Back to Basics

Back to Basics: Opioid and Substance Use in the Workplace

Back to Basics is a weekly feature that highlights important but possibly overlooked information that any EHS professional should know. This week, we examine opioid and substance use in the workplace, and the federal recommendations for drug program implementation.

Opioid and substance use is a prevalent issue that causes hazards to the individual using and their coworkers around them. EHS professionals need to be aware of the scope of the problem and the proper prevention strategies and programs they can use to keep their workforce safe. The National Institute of Environmental Health Sciences (NIEHS) provides extensive information and materials that can help employers understand and help their workforce with opioid addiction in their respective industries.


Opioids, such as oxycodone, hydrocodone, morphine, and fentanyl, are a class of drugs that are used to reduce pain, according to the NIEHS. These can all come as prescriptions, along with other drugs called benzodiazepines, which are central nervous system depressants used to induce sleep, prevent seizures, and relieve anxiety. Examples of these include Xanax, Valium, and Ativan, and people should avoid taking them along with opioids as much as possible. All of these drugs could potentially cause workplace hazards, along with illegal opioids, such as heroin, illegally produced fentanyl, and other synthetic opioids.

Substance use disorder is defined by the NIEHS as “a negative pattern of substance use, with recurrent and significant adverse consequences for the individual and co-workers.” This is usually accompanied by substance dependence, which occurs when the user has developed a tolerance for a drug and experiences withdrawal symptoms. An opioid addiction is the “chronic, relapsing disorder characterized by compulsive drug-seeking and use despite adverse consequences.” Opioid addiction is considered to be a brain disorder because it involves functional changes in the brain that affect a person’s senses of reward, stress, and self-control.

Effects on the workplace

EHS leaders need to understand the signs of opioid and substance abuse among their workforces because an employee using on the job is a safety hazard for everyone. However, it is crucial that safety managers realize that opioid misuse is not an individual moral failing, and it is often caused by a combination of many different factors.

Many cases of opioid addiction begin with treating pain, whether physical or emotional, and that includes when employees get hurt on the job and need to go to the doctor or hospital for treatment. Employees might receive an opioid prescription, and because of the effects of the drug and the pain they are experiencing, they can become susceptible to abusing that prescription, says the NIEHS.

In worker’s compensation incidents, insurance companies will often challenge the cause of a worker injury and the need for treatment, which can lead to a delay in care and prolonged pain, and then potential drug abuse. Additionally, in certain industries, such as emergency medical services (EMS), law enforcement, healthcare, and public service, there are frequent occupational exposures to drugs, needles, and other paraphernalia, which can all be considered hazards.

Signs and symptoms

There are both physical and behavioral signs of drug addiction that employers should watch out for, according to the NIEHS. The physical signs can include change in appearance, small pupils, decreased respiratory rate, unresponsiveness, drowsiness, loss or increase in appetite, weight loss or gain, intense flu-like symptoms, and wearing long sleeves frequently to conceal the arms. The behavioral symptoms can involve a change in attitude or personality, avoidance of family and friends, a change in friends or hobbies, drops in performance at work, isolation and being secretive, moodiness, irritability, nervousness, giddiness, and the tendency to steal.

The signs of an overdose include stupor, pinpoint pupils, cold and clammy skin, cyanosis, coma, and respiratory failure, which can lead to death. In the case of an overdose that could occur during a shift, employers should keep naloxone, also known as Narcan, inside their first aid kits and emergency preparedness training. There are different state laws regarding naloxone, but as of July 2017, the NIEHS reports that all 50 states passed laws that make naloxone accessible without a prescription, and 40 states passed legislation that eliminates arrest, charges, or prosecution for reporting overdoses. Employers should check their state laws for more specific guidance.


The potential challenges that employers may face while trying to implement a supportive policy could include the lack of management commitment and worker involvement, inadequate hazard assessment and control, occupational stress and bullying, and the lack of support systems such as sick leave, employee assistance programs, and family leave. 

In addition, the implemented standards for ergonomics, workplace violence prevention, indoor air quality, fall hazards, drug hazards in healthcare, psychological health, minimum staffing, and chemicals may be outdated or absent, according to the NIEHS. Employers should reassess the effectiveness of their hazard prevention programs and employee assistance programs to make sure that these obstacles are addressed.

Supportive policy

When dealing with opioid addiction, employers must first and foremost practice having sympathy, empathy, and compassion for their employees. In terms of policy, the NIEHS recommends that leaders should move from a punitive drug policy at work to a supportive one, because the threat of punishment or termination along with the stigma around drug use can exacerbate the problem and stop employees from asking for help. A supportive drug-free policy has several components:

  • Written policy with union and employee involvement
  • Training for supervisors, managers, union reps, and employees
  • Access to treatment for addiction, facilitated by the workplace or union
  • Leave of absence for detoxification and treatment
  • Leave for medical appointments and recovery meetings
  • Alternate duty assignments
  • Reassignments to nonhazardous work

Employers need to be more proactive instead of reactive, and understand that jobs can be a lifeline for those struggling with addiction, because they can provide daily structure, a sense of purpose, stability, and social support, as well as a paycheck. Managers must foster an environment where it is safe to talk about mental health and substance use, and ensure confidentiality. They should also work with stakeholders to revise policies and programs, and establish return-to-work policies.  

The NIEHS also recommends alternative-to-discipline (ATD) programs, which are designed to help workers recover from addiction and return to work without losing their jobs. An ATD program starts with an employee entering a substance use treatment program. Then, an individual sobriety and recovery program should be established, along with return-to-work agreement that involve drug testing and participating in recovery programs. In industries like healthcare and law enforcement, the employee should not be allowed access to narcotics. The final step is continued treatment and monitoring for periods of two to five years. The NIEHS emphasizes that these programs have been successful because they provide a nonpunitive pathway for workers to obtain treatment and keep their jobs.

For more information, see the full NIEHS presentation on opioid addiction here, and the full list of NIEHS workplace training resources here.

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