Drugs and Alcohol in the Workplace (Part 2) | The WorkSAFE Podcast

One in four adults binge drinks, and one in ten adults uses illicit drugs. They’re not out on the street, though: research shows that most of these adults are working at jobs. In this discussion, we explore the risks that safety professionals need to know about, and best practices for mitigating them. This episode is part two of a two-part series on drugs and alcohol in the workplace; part one is here. The following is a transcript of the conversation, which you can also hear using the player.

Part 2: Drug Testing and Managing Claims

Benskin:

Welcome to the WorkSAFE Podcast. I’m here with two people who have been on the podcast with us before, but could you both introduce yourselves again for our new listeners?

Dumas:

Sure. I’m Breck Dumas. As I said in our last podcast, my background is in politics and business. I worked as a U.S. Senate staffer, as a researcher and as a representative, and I also served as the editor of the Columbia Business Times. Now, I exclusively write, and have researched on the usage of drugs in the workplace.

Sweeten:

I’m Terri Sweeten. I’m a field service manager, and my entire career has been in the world of workers compensation. I started when I was in college at the Division of Work Comp, and I worked up through being a claim rep, a supervisor, a safety consultant, and now I’m doing field service work.

Benskin:

The topic of discussion today is the overarching impact that drug and alcohol, or substance abuse in general, has in the workplace. How widespread of a problem is this in society and in industry today?

Drug users are in the workplace

Sweeten:

According to the National Council on Alcoholism and Drug Dependence, more than 70 percent of those abusing illicit drugs in America are employed. Most of the time, we think of drug users as not being actively employed, but unfortunately, according to the articles, studies and research, they are actively employed in the workforce.

Benskin:

Breck, you’ve also found that to be true in your research on performance-enhancing drugs, because a lot of your research indicated that people are taking these drugs to enhance their performance on the job, right?

Dumas:

Absolutely. They intended to be top performers, and didn’t see their situation as being one of abuse. And I’m not saying it is either. It’s very subjective and on an individual basis. But we’re talking about maybe the difference between recreational drug use or substance abuse, and then the use of prescription drugs that are enhancers.

Bottle of pills spilled onto table.
Benskin:

You’re talking about enhancing. We always see drugs as performance degraders – a detriment to work performance, but to your point, some can enhance performance. But it’s still the same widespread problem of substance abuse in business. Terri, how do employers address that, when maybe the employee’s performance is being enhanced – when it’s not just a detriment, or safety risk to employees and coworkers?

Sweeten:

Well, one thing we understand is that employers need to get as much productivity out of employees as they can. But when they do that, it also affects that employee’s health. So eventually, the use of those enhancing drugs is going to result in a workplace injury, or an employee becoming unhealthy and being sick. Employers have to have a policy, and they can’t turn a blind eye to an employee using something to enhance their productivity, and then say, when they’re doing something that hurts the company, that we want to have a different policy. They should have one policy that covers any use of drugs and alcohol in the workplace, stick with it, and not discriminate against their employees.

Benskin:

We’ve talked about it before: having that drug and alcohol policy in place prior to employment is key. Are there other resources that employers can utilize to try and deter employees from abusing substances in the workplace?

Files and policies in a drawer.

Be aware of your employees’ behavior

Sweeten:

Sure, there are a lot of policies and procedures, but what they need most is awareness. They should always know what their employees are doing, how they’re doing it, and how they’re performing. If they see changes in that employee – if they see that an employee used to always do their work in one way and now they’re doing things differently and unsafely – they need to take action, before they have a workplace injury instead of afterwards. Once they have an injury, it’s a whole different scenario. They can’t discriminate; they can’t let someone go as a result of a workplace injury. They need to deal with any kind of concerns before they have an injury; once they have an injury, they need to seek legal counsel.

Benskin:

It’s human nature: it always takes some type of an injury or incident to bring that awareness.

I think sometimes these employees who are abusing substances are giving off signs that other employees, or the employer, are seeing. Why do you think coworkers and/or supervisors don’t address this problem, when they notice the signs of substance abuse, before it turns into an injury in the workplace?

Sweeten:

I think it comes down to productivity – if they’re getting the job done. We hear that nationwide there’s a shortage of good, qualified employees. If they’re getting the job done, sometimes employers turn a blind eye until that injury occurs.

Benskin:

You spoke about the shortage of employees. Let’s talk about that. Breck mentioned welding in particular, and how hard it is for them to find welders who can pass a drug screening. Do you think that’s becoming more prevalent? We push for all employers to have a drug and alcohol policy. Have you seen employers who don’t have a policy just so they can hire employees to get the job done and maintain their business?

Sweeten:

I have. I’ve had employers tell me “If I did pre-employment drug testing, I could not hire an employee.” Unfortunately, you’re hiring a problem when you do that. According to addictioncenter.com, some people who abuse drugs or alcohol might qualify as high-functioning; able to reach personal and professional success despite substance abuse. So, you can’t always tell by the person walking in the door. You really need to do that testing and have a pre-employment test on-site. There are good employees out there who can be productive without drug use. Employers need to try to search out those individuals, because once they have a claim and they’re under the influence, it raises work comp costs, it involves more emergency room care, and they’re going to pay for it in the long run if they don’t take care of it in the beginning.

The costs of bypassing tests

Benskin:

In the work comp industry, we talk about the experience mod of a company based on past injuries. Terri, you talked about employers who say they’d never be able to hire anyone if they did pre-employment drug screenings. Do you see that reflected on their e-mods? Do those companies who have that stance tend to have more frequent injuries?

Sweeten:

They do, and they tend to have a higher experience mod. The reason for that is that employees who are using drugs and alcohol in the workplace know which employer doesn’t test. I’ve had people out there say, “I can’t go to that employer because they’ll test me, but I can go to the one down the road and they won’t.” Typically, the one down the road will have the higher e-mod and higher frequency and severity of injuries, but they’re also going to have those employees out and not working, which leads to a loss of business.

Dumas:

Terri speaks to a really good point. There’s this flip side that some employers express that it makes them less competitive if they do drug tests. It’s a determination for each industry or business: Do I want to pay for this on the front end or on the back end? It is a reality. Especially touching back on certain drugs that have less of a social stigma, like recreational use of marijuana, or even medical use. There are some employers who don’t care about that anymore. It used to be a really big deal, but now it’s seen, especially if someone has a desk job – what do I care? Especially in certain industries, you’re going to attract more people if word gets around that you’re not testing for weed, frankly. That’s part of the discussion that I think gets overlooked a lot of times.

Sweeten:

Society has come across that it’s okay to be under the influence of something to get your job done. Unfortunately, that leads to more injuries. Approximately 16 percent of emergency room patients injured at work have alcohol in their system. That’s 16 percent who are getting injured – there are a lot who aren’t getting injured, and there are a lot who aren’t reporting a claim. That’s a lot of people out there under the influence of something.

Benskin:

That’s a pretty big number, 16 percent under the influence of alcohol after they’ve been injured. That goes back to accident investigation, too, from an employer’s standpoint. If an employee gets injured on the job, it’s very important to dive right in to the circumstances surrounding that injury, and then also to do drug screenings when the injury occurs. Can you speak a little bit about that?

Work comp law and self-administered tests

Bottle of pills with alcoholic drink.
Sweeten:

I can. The Missouri work comp law changed in 2017, and the law now specifically states that an employer must test an employee within 24 hours post-injury. That’s not 24 hours of knowledge, that’s 24 hours from the time that employee got injured. That employer needs to be well aware of an injury. They need to have a good accident reporting policy in place, so an employee knows that when they’re injured, supervisors should know so they get it reported to the right person. They need to get that drug test done within 24 hours, and if it is a positive drug test, it could be up to a 50 percent penalty under the work comp law; the employee may be responsible for part of their work comp claim.

If the cause of injury is that the employee’s under the influence of alcohol, and they’re involved in an auto accident, they get a DWI – those are some of the scenarios that we’ve seen in the claims handling profession – that could be a total denial of the entire work comp claim. Because it’s up to that employee to prove that being under the influence didn’t cause that accident. That’s pretty hard to do when you get a DWI. The employer has to take the next step, though. They have to do drug testing and get it to a certified clinic and lab. If they do have a positive test, they need to get it certified and then follow through to take advantage of what’s available to them under work comp law.

Benskin:

A lot of our policyholders are in rural areas; they may not have quick access to a screening lab to send their employees within that 24-hour period. As I understand, there are some new resources to help with that post-injury testing. Companies like Orasure actually provide testing kits that employers can use right there on the job site. What’s been your experience with those types of resources, and are they appropriate for employers in rural settings?

Sweeten:

We have a lot of employers doing the self-administered tests. They do tend to be in rural areas, because if they’re going to send their employee for a drug test, they’ll be gone for half a day by the time they drive to the location and get tested. What they’re doing is if they get a positive test, then they send that individual to a clinic for a follow-up. The majority of your tests are probably going to be negative, so that solves for making the employee travel, doing the extra testing, those types of things. MEM is developing some contracts and programs that will help reduce those costs associated with the self-administered tests. Employers just have those available in their office, the employee takes the swab and does it themselves. If it comes back positive, then you go on further to the next step. If it’s negative, then you move on to managing that claim.

Dumas:

So, if a substance shows up but they have a prescription, does anybody care?

Sweeten:

At that point, they need to ask the physician about the restrictions on the use of that. Can they drive? Can they operate heavy equipment? The answer may be yes, under the influence of this drug, you can. You can Google just about any drug and get the side effects and precautions for it, and employers do some of that too. If it says you can’t drive, then you can’t operate our equipment or our vehicles.

Technician draws blood from patient.

Prescription drug misuse and testing

Dumas:

Another interesting point: I wonder if, in some industries, drug usage and the increase in prescription and non-prescription is sort of “wagging the dog.” Let me give an example. With life insurance underwriting now, they don’t rate up often for someone being on antidepressants, which has not always been the case. The reason for that is that it’s so widespread. So many patients, customers, clients, Americans – however you want to describe them – are on those medications that it’s become sort of a new baseline. You have to wonder if, at least in certain instances – maybe in trades, where they’re not operating heavy machinery – if people are going to say, like we’ve talked about, “So many people are using XYZ drug, let’s just throw that one out because it doesn’t make us competitive.”

Then you have this added situation where people are using prescription drugs that are easily available. We’re talking about Ritalin, morphine, valium, Adderall, Ambien and codeine. These things that are household prescriptions that become the norm and probably aren’t going away anytime soon. People have become dependent on them. We’re seeing the extremes with the opioid crisis in the U.S. I don’t think anybody has an easy solution to that one. It’s evident that the access that people have to drugs across industries is impacting how people operate and how they do business.

Benskin:

That’s an important point, to call out some of those more prevalent drugs, even though they’re prescription and they’re mainstream. You know, if you go into the doctor and have a certain set of symptoms, that’s the drug that they’re going to prescribe to treat that. I think that kind of muddies the waters a little bit when it comes to work comp in particular, and how employers address that substance abuse or being under the influence. That makes it more difficult from an employer’s standpoint to try and mitigate the risk associated with substance abuse.

Also, on the backend, what does the disciplinary action look like to not only cover the liability that your business has with an employee under the influence, but also the liability if you wrongfully terminate an employee and it is a prescription drug that they have a valid prescription for? It’s figuring out what drug the employee is on, finding the list of limitations or restrictions that the pharmaceutical industry puts on that drug and then trying to apply that to the workplace.

Sweeten:

Exactly. Now we’re getting outside of our expertise, so employers really need to seek legal advice on to what you can and can’t do with employee discrimination and wrongful termination; those aspects are outside the work comp world. It is, unfortunately, the reality we’re living in.

Dumas:

It’s interesting because it’s kind of the market. Is having a policy in place going to disincentivize employees from using substances? A lot of them are probably going to just go get a job somewhere else. That’s the reality of it, if it’s something prescription or not. Getting into the liability issue, like you said: Legal counsel is just a given on any of these scenarios up front, because prescription and use don’t necessarily equal abuse, and I think we all recognize that.

Reporting a claim with a positive drug/alcohol test

Benskin:

Back to claims management. If we have an injured employee who reports a claim, goes through that post-injury drug screening and they come back positive, what are the next steps as an employer? How do you address that, both with the employee and with the insurance carrier, knowing that employee was under the influence of a substance?

Sweeten:

First of all, you need to make sure it does go through a certified lab so there’s no question that it was read by a certified, qualified individual. If you have a certified test, keep in mind that may be a little bit after the claim; sometimes those drug tests don’t come back immediately. The majority of the time, that’s going to go to the employer. Employers have to set up for their initial medical care with a provider that will do the drug test. They can also self-administer, but they need to know where they send that off to should it turn positive.

If they have that in place, then when that test comes back, they need to notify their claim rep and have that discussion. Do they have a drug and alcohol policy? Is it enforced? Yes, we knew that employee was under the influence and we didn’t do anything about it. Or no, we didn’t have any idea, we do have a policy and we will enforce it. If that’s the case, then that penalty under work comp statute can be considered for that employee, or the total denial of the claim, depending on the scenario.

Benskin:

Is there anything else that either of you want to flesh out before we wrap up?

Dumas:

If it’s beneficial, I think it’s noteworthy that employers might want to pay careful attention to young workers. We’re seeing a lot of drug usage that’s following from high school into college or from high school right into the trades. Primarily Adderall and steroid usage. A lot of college and high school athletes start taking steroids and of course none of them are tested. It becomes something that they use a lot and it has its own consequences. That’s something to pay attention to; something that you typically wouldn’t suspect.

Here at the University of Missouri not too long ago a student overdosed in the library on Adderall. My understanding is that you’d have to have a whole lot of that in your system for that to occur. The point is, it’s out there and available, and a lot of these kids have used them to become high performers. So, being aware of that. I guess you can speculate and be paranoid. That’s the other thing: Do we become suspicious of everyone who’s a top performer? Of course not! It’s something that should be considered, I’d think, in a drug policy.

Pharmacist examines a lab test.
Sweeten:

One thing from a work comp claims standpoint, too. I get this question a lot: What if my employee doesn’t report that claim until 25 hours after the injury, what do I do? First, you have to have a clear accident reporting policy. MEM has one on our website. It’s easy to follow; take it and fill in your own information. It clearly tells employees when they’re supposed to report. We always recommend that they report before the end of the shift. The reason we recommend that is everyone knows when they get off work. They may not know what “immediately” means or some word like that, but they know when they get off work. If an employee reports a claim before they get off, you should have enough time to get a drug and alcohol test.

If an employee reports it beyond that 24 hours, we do recommend to go ahead and do the testing. If it turns out positive, you still have a policy in place that you can follow. We may not be able to take a drug penalty or deny the claim, unless we can prove they were late reporting only to avoid a drug test.

OSHA regulations and final thoughts

Sweeten:

Another thing that we hear an awful lot in our world right now is that OSHA came out with some new guidelines that you should pick and choose who you drug test. For example, if someone’s got a bee sting or carpal tunnel, they shouldn’t be drug tested. OSHA’s objective was to avoid companies threatening a drug test to keep employees from reporting a claim. So, as long as you have an accident reporting policy, you’re not threatening that employee with a drug test to keep them from reporting. You’re fine across the board from OSHA. We’ve talked to a lot of inspectors, we’ve done research, and we’ve gotten legal opinions.

The legal opinions are: follow your drug testing policy for all employees. Don’t discriminate. Do the test if someone seeks medical care outside of your employment. Have a good accident reporting policy in place. I’ve been told by OSHA inspectors that if companies have a good policy in place, they’re not discriminating or threatening employees to not report a claim. They won’t even consider that when they’re going in to do an inspection. Our employers just need to make sure they have a good, firm policy in place, they follow it, they don’t discriminate, and they do the drug testing and keep their employees safe and their workplaces safe.

Benskin:

We like to ask all of our guests on the podcast to give us their biggest safety tip. What would be an overarching safety tip that you live by?

Dumas:

Oh, boy. I have a desk job, so I would say generally, know your industry. If I were going to give advice to an employer – you’re going to have a better idea of what’s going to apply to your own employees and to your business. And doing right by people makes things work out.

Sweeten:

Drug abuse and addiction cost American companies $81 billion every year. If you look at those numbers, I don’t think employers can just sit by and turn a blind eye to all the things that we’ve been talking about today – that Breck talked about. It’s not just what you see like marijuana or cocaine. It’s all of these enhancing drugs; things that are readily available through a prescription or on the market. Employers have to protect themselves, and the best way to do that is to have a written and enforced drug and alcohol policy. Don’t discriminate. Across-the-board testing will help you keep your employees safe and injury-free.


Thanks to Terri and Breck for sharing their expertise on the podcast. Check out our other WorkSAFE Podcast episodes, and subscribe for more workplace safety stories and insight.

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