Friday, January 31, 2020

Views on Opioid Abuse Off and On the Job: What’s Right and What’s Wrong

A true epidemic involving drugs is in progress in the US.  Products containing opium, including heroin, methadone, painkillers, and the extremely powerful Fentanyl, were responsible for 47,000 2017 American overdose deaths, about the same as the number of suicides and more than all with guns, and has certainly increased since.  It is different from previous concerns about cocaine and marijuana, not only since the fatality numbers are vastly higher but that the substances are legal. 
A lot has been written about this problem during the past half-decade, but our understanding of it is still badly deficient.  We know that opioids are most abused by whites in relatively poor areas, and that deaths, spurred mostly but not completely by Fentanyl, have decupled in 20 years.  Beyond that, what is being written lately in major-publication articles?

The first is Olga Khazan’s boldly titled “The True Cause of the Opioid Epidemic,” in January’s The Atlantic.  Khazan considered a lot of material, starting with “should they be arresting people?” (no, not for a public health issue), and moving on to a JAMA study showing a correlation between opioid deaths and auto assembly factory closings (did not mean causation), including speculation that such downturns made people feel that “it’s not really worth investing in myself” (but what does that have to do with careless drug use?).

The strangest finding mentioned in this piece, though, was a study showing “that with each percentage-point increase in the unemployment rate, the death rate from opioids rises by 3.6 percent.”  If that is true, then why, from 2010 to 2017, did opioid deaths more than double when joblessness dropped from 9.6% to 4.3%? 

Other things mentioned in Khazan’s article include comparisons with alcohol, hard since drink’s effects are almost always behavioral and chronic, along with an excellent note that in states where doctors were required to fill out three copies of controlled-substance prescriptions, such death rates were far lower, and one researcher calling the epidemic “an everything problem.”  One point I add is that the line between legitimate medical use and dangerous abuse is not as clear as just following directions, especially when those can be “as needed,” and that restrictions can impede those who require these drugs the most.

Now on to workplaces, with “As nation struggles with opioid crisis, workers bring addiction to the job” (Charisse Jones and Jayne O’Donnell, USA Today, December 26th).  This effort started with a restaurant table busser, inexperienced with marijuana, being unable to fulfill her assignment after partaking, and moved to the general topic of people using mind-altering drugs at work.  As with overdose deaths, this issue is not clear-cut.  One problem is that many workers, especially at low-level jobs, function as well or even better while under various influences, and some do even better.  One writer documented during the 1980s, when cocaine use by major league baseball players reached a peak, that a number of them performed their best in years when they were using, and authority Bill James wrote that most players, though with their tendencies often changed, only broke even in performance during and after substance rehabilitation.

Yet while the highest shares of workplace psychotropic drug use are in low-level positions, it does often turn up in other ones.  Unrestricted telecommuting can mean more drugs, and as long as there have been jobs there have been workers under alcohol influence.  If it is clearly detrimental to performance, management is reasonable to take the approach advocated 36 years ago in Robert Townsend’s Further Up the Organization: “Don’t try to tell people how to conduct themselves at home.  But if someone comes to the office zonked a third time, fire him without bothering to find out what he’s using.”  While alternative methods, such as clear threats and placement in rehab programs, can be better, Townsend’s approach still gets to what is and is not a problem.  That is what, with drugs of any kind, we need to address.  

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