Recovery Friendly Workplace

National Safety Council’s Substance Use Cost Calculator for Employers:
https://www.nsc.org/forms/substance-use-employer-calculator

Key facts for employers:

• More than 85,000 Americans died from a drug-related overdose from August 2019 – August 2020, according to the U.S. Centers for Disease Control and Prevention (CDC).
• Unintentional overdoses due to nonmedical use of drugs or alcohol increased for the seventh consecutive year, according to the U.S. Bureau of Labor Statistics.
• “The total incremental costs of health care due to pain ranged from $261 to $300 billion. The value of lost productivity ranged from $11.6 to $12.7 billion for days of work missed, from $95.2 to $96.5 billion for hours of work lost, and from $190.6 to $226.3 billion for lower wages,” according to the National Institutes of Health.
• Workers with a current substance use disorder/opioid use disorder miss an average of 14.8 days per year, and those with a pain medication use disorder miss an average of 29 days per This is in contrast to an average of 10.5 days for most employees, and an average 9.5 days for workers in recovery from a substance use disorder/opioid use disorder.

Steps Employers Can Take to End the Epidemic

1. Ensure employees and their families have access to evidence-based care for substance use disorders/opioid use disorders and mental illness.
   • Check your benefit package to ensure there are no barriers to accessing evidence-based treatment of substance use disorders/opioid use disorders or mental illness. This includes removing barriers like prior authorization requirements for medications used in the treatment of substance use disorders/opioid use disorders and requiring no- or low-cost sharing for services provided by addiction medicine, psychiatry and other health care professionals who may be part of the health care team for employees and their dependents. See treatment recommendations, National Institutes for Occupational Safety and Health.
   • Require that your health plan or third-party administrator (TPA) verify that the network of physicians to treat opioid use disorder (OUD) includes access to opioid treatment programs (OTP) and physicians who have a federal waiver to prescribe buprenorphine for OUD who are currently accepting new patients. See this success story from Ohio.
     
   • Ensure that employment applications do not ask about a prospective employee’s history of mental illness or substance use; questions that may be in violation of the Americans with Disabilities Act or other laws.
2. Review and revise internal policies to support comprehensive, compassionate care for patients with pain
   • Check your benefit package to identify and eliminate barriers to non-opioid pain care, including high cost-sharing for non-opioid options such as physical therapy, cognitive behavioral therapy, acupuncture and other Opioid prescriptions decreased 37 percent between 2014-2019, but non-opioid pain care has not increased due to continued cost and access barriers.
   • Consider flex-time or other arrangements to help employees access non-opioid modalities; it is untenable to put patients and physicians in the situation where opioid therapy is the only one that will work for a patient’s work, home and social circumstances.
   • For patients who benefit from reduced pain and improved function while receiving opioid therapy, do not force patients to reduce their dose or duration as a condition of continued employment.
3. Promote harm reduction at work
   • Similar to an AED, consider installing an easily accessible naloxone rescue station such as a wall-mounted display/storage unit or through your EAP or Human Resources group, have naloxone products readily available at the workplace, including instructions for use. Helpful guidance from the CDC.
   • Include signage in prominent areas where employees obtain information, including employee newsletters, to ask their physician about naloxone, obtain training to recognize signs of overdose and how to administer naloxone.
   • Promote your state’s availability of naloxone via a standing order—so that individuals can obtain naloxone without a prescription.
4. Promote harm reduction at work
   • Acknowledge the presence and impact of stigma at the patient, provider, institutional and social level for employees with chronic pain, those who use drugs and have substance use disorder/opioid use disorder, and harm reduction services.
   • Treat all employees with compassion and dignity without dismissing the need for medical management of their therapy.
   • Dispel myths about naloxone and promote fact and evidence-based harm reduction.
   • Acknowledge health disparities in all aspects of healthcare as a form of stigma – racial and other biases, language differences, gender, economic disparities, and other factors create barriers to care for chronic pain, substance use disorder/opioid use disorder, and mental illness.
   • Communicate, support, and encourage the need for medical care provided to your employees and communities to be patient-centered, well-coordinated, and ensure that treatment plans account for each patient’s individual needs.

Additional Resources

• The AMA End the Overdose website hosts an array of information and resources from the AMA Opioid and Pain Care Task Forces as well as information related to stigma.
• “Advocacy and Action to End the Opioid Epidemic by the AMA Opioid Task Force”.
• “Evidence-Informed Pain Management: Principles of Pain Care from the AMA Pain Care Task Force.
• Addressing Obstacles to Evidence-Informed Pain Care.
• A one-page document to support comprehensive treatment options for patients.
• A glossary of commonly misunderstood terms used in pain care.
• Language matters – an informational document to reduce stigma.
• Fair Insurance Coverage is the Law.

Medication-Assisted Treatment for Opioid Use Disorder.

Supportive Information:

Recovery-Ready Workplace Resource Hub | U.S. Department of Labor (dol.gov)

AMA Key Considerations for Employers (PDF)

Workplace Solutions: Medication-Assisted Treatment for Opioid Use Disorder (cdc.gov)

The success of the RFW initiative has spread across the country, and over 35 entities, spanning 25+ states, have reached out to learn how to best replicate the initiative to meet the needs of their communities. The addiction crisis is bigger than New Hampshire, but together, we are forging a path that brings increased access to recovery, strengthening our workforce and communities in the process, and we hope others continue to join us.

To learn more about the work that is being done in other states around Recovery Friendly Workplace, please access this folder: https://bit.ly/RFWMulti-StateMap, where you can download a clickable pdf that links to additional information on other states’ efforts. This map will be updated 1-2 times per year to incorporate additional information received on RFW-related initiatives. For questions around other states’ work, you may reach out directly to those states or Samantha Lewandowski, Assistant Director of New Hampshire’s Recovery Friendly Workplace initiative, at sam@recoveryfriendlyworkplace.com.

Additionally, New Hampshire RFW currently hosts an RFW Multi-State Community of Practice (CoP) designed to bring states together across the country who are doing RFW-related work. This CoP meets roughly 3-4 times per year and focuses on sharing best practices, navigating shared challenges, reducing silos, and fostering collaboration. If you run or are part of an RFW initiative, particularly in the non-profit sector, and would like to be part of this CoP, please contact Samantha Lewandowski at sam@recoveryfriendlyworkplace.com.

Thank you for your interest in this life-changing and life-saving work!