Prescription Drug Abuse at Work

Written by Sally Spencer-Thomas

What is the most concerning substance abuse trend facing workplaces today? Is it meth? Heroin? Cocaine? When we look at who is showing up in our emergency rooms after overdosing and who is showing up at addiction treatment centers, the drugs that are affecting the working aged population most are the drugs we usually get with a prescription.

What is prescription drug abuse? Prescription drug abuse is the non-medical use of prescription medications. Prescription medications are only safe for the prescribed patient, for the prescribed reason, for a prescribed time. After they have been used for their intended purpose, they should be safely discarded, and yet many stockpile and share these potentially deadly and addicting medications, leaving them readily accessible for abusive purposes.

For example, OxyContin, which is essentially the same drug as heroin, is often prescribed for pain relief after major surgery. This toxicity of this medication is perceived quite differently when it comes in a prescription pill bottle from the medicine cabinet, and yet the body doesn’t know the difference between this pill and its illicit cousin heroin. The common perception is that these prescription drugs are safe because they come from a doctor rather than off the street. Yet, the consequences of abuse can be just as deadly.  When we look at national overdose deaths, we find that prescription drug abuse deaths are:[1]

·      Four to five times higher than those of black tar heroin in the 1970s

·      Twice as high as the peak years of crack cocaine in the 1990s

More people are dying each year from prescription drug overdoses than from heroin and cocaine overdoses combined.  In 2005 there were 22,400 prescription drug overdose deaths in the United States versus 17,000 homicides.

 The alarming trend in prescription drug abuse poses a dilemma for doctors. Chronic and severe pain is often best managed with narcotic based medicine until the source of the pain has healed. Very often drug-seeking patients will show up at their primary care clinic complaining of dental or injury pain and will claim they “just need something to get them through the weekend.” Since pain is so subjective, prescribing healthcare providers are often unsure about how to handle such situations and may err on the side of relieving the symptoms the best way they know how.

Sometimes workers who had legitimate pain medication prescriptions find themselves hooked and will “doctor shop” to get additional refills to support their addiction. Other overwhelmed overachievers may turn to prescription drugs for an edge in our highly competitive society. It is not uncommon for Mom or Dad to sneak stimulant pills prescribed for their teen’s Attention Deficit Disorder so that the parent can work longer hours.

The impact of prescription drug abuse on the workplace is evident. Because these pills are usually paid for through insurance, the healthcare costs for workplaces are affected when the drugs are being abused. Performance is impacted when workers are operating under the influence of narcotics, but unlike the abuse of other substances, prescription drug abuse often leaves little evidence: no smell, no paraphernalia, and no visible marks on the skin. Workers can abuse the drugs right at their desks without others noticing.

With all these pills around, the opportunities for intentional and unintentional overdoses increase significantly. Emergency room monitoring shows an upward trend of people experiencing medical crises from these effects.[1] Given these health risks and workplace implications what can employers do?

Like other health issues, the best intervention is early detection. Thus, workplaces can raise awareness by educating employees about the dangers of prescription drug abuse and offer screening to identify those at risk for abuse. Workplaces can help promote events like the Colorado Department of Public Health’s “Take Back” challenges where people can bring in unused prescription medications and dispose of them safely. When writing policies regarding substance abuse, prescription drug abuse should be included. Whatever the approach, workplaces that acknowledge the potential risks of prescription drug abuse will be better able to proactively work to reduce its impact.

Acknowledgement

I would like to thank Beverly Gmerek from Peer Assistance for her leadership in the area of prescription drug abuse prevention and for the information presented at the May 14^th, 2010 Colorado EAPA meeting which was used for the basis of this article.

About the Author

As a psychologist and the survivor of her brother’s suicide, Dr. Sally Spencer-Thomas addresses the issue of suicide prevention, intervention and postvention from many angles.  Currently she is the Executive Director for the Carson J Spencer Foundation (www.CarsonJSpencer.org), a Colorado-based (USA) nonprofit that is dedicated to “sustaining a passion for life” through suicide prevention, social enterprise and support for emerging leaders.” In 2009, the Carson J Spencer Foundation launched the Working Minds Program (www.WorkingMinds.org), a comprehensive suicide prevention initiative for workplaces.  As a professional speaker, she frequently presents keynotes and trainings for workplaces, campuses, and conferences around the world. In addition, she is the Executive Secretary for the National Action Alliance for Suicide Prevention, the public-private partnership advancing the Surgeon General’s National Strategy for Suicide Prevention. Finally, she is the Division Chair for Survivors of Suicide Loss for the American Association of Suicidology.  

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[1] Gmerek, Beverly (2010, May 14). Prescription Drug Abuse. Presentation at the Colorado EAP Meeting. Denver, Colorado

[2] Gmerek, Beverly (2010, May 14). Prescription Drug Abuse. Presentation at the Colorado EAP Meeting. Denver, Colorado

WORKING MINDS: Suicide Prevention in the Workplace

Working Minds: Suicide Prevention in the Workplace

Who is at Risk?

Which occupation is at most risk for suicide?  Military? Dentists? Psychiatrists?  Police officers?  This question is confounded by a number of issues that complicate the answer.  Some occupations are heavily male. We know men take their lives four times more often than women, so are higher suicide rates in those occupations a function of the occupation itself or the fact that men are higher risk?  A similar argument is made for unskilled and temporary jobs when we know the stress of poverty and unemployment also plays a role in suicide risk.

Nevertheless, we know that some occupations, by the nature of the work, may place individuals at higher or lower risk for suicide. For instance, when an occupation has special knowledge of or access to a lethal means of suicide (e.g., medicine among doctors and nurses), there is often an increase in risk.  Certain occupations tend to have higher levels of stress and isolation such as the farming industry might have elevated risks.  Some industries have what is called the “healthy worker effect.”  That is, the workplaces tend to select psychologically hardy people because of comprehensive screening that takes place before employment. Thus, these occupations may be protected from suicide risk to some degree. Finally, it is possible that certain types of people who are at an increased risk of suicide might be attracted to certain types of work.  For example, people who are prone to alcohol abuse, a known risk for suicide, are often attracted to workplaces where alcohol is available.

One noteworthy finding is that men and women working in non-traditional occupations seem to have a higher risk of suicide. In other words, women working in male-dominated professions and men working in female-dominated professions may experience increased internal occupational stress and social isolation that increases their risk. For example, we see very high rates of suicide among female physicians for this reason.

High performers consistently achieve high levels of accomplishment and are regarded as leaders and innovators.  One such high performer noted that being in this position is like being up on a high tight rope without a safety net.  It feels as though everyone around is watching in fear or perhaps anticipation of when the high performer will slip and fall.  For these reasons, there is often no turning back for the high performer, even when the legs begin to buckle.  While it is mostly exhilarating to try to wage such a precarious balancing act, one glimpse down can cause terror.  The truth is all humans have their faults and weaknesses, and for the high performer, it is only a matter of time for his or hers is exposed.  Sometimes it comes in the form of a mental collapse from exhaustion, and the high performer feels an acute sense of failure. When the curtain is drawn and the wizard’s real self is revealed, the high performer worries about how to maintain his or her credibility.  Sometimes the perception of judgment is far more critical from the high performer’s perspective than from those around him or her.  During these times the sense of belongingness and purposefulness may be impacted, causing the high performer distress and suicidal thoughts and behaviors. When this happens, these top leaders may be very reluctant to seek help because the fall they anticipate would be so great.

Why Suicide Prevention in the Workplace Makes Sense

One thing we know is true: few of us get through this life without periods of acute distress or a break with some form of mental illness. We also know that the burden of suicide is carried by the working aged population. For example, suicide is the second leading cause of death for people aged 25-34 and as other suicide rates are dropping (e.g., youth suicide rates), the rates among working aged men and women are rising. In order to combat this growing concern, we need to engage a wider circle in the suicide prevention movement. Workplaces are a logical choice given that so many people of working age are employed. Workplaces give people a sense of purpose and community – both psychological buffers to distress. They also usually have built in mechanisms for disseminating information about health risks and linking employees to resources, like Employee Assistance Programs. Co-workers usually have more face-time than neighbors or even family members, and may be able to pick up on changes in appearance, behavior or mood more quickly.

Five Simple Steps Workplaces Can Take to Prevent Suicide

While suicide prevention may seem like an intense endeavor for workplaces to take on, there are many prevention strategies that do not take much effort but yield tremendous results:

1.     Promote the National Suicide Prevention Lifeline (1-800-273-8255). This toll-free hotline is free and accessible 24/7. Answered by certified crisis call centers, all calls are routed locally. For free materials visit their website:

2.     Train Workplace Staff to Become Suicide Prevention Gatekeepers. In just over a lunch hour, employees at all level of a workplace can be taught how to identify warning signs and risk factors and help link distressed co-workers to appropriate care.

3.     Offer Educational Programs on Mental Illness. Increase awareness about the signs and symptoms of depression, bipolar disorder, alcohol dependence and other mental illnesses that can lead to suicide. By offering stories of recovery and successful treatment, workplaces can let employees know that it’s okay to ask for help.

4.     Reward Mental Wellness. Just as workplaces offer incentive programs for nutrition and fitness, we can also create motivation and opportunities to obtain optimal mental health. For example, employees can earn points when they take workshops on how to reduce stress or improve sleep.

5.     Change the Conversation through Social Marketing. A multi-media campaign can let people know they are not alone if they are thinking about suicide, and that many resources exist to help.

As our workplaces shift from the industrial age to the information age to the conceptual age, we come to increasingly rely on our mental muscle to get us through our work day. Like any other muscle, our mental muscle can get injured or fatigued, and we can experience high levels of distress, sometimes leading to a suicide crisis. Workplaces can prepare for this in many ways and develop a comprehensive approach to reduce suicide risk and promote mental resiliency.

Written by Sally Spencer-Thomas