Economic Value of Drug Testing in the Workplace. for Health Payers and Employees

Transcription

1 Economic Value of Drug Testing in the Workplace for Health Payers and Employees Author: Scott Howell, M.D., MPH &TM, CPE, Chief Medical Officer, Tenet Diagnostics Copyright 2017 Tenet Diagnostics, Inc. All rights reserved.

2 TABLE OF CONTENTS Mandatory Guidelines Introduced Putting Drug Tests to Work Work-Related Accidents Medicaid and Drug Testing Greater Social Good Page 2

3 OVERVIEW Drug abuse in the workplace has become a common problem nationwide. For many payers and employers, the time has come to consider all available options for resolving this issue. As the opioid crisis continues to penetrate across all racial and socioeconomic strata, hard-working middle-class America has become devastated. Today, it s become an imperative to understand the implications and impact of this epidemic on America s workforce, gain a more comprehensive understanding of how deeply this issue cuts, and take action. Consider these eye-opening numbers: 70 percent of the 14.8 million Americans who abuse drugs are employed. 1 When an employee abuses drugs, employers and payers take on the risk of: workplace injuries, compromised productivity due to absenteeism and presenteeism, and liability. 2 Drug abuse can cost U.S. business owners more than $140 billion dollars every year, which includes turnover rates for employees who abuse drugs. 3 The drugs at the root of this issue include cocaine, heroin, ecstasy, methamphetamine and prescription drugs. Designation of the opioid crisis as a public health emergency in October 2017 takes an important step toward solving a problem that impacts people of all ages and ethnic groups throughout the country. While it is expected that this declaration will offer states and federal agencies more resources and power, what is really required is greater access to toxicology labs and drug testing. Absenteeism or missed work Employee use of prescription pain relievers at work Positive drug test Impaired or decreased job performance Family member of employee affected Complaints to HR / Negative impact on employee morale Near miss or injury Borrowing or selling prescription drugs at work Arrest (on/off job) Overdose None of the above Source: Seventy-one percent of U.S. employers say they have been affected in some way by employee misuse of legally prescribed medications, including opioids. 4 Most employers have a drug-free workplace policy directed at illegal drugs, but fail to test for prescription drugs despite growing misuse of opioids. Other findings include: Only 19 percent of employers feel extremely prepared to deal with prescription drug misuse in the workplace 81 percent lack a comprehensive drug-free workplace policy 41 percent of those that drug test employees are not testing for synthetic opioids 70 percent would like to help employees who are struggling with prescription drug misuse return to their positions after completing treatment. 5 Page 3

4 OVERVIEW (continued) The stark reality is that our current system does not have the necessary capacity to truly meet clinical demand for testing. It is incumbent upon our nation s insurance companies and health plans to expand their contracting and reimbursement with an expanded network of labs that can meet the needs of medical providers who are ordering drug tests. With increased access to testing, both providers and patients will be better positioned to curb this deadly epidemic. Employees who abuse prescription drugs are two to five times more likely to take unexcused absences, be late for work, be injured or violent at work, file workers compensation claims, quit or be fired within one year of employment, according to the National Safety Council. 6 The up side of this equation is that employees are more likely to undergo treatment when it is fostered by an employer, and individuals in recovery go on to become better workers using less healthcare, taking less unscheduled leave and involving slightly less turnover than their non-abusing colleagues. In fact, each employee who recovers from a substance abuse disorder saves a company more than $3,200 a year. 7 Page 4

5 SECTION 01 MANDATORY GUIDELINES INTRODUCED New federal mandatory guidelines 8 for workplace drug testing became effective on October 1, 2017, and include the authority to test for four semi-synthetic opioids: oxycodone, oxymorphone, hydrocodone and hydromorphone. These are prescription opioid pain medications that are commonly known as OxyContin, Vicodin, Percocet and Dilaudid. Source: These four prescription pain medications were added to the standard testing panel because data indicates that although they are prescribed, they are the prescription pain medications that are most frequently used without medical authority. However, under the revised Mandatory Guidelines, positive drug testing results that have a legitimate medical explanation (e.g., supported by a valid prescription), as determined by a Medical Review Officer (MRO), will not be reported to federal agencies. These revised Mandatory Guidelines for Federal Workplace Drug Testing Programs using Urine (UrMG) affect all federal employees in a testing designated position, which is defined by each agency s Drug-Free Workplace Program. In 1986, the Federal Drug-Free Workplace Program was initiated by Executive Order to establish the goal of a drug-free federal workplace. The Program made it a condition of employment for all federal employees to refrain from using illegal drugs on or off duty. Employers should consider working with employee assistance programs to develop policies that include conducting pre- and post-employment drug testing for prescription drugs, teaching managers to spot addiction and developing a strategy to intervene. They should also find insurance plans that cover treatment, a system for supporting employees returning to work post-treatment and an assessment of whether the company culture encourages substance abuse. 9 Page 5

6 SECTION 02 PUTTING DRUG TESTS TO WORK Employment drug testing is a powerful risk mitigation tool that provides far-reaching organizational and societal benefits. In addition to promoting a safer, more productive workplace, it can help to decrease employee turnover and absenteeism, reduce employer risk, and lower workers compensation incidence rates.10 A standard 5 or 10 panel urine drug screen typically costs between $30 to $60, but the hidden costs of not having a drug testing program can be dramatically higher. In fact, abuse of tobacco, alcohol, and illicit drugs is costly to the U.S., exacting more than $740 billion annually in costs related to crime, lost work productivity and healthcare.11 Keep in mind that healthcare accounts for about one-third of costs attributable to the prescription opioid epidemic, while one-fourth of costs are borne by the public sector.12 Workforce Drug Testing Index: As overall substance abuse rises across the United States, drug testing programs continue to play an important role in helping to create safe, drug-free workplaces. Source: Page 6

7 SECTION 03 WORK-RELATED ACCIDENTS OPIOID CRISIS IN THE WORKPLACE 16 $10B According to the American Society of Addiction Medicine, opioid abuse costs employers approximately $10 billion from absenteeism and presenteeism alone. The Centers for Disease Control and Prevention says that while it is unknown how many drug and opioid overdose deaths are associated with workplace injuries and illnesses, this national epidemic is impacting workers and employers. $19,450 A 2016 report notes that opioid abusers cost employers as much as $19,450 annually in medical expenses on average, compared with $10,853 for non-abusers. Up to 20 percent of work-related fatalities test positive for drugs or alcohol. Substance abuse endangers co-workers, employers, as well as consumers, clients or partners and workplace accidents due to drug abuse can have farreaching implications. 13 Despite the numerous safety protocols at the workplace, 40 percent of all industrial workplace fatalities are caused by substance abusers. 14 These people may not realize the danger they create by using at work, or while recuperating from substance abuse. Substance abusers are ten times more likely to miss work, negatively impacting themselves and others by jeopardizing their jobs and creating backlogs. Safety is one of the main reasons why employers opt to perform random drug tests on employees. It is especially important in a company where employees drive, work directly with consumers, operate machinery or perform manual labor. The construction and manufacturing industries in particular have an especially high rate of on-the-job drug use. When an employee is caught using drugs, the employer can help by putting them in a recovery program that s paid for by the business or health plan. After completing the recovery program, the employee can return to work, saving the employer the expense of hiring and training a new employee. Productivity Levels Workers who report having three or more jobs in the previous five years are about twice as likely to be current or past year users of illegal drugs as those who have had two or fewer jobs. 15 Drug abuse can cause lost productivity due to: After-effects of substance use (withdrawal) Preoccupation with obtaining and using substances while at work, interfering with attention and concentration Illegal activities at work, including selling illegal drugs to other employees Psychological or stress-related effects due to drug use by a family member, friend or coworker that affects another person s job performance Page 7

8 SECTION 03 All of these factors can lead to inconsistent work quality, poor concentration, lack of focus and carelessness. The workplace can be an important place to address drug abuse issues. By establishing a drug-free workplace, employers can help employees and their families through referrals to community resources and services. Considering that the U.S. represents five percent of the world s population and consumes 60 percent of the world s supply of illicit drugs, drug testing can be viewed more as an investment 17 against the cost of low productivity. Liability Legally, employees who are injured on the job or fired because of drug-related incidents are not entitled to compensation and are less likely to file suit against their employer. By testing employees for drugs, employers are helping protect their company from liability, potentially lower workers comp costs and, in some states, premiums. Employers can use positive drug test results, for tests taken immediately after work injuries, as a method of denying or defending workers comp claims. 18 Harm Caused by Drugs Harm to others Harm to users *With a maximum possible harm rating of 100 Alcohol Herion Crack Cocaine Methamphetamine Cocaine Tobacco Amphetamine Cannabis GHB Benzodiazepenes Ketamine Methadone Mephedrone Butane Qat / Khat Anabolic Steriods Ecstasy LSD Buprenorphine Mushrooms Source: Page 8

9 SECTION 04 MEDICAID AND DRUG TESTING In the world of public policy and legislation, the question of whether or not to require drug testing for welfare recipients is divisive and emotionally charged. It s important to keep in mind, however, that government healthcare programs are among the biggest suppliers of prescription painkillers, and Medicaid may play a role in promoting opioid abuse and addiction. Data from the Centers for Disease Control and Prevention show that overdose deaths per capita rose twice as much on average between 2013 and 2015 in states that expanded Medicaid than those that didn t. The number of opioid-related inpatient hospital stays nationwide (among states submitting data) that were paid for by Medicaid increased by about 40 percent between the fourth quarters of 2012 and 2014 about four times the rate of growth in Medicaid enrollment. 19 These problems have become even more acute following Medicaid expansion. 20 As of May 2016, at least 17 states were in the process of creating drug testing legislation for welfare recipients, according to the National Conference of State Legislatures (NCSL). Several states include other assistance programs, such as medical assistance, Supplemental Nutrition Assistance Program, child care, and other state-funded programs. At least 12 states include language requiring testing only if there is reasonable cause to believe the person is using illegal substances. In most cases, if the applicant or recipient tests positive they are ineligible for benefits for a specified period of time or until they complete a substance abuse treatment program. 21 Drug testing can identify individuals who can benefit from substance abuse treatment and monitor those who are in a treatment program. For pain management, drug testing ensures optimal dosage and prescription adherence, and helps to mitigate drug diversion. Page 9

10 GREATER SOCIAL GOOD SECTION 05 Workplace drug testing makes the stakes of drug use and abuse even higher, encouraging employees to be less inclined to use drugs if they know it could threaten their employment. A random testing program is a key component in making drug testing truly effective. According to the Office of Health and Safety Services, ongoing employee drug testing lowers the number of employees who test positive. 22 Drug testing today is highly accurate, with a number of methods to ensure validity, coupled with incentives in some states that include reduced insurance costs and workers comp discounts. 23 Ultimately, employers are concerned about safety as the primary framework for drug testing. It s much more preferable to avoid the accident rather than determine what happened after the fact. Currently, only a few jobs have federally mandated drug testing: pilots, truck drivers, train operators and occupations deemed safety sensitive. The National Safety Council recommends employers be proactive, and take the following steps to create a drug-free work environment: 24 Partner with prescription drug and health plan providers to help gatekeep, monitor, and intervene on the use of prescription drugs Review the company s drug-free workplace policy to protect employees and reduce liability Ensure that any employee drug-testing program includes testing for the most commonly prescribed opioid painkiller drugs Educate employees about confidential help available through an employee assistance program Remind employees about the drug-free workplace policy, testing policies, and confidential help available through an employee assistance program Medicaid, Medicare, and major insurance companies face increased costs for drug test screening. These costs are not caused by a spike in the use of narcotics by subscribers, but from unnecessary testing and overbilling by doctors and drug screening companies. Therefore, it s important to partner with a highly reputable drug testing facility that offers fast, accurate, high-quality laboratory and genomic testing, and serves as a collaborator with employers, payers and clinicians by providing an extensive range of testing services, including specialized diagnosis, screening and evaluation. About Tenet Diagnostics, Inc. Tenet Diagnostics, Inc. offers fast, accurate, high-quality laboratory and genomic testing to hospitals, clinics and physicians offices to help them provide the best patient care. As collaborators with employers, payers and clinicians, we offer an extensive range of testing services, including specialized diagnosis, screening and evaluation for a host of conditions and diseases related to orthopedics, pain management, primary care and oncology. Tenet Diagnostics has been accredited by the College of American Pathologists (CAP) to ensure the highest standard of care for patients. Visit Page 10

11 END NOTES 1 Wilcox, S. (2015, April 26) Drugs and Alcohol in the Workplace. Retrieved October 18, 2017, from org/about-addiction/addiction-update/drugs-and-alcohol-in-the-workplace 2 Yogoda, Robert. (2016, August 4). Addiction in the Workplace: Tips for Employers. Retrieved October 18, 2017, from 3 Why is Drug Testing Important for Employers? (2014, March 28). Retrieved October 18, 2017, from 4 As Opioid Epidemic Rages, As Opioid Epidemic Rages, Elejalde-Ruiz, A. (2017, April 10). Cost of substance abuse hits employers hard, new tool shows. Retrieved October 18, 2017, from 7 Elejalde-Ruiz, B. (2017, September 29). Mandatory Guidelines for Urine Testing Updated to Include Four Semi-Synthetic Opioids. Retrieved October 18, 2017, from 9 Elejalde-Ruiz, , 2. M. (n.d.). Drug Testing Promotes Workplace Safety. Retrieved October 18, 2017, from Articles/2012/10/01/Drug-Testing-Promotes-Workplace-Safety.aspx 11 Abuse, N. I. (n.d.). National Survey of Drug Use and Health. Retrieved October 18, 2017, from gov/national-survey-drug-use-health 12 Costs of US Prescription Opioid Epidemic Estimated at $78.5 Billion. (n.d.). Retrieved October 18, 2017, from wolterskluwer.com/company/newsroom/news/2016/09/costs-of-us-prescription-opioid-epidemic-estimated-at-usd78.5- billion.html 13 Workplace Accidents and Drug or Alcohol Abuse -. (2014, May 19). Retrieved October 18, 2017, from bradfordhealth.com/workplace-accidents-drug-alcohol-abuse/ 14 Workplace Accidents and Drug or Alcohol Abuse, Sandy Smith Mar 11, (2014, March 11). Drug Abuse Costs Employers $81 Billion Per Year. Retrieved October 18, 2017, from 16 Addressing the opioid crisis in the workplace. (n.d.). Retrieved October 18, 2017, from insights/clientadvisories/pages/addressing-the-opioid-crisis-in-the-workplace.aspx 17 Cost of Drug Testing. (n.d.). Retrieved October 18, 2017, from 18 Workplace Drug Testing and New OSHA Regulations. (2016, October 27). Retrieved October 18, 2017, from Finley, A. (2017, September 24). Does Medicaid Spur Opioid Abuse? Retrieved October 18, 2017, from wsj.com/articles/does-medicaid-spur-opioid-abuse Finley, A., Finzel, R. (n.d.). Retrieved October 18, 2017, from 22 Drug Testing. (n.d.). Retrieved October 18, 2017, from 23 Screening, N. D. (n.d.). Why Workplace Drug Testing is Essential in Retrieved October 18, 2017, from As Opioid Epidemic Rages, Page 11

12 Copyright 2017 Tenet Diagnostics, Inc. All rights reserved.