Businesses aren't immune from the drug epidemic that's hitting central Ohio hard.

For every person who dies from a drug overdose, the federal Centers for Disease Control and Prevention says another 130 people are living with an addiction. And in 2016, more than 350 Franklin County residents—an increase of 71 percent over the last five years—overdosed and died.

The opioid epidemic—that's not hyperbole; it meets the public-health definition of the word—has been described as the worst drug crisis in US history, and Ohio has been identified as an epicenter for drug seizures, arrests, overdoses and deaths.

It's not an issue that simply vanishes at the doors of the state's offices, factories, warehouses, restaurants, retail shops and other places of business.

“If it's rampant in our community, it's a workplace problem,” says Dee Mason, the founder and CEO of Working Partners, a Canal Winchester company that helps businesses create and manage drug-free workplace programs.

But Mason and others who are trying to stem the tide of opioid abuse say that as businesses grapple with their own issues of lost productivity, higher absenteeism, greater risk of workplace accidents and other problems brought on by substance use among employees, they also must be part of the effort to address its broader consequences in their communities.

A new Franklin County Opiate Action Plan released in June by county commissioners and Columbus Mayor Andrew Ginther issued only vague calls about “partnering with business leaders” to address the crisis. The mayor, however, says employers soon will become an integral part of the city-county plan to educate the public, expand treatment and reduce the number of drug-related deaths.

“It's impacting businesses: their employees, their families, their customers, their communities,” Ginther says. “We know we're in for the long haul, and that's why we need the help of the private sector.”

On-The-Job Impact

The opioid epidemic has hit businesses in ways both big and small across central Ohio. Convenience stores and gas stations in some parts of Columbus have locked off their restrooms to stop people from overdosing on their premises. Fast-food franchises have inquired about stocking an easy-to-administer anti-overdose drug.

Entire industry sectors report that it's increasingly difficult to find job applicants who can pass pre-employment drug-screening. The Ohio Bureau of Workers' Compensation, which recognized early the overuse of prescription opioids, has put limits on their use to treat on-the-job injuries and begun covering treatment for opioid-dependent workers.

“We're looking at it more as a side effect of the drugs we paid for,” says John Hanna, who directs the pharmacy program for the state agency.

While less than 10 percent of US workers are categorized as substance abusers, according to the US Substance Abuse and Mental Health Services Administration, more than 70 percent of addicts are employed. Those statistics cover abuse of all drugs, as well as alcohol, which remains the biggest workplace problem.

But Mason and others say the impact of opioids—a category of drugs that ranges from prescription painkillers such as OxyContin to an extremely potent form of heroin that's blamed for the alarming increase in overdoses and deaths—comes to work with more than just a relatively small number of employed addicts.

Heroin is most often used by people who are so far down the path of addiction that they've lost or left jobs. There's a far greater number of parents, siblings, significant others, close friends and others who are trying to keep their minds on job duties while worrying constantly about addicted loved ones.

“Think about it,” Mason says. “You're on the job and your youngster or your brother or whatever (is a substance abuser). Think about the distraction. … You're waiting for that call. You don't know what's going to happen. Are they in treatment? Did they skip? It's horrible, and it's a very huge distraction.”

Substance abuse has a very definite impact on productivity, workplace safety and employers' healthcare costs. Addicts call in sick more often and are more likely to be involved in accidents both on and off the clock. There are no statistics on the toll substance abuse takes less directly in the workplace, but David Royer, CEO of the Alcohol, Drug and Mental Health Board of Franklin County, says it's a prime example of the adage that when you hire one person, you hire an entire family.

“You can have some risk factors out there inside families that you may not necessarily see with a direct employee of your firm,” he says. “Any health-related issues … that add stressors, I would think it's germane to the employer to think about it. We see more and more employers focused on wellness programs. We know that the better we take care of ourselves, the less cost we incur as a business for health-related issues. This one is so unfortunately critical that it's going to take special, highly focused kinds of initiatives.”

Enlisting Employers

As part of the Franklin County action plan, a corporate advisory council yet to convene will guide private sector involvement in what still is an effort largely confined to law-enforcement, public-health departments and other government agencies. Royer and Teresa Long, MD, Columbus' public-health commissioner, have some ideas to get the panel started.

Royer envisions educational initiatives in the workplace created by the region's big employers and shared with its small businesses. The lessons would cover topics such as the responsible use of painkillers, the proper disposal of medications that are no longer needed and the need to store prescription drugs where they're not accessible to others.

He sees employees taking home that newly acquired knowledge and sharing it with their families, including elderly relatives whose medicine cabinets can become hunting grounds for addicts.

“Schools are where we have our children congregate,” Royer says, alluding to classroom-based anti-drug programs that were common in the 1980s and 1990s. “The workplace is where we have our adults within certain age groups congregate.”

Long has called on businesses to keep substance-abuse treatment in their employee health plans. It was required as an essential benefit under the 2010 Affordable Care Act, or Obamacare, but congressional Republicans have considered making such coverage optional.

Royer wants employers to distribute disposal kits that allow people to neutralize and get rid of unused medication. Long wants businesses to stock naloxone, a drug that blocks the effect of opioids and is administered to counteract overdoses.

Columbus Police, EMS and Franklin County sheriff's deputies carry the drug, which now is available as a nasal spray. Long says businesses should train their employees how to administer naloxone if it's needed for coworkers or customers.

“I keep asking why it's not in every workplace,” she says. “It's a lifesaver, the equivalent of CPR.”

Policies in Place

Many employers already have the tools needed to address substance abuse among their workers, even though those tools might need some sharpening.

In 1988, Congress approved the Drug-Free Workplace Act, which required some federal contractors and all federal grant recipients to establish policies to discipline, fire or demand treatment for employees who are caught with illegal drugs at work.

Rules have been expanded over the years to require drug-testing in federally regulated industries such as trucking, mass transit and aviation. As a member of the US House, now-US Sen. Rob Portman of Ohio sponsored legislation that helps small businesses establish drug-free workplace policies.

Ohio gives businesses a break on workers' compensation premiums if they implement safety programs that include drug and alcohol testing and at least an hour of substance-abuse education yearly. Participating businesses must test all new hires, anyone involved in a workplace accident and anyone supervisors reasonably suspect of being under the influence of alcohol or drugs at work.

A 4-percent discount for those efforts rises to 7 percent if employers randomly test 15 percent of their workforce annually.

But policies don't equal progress. A National Safety Council survey in May found that while more than 70 percent of US employers have felt an impact from prescription drug misuse—absenteeism, positive drug tests and family issues are among the most common—fewer than 20 percent feel “extremely prepared” to deal with the issue.

The council concluded that 81 percent of company policies are incomplete. They most commonly fail to address issues such as employee use of medical marijuana and employees' responsibility to notify supervisors if they're taking legally prescribed drugs that might affect their job performance.

“Almost every employer has a policy, or at least they think it's a policy,” Mason says. “It might be as little as two paragraphs: Though shalt not, and if you do we'll take action up to and including termination. That's not a policy.”

‘Not a Gotcha Program'

Good drug-free workplace programs have five elements, Mason says: written policies and procedures, awareness and education, supervisor training, employee assistance, and testing.

Weiland's Market in Columbus touches all bases with its decade-old program, and Business Manager Sheila Freeman calls it “a godsend to us.” The Clintonville grocery store requires drug-testing within 90 days for all new hires and pays for an expanded panel of screening that includes the type of opioids at the heart of Ohio's crisis. Most drug tests—including those required of employers covered under federal law—don't include screening for synthetic opioids such as fentanyl.

New employees of Weiland's who fail their test are terminated, Freeman says. Existing employees who fail random drug tests aren't disciplined if they undergo a drug-and-alcohol assessment and agree to abide by whatever treatment recommendation is issued as a result.

“If they agree to do that, we want to help them,” Freeman says. “It's been rewarding. They come back and say thank you.”

Because employees' duties include working with deli slicers and knives, driving forklifts and unloading trucks, the US Occupational Safety and Health Administration classifies grocery stores among high-risk industries for workplace accidents. Worker safety is the underlying reason for Weiland's Market's policies, Freeman says.

Ronald Suttles, interim chief of employer services for the Ohio Bureau of Workers' Compensation, says safety is always at the heart of drug-free policies. State government worked with businesses, organized labor and industry experts in developing the guidelines it issues for what it refers to instead as “drug-free safety programs,” he says.

“It's not a ‘gotcha' program,” Suttles says. “Part of the policy includes getting treatment and then getting that person back in the workplace.”

The Root of the Problem

The history of the current opioid epidemic dates back to the 1990s, when medical organizations began referring to pain as a vital sign and recommended that pain management be a priority in treatment. Although other vital signs such as blood pressure can be measured objectively, doctors had to rely on patients to report their own pain levels, and patient-satisfaction surveys used by the federal government to determine Medicare reimbursement rates asked people if they felt doctors did enough to control their pain.

Several studies and marketing campaigns described prescription opioids as safe and nonaddictive, and their use skyrocketed. Injured workers—they number about 100,000 annually in Ohio—were among those receiving the drugs.

Before the Bureau of Workers' Compensation began limiting their use in 2011, the agency found more than 8,000 Ohio workers with opioid prescriptions at doses higher than what's considered clinically dependent. Nearly 5,000 of those workers had prescribed doses eight times higher than the clinically dependent threshold.

“We had a whole class of legal addicts. For years we had a lot of folks addicted to pain medicine, and they were legal,” says Royer of Franklin County ADAMH. “Over here were the illegal addicts. So then you shut the spigot off to the pills, and it migrated over. That's when it really started to explode. That's when they had to go find it in the illegal markets.”

A Different Approach

In October 2016, as the state put in place new limits on the doses and duration of opioids prescribed to injured workers, it also began covering treatment for those who became dependent on drugs that were covered under workers' comp claims. The bureau now reimburses companies for up to 18 months of an employee's medically assisted treatment, behavioral and psychological counseling, or inpatient detoxification.

Some contrast the focus on treatment and compassion for addicts in the current drug crisis with the zero-tolerance focus on strict sentencing during the war-on-drugs era decades earlier. They point to the demographic differences this time around: Opioid abuse affects mostly whites, extends to rural and suburban America, and is dispersed among economic classes.

But others say evolving attitudes toward addiction, lessons learned from those earlier anti-drug efforts and the sheer magnitude of this opioid epidemic are also part of the change in approach.

“We're not going to arrest our way out of this problem,” says Hanna, who as pharmacy program manager for the Bureau of Workers' Compensation helped shape Ohio's more benevolent response. “We're certainly not going to fire our way out of it, either.”

As Royer speaks with central Ohio corporate leaders and business owners, he tells them the same thing: Addressing the opioid epidemic is going to take all hands on deck.

“There are no trends that I've seen yet that are trending the right way,” he says. “Deaths are up. Overdoses are up. … Children being taken from families due to parent use is up. Everything is trending the wrong way.

“I've been in this business for almost 40 years. I have never seen something like this, even at the heyday of the crack epidemic or the methamphetamine problem. This one is outpacing all of us. It's killing our citizens, it's destroying families, and it's impacting every sector of our economy. So when you have that stark reality, you have to bring all parties together, each contributing what they have to construct something that will stem the tide of everything going the wrong way.”

Bob Vitale is the associate editor.