The Ups and Downs of Illicit Drug Use for Employers

(Spring 2018)  The national attention being given to the misuse of heroin and prescription pain medications (central nervous system depressants or “down” drugs) is unprecedented – and rightly so. The rate of fatal opioid overdose deaths was five times higher in 2016 than 1999, and the Center for Disease Control and Prevention (CDC) attributes overdose drug deaths — the majority of which are caused by opioids — as a contributing factor to the county’s decreasing life expectancy. It’s not good, but fortunately for the workplace, the rate of positive drug tests for these depressants or “down” drugs is holding steady or decreasing.

According to Quest Diagnostic’s Drug Testing Index, the rate of tests positive for heroin held steady from 2015 – 2016, following a four-year increase in positive tests. Even better, positives for the commonly misused pain medications oxycodone (e.g., Oxycontin™) dropped 28% from 2015 to 2016, and the rate of hydrocodone (e.g., Vicodin™) positives decreased for the second year in a row.

But moving quietly in the wings is another major drug concern – this time involving the increasing use of central nervous system simulants, the “up” drugs. The misuse of cocaine, prescription amphetamines and methamphetamine is on the rise. Again.

Cocaine, including crack cocaine, claimed the lives of more African American males in 2012– 2015 than even heroin (7.6 versus 5.4 per 100,000 men). And according to the National Survey on Drug Use and Health, there was a 61% increase in new cocaine users (12 years of age and older) from 2013 – 2015.

At the workplace, rates of positive tests for cocaine increased 12% from 2015 – 2016, putting the rate of positives at a seven-year high. This increase is especially disturbing since the country made some significant strides to eradicate the supply and use of this drug when it was being used at an alarming rate in the mid-2000’s.

But recently, the supply of cocaine coming into the country from Columbia has been increasing and is as pure, inexpensive and as available as ever. The Office of National Drug Control Policy estimates Colombian cocaine production is at its highest level since 2007 and “an increase of more than 100 percent compared with 2013.”

Some hypothesize this is due, in part, to the country’s peace settlement that pays farmers to stop growing coca plants. Instead of immediately causing a drop in production, farmers reportedly started growing it so they could be paid for stopping in the future. Other reasons for the surge are reported to be related to reduced eradication efforts in Columbia and increased U.S. demand for the drug.

Prescription Amphetamines, such as Adderall™ and Ritalin™, are designed to increase alertness, attention and energy and generally prescribed to treat attention deficit hyperactivity disorder and narcolepsy. From 1996 – 2012, while use with youth increased 50%, use among individuals of working age increased 700%, causing some to question whether the drugs were legitimately prescribed or obtained illegally. Others observed that the dispensing of prescription amphetamines for attention disorders became very popular in the millennial generation, and now those young people are entering the workforce, possibly bringing their misuse of these meds with them.

Of concern to employers, the rate of workplace drug tests positive for amphetamine, including methamphetamine, increased more than 8% from 2015 – 2016, primarily caused by prescription stimulants.

Methamphetamine, wildly popular in the late 1990’s – early 2000’s, appears to be making a comeback, too. In the workplace, the rate of positive tests for meth increased 64% from 2012 – 2016.

While there is a prescription form of methamphetamine available (i.e., Desoxyn®), prescribed for attention disorders and obesity, most meth used illicitly is bootleg. Though some users continue to make small batches themselves, over the past ten years the U.S. has seen a dramatic decrease in the number of large-batch meth labs. This decrease is primarily credited to the passage of several laws making it more difficult to access the ingredients necessary to make the drug (e.g., the Combat Meth Act of 2005 that took pseudoephedrine off the shelf and put it behind the counter of drugstores).

Now, the majority of meth originates in Mexico and is reported to be purer and cheaper than ever – which may help explain the increase in popularity. Another reason cited for the rise in the drug’s popularity is that heroin users are switching to meth, thinking it’s safer and less lethal than opioids. Yet according to the CDC, deaths caused by meth increased 255% from 2005 – 2015, and in 2017, while 4193 people died of fatal opioid overdoses, 5300 died from overdosing on meth.

And unlike the tools we have to combat opioid addiction (like naloxone, which can interrupt an opioid overdose), there are no rescue drugs for a meth overdose or medications suitable to treat addiction to meth.

If history has taught us anything, it is that people will continue to use substances in harmful ways.  Whether it is due to lack of knowledge or the desire to self-medicate or alter their realities, as long as individuals have a hunger for mood-altering drugs, they’ll be available. As employers, we have a duty to control our environments for safety, health and productivity as best we can.  No matter if the drug of the day is an “up” or “down,” stay the course with a comprehensive, best-practice drug-free workplace policy and program that will stand the test of time and the drug of choice.

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