Creating recovery-friendly workplaces

People who work in manual labor have higher rates of injury and overdose

Our country's ongoing opioid crisis has many faces, from teenagers on Cape Cod to middle-aged parents in West Virginia. A recent report from the Massachusetts Department of Public Health provides another demographic affected by opioids: people who work in the trade industries, namely construction. The report broke down overdose deaths by industry, and construction workers were involved in almost a quarter of overdose deaths recorded in the state over five years. Farming, forestry, and hunting, along with fishing, are the next most dangerous industries. And there are relatively high overdose death rates for women working within health care support and food services.

This research supports what we have seen in our own work treating patients for substance use disorders who work in manual labor jobs. On-the-job hazards and related injuries are common, and pain medications of all kinds tend to be readily available as workers informally share and sell them on worksites.

The need for recovery-friendly workplaces

A recent National Safety Council report found that 70% of surveyed employers have been impacted by prescription drug misuse, but fewer than 20% feel extremely prepared to deal with it. The financial cost to employers in lost productivity is significant: in Massachusetts alone, opioid addiction cost businesses $2.5 billion annually from employees who aren't functioning at full capacity, and $5.9 billion in lost productivity from people who can't join the workforce due to addiction. Opioid use disorder has kept nearly 33,000 people in Massachusetts from participating in the labor force each year, on average, over the past five years.

But what could a recovery-friendly workplace look like? Drawing inspiration from models like Supported Employment, an evidence-based intervention for individuals with serious mental illness, and recovery high schools, we describe five key features of a recovery-friendly workplace:

Available counseling for scheduled and on-demand recovery support. Manual labor workers with varying schedules often have trouble making appointments in traditional healthcare settings, which tend to be offered only during normal business hours. Missed work equals lost income, which is harmful to workers and employers alike. An onsite counselor for large worksites or availability of remote telehealth counseling on-demand during work breaks could encourage participation in these programs.

Peer support groups built into the daily schedule. Like individual appointments, therapy groups often occur during the business day. Open and safe discussions with crewmates who are also in recovery can help build a culture of mutual support. Onsite peer support by recovery coaches in the industry might be particularly impactful.

A supervisor who understands the challenges and needs of people in recovery. Slip-ups are part of the recovery process, and a positive drug test should signal the need for more counseling support and closer monitoring, not automatic termination of employment.

Support for medication-assisted treatment. We've heard anecdotally about certain union health insurance plans that deny coverage of buprenorphine (Suboxone), a medication for opioid use disorder that calms cravings and halves the risk of overdose death. This kind of discrimination is a federal crime, and for good reason — imagine employer-based health insurance refusing to pay for insulin for workers who have diabetes. Unfortunately, stigma and fear of retribution may keep union workers from speaking out to claim their rights.

Onsite drug testing (where appropriate) and telepsychiatry. Regular drug testing could help make construction sites safer and indicate when people need more support. Crews often share transportation to and from worksites, making it hard for an individual to leave in the middle of the day for a medication appointment or to provide required toxicology testing for their program. Telepsychiatry visits in a secure room on a worksite could allow people to get assessed more regularly and prevent missed doses of recovery medications like buprenorphine.

Recovery-friendly workplaces may lower healthcare costs

Employers in all kinds of industries should consider how establishing recovery-friendly workplaces may help them access an underutilized workforce while addressing a vital social need. People in recovery from opioid use disorder commonly describe their core recovery goals as needing to keep busy, to achieve financial self-sufficiency, and to recapture the dignity of being a working member of society. Our clinical work can go only so far in supporting our patients' recovery, but with the right kinds of partnership across sectors, we can make great strides together.

Given the high prevalence of substance use disorders in certain sectors, investing in supported employment with recovery support and medication-assisted treatment might reduce costs associated with missed work as well as employee hiring and retraining, improving overall work quality while also lowering overall healthcare costs. Finally, substance use is rampant on construction and manual labor worksites, so investing in recovery support and treatment might improve the relationship of workers with management and unions and reduce risk for accidental injuries in the future.