Kentucky county of fewer than 12,000 people, a 53-year-old mother, her 35-year-old son, and seven others die by overdosing on prescription painkillers obtained from out of state pain clinics.(5)
These are not isolated events. Each day, 44 people in the United States die from overdose of prescription painkillers. Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014. (6)
A big part of the overdose problem results from prescription painkillers called opioids. These prescription painkillers can be used to treat moderate-to-severe pain and are often prescribed following a surgery, injury, or for health conditions such as cancer. In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis. The most common drugs involved in prescription overdose deaths include:
- Hydrocodone (e.g., Vicodin)
- Oxycodone (e.g., OxyContin)
- Oxymorphone (e.g., Opana)
- Methadone (especially when prescribed for pain)
Prescription painkiller overdose deaths also often involve benzodiazepines. People who take prescription painkillers can become addicted with just one prescription. Once addicted, it can be hard to stop. In 2013, nearly two million Americans abused prescription painkillers. Each day, almost 7,000 people are treated in emergency departments for using these drugs in a manner other than as directed.
Taking too many prescription painkillers can stop a person’s breathing—leading to death. 7
This escalating problem not only affects those taking the mediacations but also those around them including friends and family, the public, and co-workers. An injured worker with a painkiller addiction not only represents a health and safety concern for that individual, but also presents potential liabilities for the employer. Imagine a person who is under the influence driving a 28,000 lb truck especially on a rainy night, or an airline pilot whose attention or reaction time is dulled by painkillers or other drugs? The potential for loss of life becomes staggering. There are also issues with lost productivity, co-worker safety, and even employee theft or violent activities to support their habit.
Despite the widespread nature of the problem, “many employers don’t have the information or knowledge they need to properly address this issue,” says Tom Fulmer, VP of Business Development for National Drug Screening. Fulmer continues, “For example, many employers state they have been affected by prescription drug abuse in their workplaces, but only about 50 percent have stated they have a written drug policy addressing the use of these medications at work.”
The stigma of substance abuse keeps many people from seeking treatment. They fear that their employers will find out and they’ll lose their jobs; this fear is reenforced by many companies because it is clearly stated in many companies’ workplace policies. Having an EAP or Employee Assistance Program is a necessary step in combatting this ever growing epidemic. In some states, this is required by statute, and some states even prohibit firing due to a positive drug tests if certain conditions are met.
This crisis is leading employers to rethink they way they do drug testing, what they test for, and the types of testing that will best fit company issues and policy. The goal of drug testing is safety of employees and the public as well as assistance to people needing help. What is in your company policy? What are you testing for and how? What messages is your drug testing policy (or lack of one) sending to your employees? To the public?
- Chang H, Daubresse M, Kruszewski S, et al. Prevalence and treatment of pain in emergency departments in the United States, 2000 – 2010. Amer J of Emergency Med 2014; 32(5): 421-31.
- Daubresse M, Chang H, Yu Y, Viswanathan S, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000 – 2010. Medical Care 2013; 51(10): 870-878.
- Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Available from URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w#fig2. Accessed August 17, 2015.
- Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2015) Available from URL: http://www.cdc.gov/nchs/deaths.htm.
- Valarie Honeycutt Spears. Ky. sees rise in overdose deaths from pills obtained in Fla. Lexington Herald-Leader 2009 Apr 12. Available from URL:http://www.kentucky.com/2009/04/12/758845/ky-sees-rise-in-overdose-deaths.html.
- Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Mortality File. (2015). Number and Age-Adjusted Rates of Drug-poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 2000–2014. Atlanta, GA: Center for Disease Control and Prevention. Available at http://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoning_involving_OA_Heroin_US_2000- 2014.pdf.
- Center for Disease Control and Prevention. Injury Prevention & Control: Prescription Drug Overdose available from http://www.cdc.gov/drugoverdose/epidemic/index.html