I wrote this the day before actor Philip Seymour Hoffman died from a heroin overdose, or as screenwriter and recovering addict Aaron Sorkin more accurately put it, “He did not die from an overdose of heroin. He died from heroin. We should stop implying if he had just taken the proper amount then everything would have been fine. He didn’t die because he was partying too hard or he was depressed—he died because he was an addict on a day of the week with a y in it.” (1)
Ask anyone associated with substance abuse treatment and they will raise their alarm about the rising number of opiate users in this country who are completely out of control with their drug of choice. Emergency room deaths by opiate overdose have now surpassed overdoses from cocaine or methamphetamine, combined, which is saying something. Opiates continue to rank near the top of the lists of the most prescribed drugs in the US (depending on which data you read), including hydrocodone, oxycodone, oxycontin, and other opiod pain relievers. And with the price of pills on the street often more expensive than heroin, some users are switching to heroin and either injecting it, smoking it, or snorting it.
The depiction of the opiate addict as unemployed, homeless, or hustling to buy dope by doing street crimes, certainly has its place in society and our history, since opium and heroin became pervasive in the US in the 1900s. But there are far more opiate abusers who have jobs, families, and even an outwardly-displayed sense of stability. Their hidden secret is what ultimately kills them if they don’t reach out for treatment before they overdose for the last time.
The Substance Abuse Mental Health Services Administration (SAMHSA), which oversees the federal government’s response to drug abuse, estimates that 10 to 12 percent of employees use alcohol or illegal drugs while at work. This number does not incorporate a shadow figure—people who abuse opiate drugs, under a physician’s prescription, at work too.
The problem with opiate use is a bit like what recovering alcoholics say about beer: “One is too many; a thousand is not enough.” What starts as a perfectly reasonable use of the drug for pain relief, soon starts to slide into taking too many, too often. Once the patient slips from, “one pill every four to six hours,” to “six pills a day,” and then on to double figures, what started as a legitimate medical use has given way to addiction.
So if the 10 to 12 percent figure for impaired employees is to be believed (and many addiction specialists think it’s low), does that mean that if you work in an office with 30 people then three or four of them are under the influence of drugs and alcohol in the cubicles next to you? It depends. Certain industries over-represent for substance abuse, with construction jobs, trucking (despite constant so-called random “safety sensitive employee” testing), retail sales clerks, and assembly and manufacturing workers near the top of the list. But should you be more aware of co-workers who put themselves, or you, or your organization at risk with their drug use? (With accidents, erratic behavior, and theft being the biggest problems.) If you’re a supervisor (or want to be one, one day), does that mean you have to be a micromanager and spy on everyone? Do you have to become the office tattletale? Or do we want bosses to simply monitor their workplaces for impaired employees and reach out to help them?
If you’re a supervisor, you have the right to address any employee performance or behavior problems that hurt your business. If it’s an off-the-job problem that crosses over to work or it affects other employees and their ability to do their jobs safely and effectively, then you have to intervene. Supervisors who need to develop the courage to have the tough-love, care-fronting conversation (caring enough to confront the employee’s impairment), can get support from other organizational stakeholders, including their bosses, peer supervisors who have more familiarity with the issue, HR, Legal, or outside addiction counselors.
Many employers have found success battling employee alcohol or drug use with polices and procedures for pre-employment testing, reasonable suspicion testing, and post-accident testing, along with referrals to their Employee Assistance Programs (EAPs), which often use the expertise of Substance Abuse Professionals (SAPs).
The challenge with opiate-impaired employees is that they may be cycling through two distinct and troubling stages while at work: either they are under the influence or they are in withdrawal. In the impairment stage, the employee may seem fine, but closer inspection reveals problems with concentration, effort, energy levels, mood swings, and just a general lethargy. Employees at high levels of opiate use may show signs of narcosis, or “being on the nod,” as they fade into a state where they look “asleep on their feet” (or at their desks). These are the employees who pass out in the bathroom stall or oversleep in their cars on their breaks or lunches, as the Central Nervous System depressant they have over-consumed takes its toll. Their pupils are like pin dots, their eyelids are at half-mast, their pulse rates are quite low, and they are not fully functioning.
To be clear, an employee who takes a medicinal dose of a prescribed opiate tablet, who is under a doctor’s care, and is following the prescription bottle directions is not the problem. That person can usually function just fine (but should not come to work if he or she can’t work safely). The employee who overmedicates with opiates or uses heroin (taking enough to drop a rhino) is the problem.
At the other end of the addiction cycle is the employee who is in some stage of opiate withdrawal. Here, we may see a completely different person: irritable, edgy, restless, anxious, sweating, shaky, achy, clammy, fighting nausea, diarrhea, an upset stomach, watery eyes, or a non-stop runny nose (2). What you might take for a seasonal allergy, could be an opiate user having a bad day. Being fully-addicted to injected heroin, an employee might have to inject the drug every four to six hours, seven days a week, to avoid wickedly-uncomfortable withdrawal symptoms, taking care not to overdose. This “going on-coming off” cycle is a brutal mistress. As one longtime heroin user puts it, “It’s hard to divorce The Horse.”
In a perfect world, an opiate addict in the workplace would come to his or her employer and say, “I’m in trouble and I need help,” before the positive urine test, before the incident or accident, and before the paramedics have to respond and give the employee a lifesaving dose of Narcan (Naloxone) to counteract the heart and lung-stopping consequences of the last fix. Employers tend to be more supportive and helpful if you ask for help with an addiction, as opposed to getting caught selling drugs at work or stealing from the warehouse or petty cash fund.
For those opiate-addicted employees who are too fearful, stubborn, or prideful to reach out for help and get treatment, their sense of denial, distorted thinking, minimizing, rationalizing, and blaming behavior will lead them to discipline, termination, or death, often in a short span of time. Having the courage as a supervisor to confront an opiate-impaired employee, or telling a supervisor or HR about your suspicions as a co-worker about another employee’s impairment is not about being a snitch; it’s about saving lives.
(1). Monde, Chiderah. (February 6, 2014). Aaron Sorkin pens tribute to Philip Seymour Hoffman. New York Daily News.
(2). Wesson D.R. and Ling, W. The Clinical Opiate Withdrawal Scale (COWS). Journal of Psychoactive Drugs, 2003. 35(2): 253-259).
Dr. Steve Albrecht, PHR, CPP, BCC, is a San Diego-based speaker, author, and trainer. He focuses on high-risk employee issues, threat assessments, and school and workplace violence prevention. In 1994, he co-wrote Ticking Bombs, one of the first business books on workplace violence. He holds a doctorate in Business Administration (DBA); an M.A. in Security Management; a B.S. in Psychology; and a B.A. in English. He is board certified in HR, security, and coaching. He worked for the San Diego Police Department for 15 years and has written 15 books on business, HR, and police subjects. He can be reached at firstname.lastname@example.org or on Twitter @DrSteveAlbrecht