Despite public perceptions that prescription drugs are less dangerous than illicit narcotics, overdoses of opioids (synthetic versions of opium i.e. codeine-like medication) caused more deaths than heroin and cocaine combined in the US in 2007.
The cost of prescription opioid abuse is already substantial and is a growing economic burden for the workplace and the greater society.
So what are the signs of opioid dependence, and how can it be treated to best benefit both the employer and employee?
The medical use of the opium poppy (Papaver somniferum) predates recorded history. Opium is the source of many opiates, including morphine, heroin, pethidine, methadone and codeine. The Latin botanical name of the 'sleep-bringing poppy' refers to the pain-killing and sedative properties of some of these opiates.
Opioids are most often prescribed by doctors or sold over-the-counter in pharmacies to treat pain, and when taken as directed they do a great job. This is good for the workforce, since successful treatment of pain results in less absenteeism and improved productivity.
According to the US Centers for Disease Control and Prevention, deaths from unintentional drug overdoses in the US have been rising steeply since the early 1990s and are the second-leading cause of accidental death. Overdoses of opioids (synthetic versions of opium) caused 11 499 deaths in the US in 2007.
South African situation
Professor Charles Parry, Director of the Alcohol & Drug Abuse Research Unit of the Medical Research Council (MRC), outlines the level of use in South Africa: "Of 8 407 persons seen in the 58 treatment centres participating in the MRC's South African Community Epidemiology Network on Drug Use (SACENDU) network (across all nine provinces) in the second half of 2010, 16.3% had heroin or other opiates as a primary or secondary substance of abuse."
Dr Hashendra Ramjee, a general practitioner with an interest in treatment of addictions, based at the Houghton House Group of Treatment Centres in Randburg as well as AKESO Hospital in Alberton, says he is seeing more younger patients using illicit opioids. "This has probably been an increasing trend over the last five years. However, among the older population there is certainly a known trend in terms of prescription or 'over-the-counter' opioid abuse (codeine). Generally, prescription/over-the-counter opioid abuse is more prevalent in the older age group of 30 to 70 years. In terms of race, there is certainly an escalation among all race groups – and a very noticeable escalation in the black and Indian population, particularly in with illicit opioid use."
What is opioid dependence?
Weich et al. in the South African Medical Journal describe opioid dependence as "a chronic relapsing disease that develops from repeated self-administration of opioids, including heroin, over-the-counter and prescription opioids…associated with distinctive behavioural patterns including compulsive substance seeking and repeated use despite horrendous consequences."
We are not necessarily talking hard-core heroin addicts here. Someone with dependence on opioids is quite likely to be sitting in an office cubicle.
What are the signs?
"There is social and occupational deterioration - deterioration of relationships at home, not fulfilling responsibilities (recurrent), agitation, restlessness, looking uncomfortable (sweaty, shaky, dazed after using), recurrent absence from work, 'disappearing' during work often and taking lots of breaks. Needle 'track' marks on arms or hands. Stealing and often asking to loan money are common," says Ramjee.
In the workplace environment this translates into:
- Absenteeism and on the job absenteeism: The worker takes longer and more frequent breaks, comes in late, and will often be 'missing in action'.
- High accident rate: They become clumsy and unfocused, and will disregard standards.
- Difficulty concentrating and confusion.
- Inconsistent work patterns, e.g. becoming unable to take initiative or work independently.
- Reduced knowledge/technical skills: They no longer stay on top of their game.
- Change in behaviour and attitudes: They may behave inappropriately, become emotional, or be withdrawn, with poor relationships in the workplace.
- Lower job quality and quantity of output.
To add to the issue, Weich et al. report that: "The problems of opioid-dependent individuals evoke shame, denial and defensiveness in the addict." Many opioid-dependent people go to great lengths to hide physical signs of their substance abuse. The 'red flags' raised above should be acted upon.
How should it be tackled?
Opioid-dependent people will not be able to work at capacity and it is in the best interests of both the employer and employee that they receive treatment. Ignoring the problem or firing the employee will not only harm the individual, but can also have negative consequences for the business. The fact is, opioid dependence is treatable, and by treating the condition, the employee's life can be transformed.
"If someone suspects that a person is using, they should access an appropriate health professional (eg. GP, Psychiatrist)," says Ramjee. "Generally, the initial step is to intervene (family, employer), build up insight and enhance motivation. Many opioid abusers are 'afraid' of the associated withdrawal syndrome, but there is medication available to manage these features, provided it is prescribed by a medical professional with appropriate experience."
He says that some form of rehabilitation and aftercare also has to be implemented. "Treatment is definitely a multi-disciplinary team approach, involving medical support, a psychologist, occupational therapist, social worker, individual therapy and group therapy, which includes 12-step fellowship self-help groups like Narcotics Anonymous. Family therapy is also a big part of treatment."
New-generation medical treatment has a long duration of action, which means once-daily dosing. It is safer and discourages attempts to abuse it through other routes (e.g. injecting, smoking or snorting) because it will not provide the high the user is looking for. This new age in the treatment of this burgeoning problem also means that often the worker can remain in the office while undergoing the various steps of the intervention.
Substance abuse policies
Nadine Harker Burnham, researcher at the Alcohol & Drug Abuse Research Unit of the Medical Research Council, says it is important that workplaces have substance abuse policies in place that reflect the company's response. "The policy often describes treatment, prevention/awareness and drug testing protocols and adopts the viewpoint that use of alcohol and other drugs threatens the well-being of the employee, his/her co-workers and ultimately negatively impacts the employer. It is essential for companies to consult relevant Acts in respect of policy formulation and sensitive issues such as drug testing.
"One thing that remains problematic in South African companies is the lack of awareness and understanding of addiction and its impacts - that stretch wider than just the individual."
For more information on treatment please visit www.here4you.co.za.
If you are an employer and would like to receive a training pack on this treatment please contact Sherrilynne Andreas at Sherrilynne.Andreas@ogilvypr.co.za to receive a practical and useful toolkit that can assist you as a HR practitioner in addressing dependence in the work place.
1. Okie, S. (2010) A flood of opioids, a rising tide of deaths. N Engl Med J, 363, 1981-1985.
2. Weich L, Perkel C, van Zyl N, Rataemane ST, Naidoo L. 2008.Review Article: Medical management of opioid dependence in South Africa. South African Medical Journal, 98(4), 280-283.
Source: Labour Advice Workshop - www.labouradvice.com