Sunday, January 27, 2013

Prescription Drug Abuse at Work

Written by Sally Spencer-Thomas

What is the most concerning substance abuse trend facing workplaces today? Is it meth? Heroin? Cocaine? When we look at who is showing up in our emergency rooms after overdosing and who is showing up at addiction treatment centers, the drugs that are affecting the working aged population most are the drugs we usually get with a prescription.
What is prescription drug abuse? Prescription drug abuse is the non-medical use of prescription medications. Prescription medications are only safe for the prescribed patient, for the prescribed reason, for a prescribed time. After they have been used for their intended purpose, they should be safely discarded, and yet many stockpile and share these potentially deadly and addicting medications, leaving them readily accessible for abusive purposes.
For example, OxyContin, which is essentially the same drug as heroin, is often prescribed for pain relief after major surgery. This toxicity of this medication is perceived quite differently when it comes in a prescription pill bottle from the medicine cabinet, and yet the body doesn’t know the difference between this pill and its illicit cousin heroin. The common perception is that these prescription drugs are safe because they come from a doctor rather than off the street. Yet, the consequences of abuse can be just as deadly.  When we look at national overdose deaths, we find that prescription drug abuse deaths are:[1]
·      Four to five times higher than those of black tar heroin in the 1970s
·      Twice as high as the peak years of crack cocaine in the 1990s
More people are dying each year from prescription drug overdoses than from heroin and cocaine overdoses combined.  In 2005 there were 22,400 prescription drug overdose deaths in the United States versus 17,000 homicides.
 The alarming trend in prescription drug abuse poses a dilemma for doctors. Chronic and severe pain is often best managed with narcotic based medicine until the source of the pain has healed. Very often drug-seeking patients will show up at their primary care clinic complaining of dental or injury pain and will claim they “just need something to get them through the weekend.” Since pain is so subjective, prescribing healthcare providers are often unsure about how to handle such situations and may err on the side of relieving the symptoms the best way they know how.
Sometimes workers who had legitimate pain medication prescriptions find themselves hooked and will “doctor shop” to get additional refills to support their addiction. Other overwhelmed overachievers may turn to prescription drugs for an edge in our highly competitive society. It is not uncommon for Mom or Dad to sneak stimulant pills prescribed for their teen’s Attention Deficit Disorder so that the parent can work longer hours.
The impact of prescription drug abuse on the workplace is evident. Because these pills are usually paid for through insurance, the healthcare costs for workplaces are affected when the drugs are being abused. Performance is impacted when workers are operating under the influence of narcotics, but unlike the abuse of other substances, prescription drug abuse often leaves little evidence: no smell, no paraphernalia, and no visible marks on the skin. Workers can abuse the drugs right at their desks without others noticing.
With all these pills around, the opportunities for intentional and unintentional overdoses increase significantly. Emergency room monitoring shows an upward trend of people experiencing medical crises from these effects.[1] Given these health risks and workplace implications what can employers do?
Like other health issues, the best intervention is early detection. Thus, workplaces can raise awareness by educating employees about the dangers of prescription drug abuse and offer screening to identify those at risk for abuse. Workplaces can help promote events like the Colorado Department of Public Health’s “Take Back” challenges where people can bring in unused prescription medications and dispose of them safely. When writing policies regarding substance abuse, prescription drug abuse should be included. Whatever the approach, workplaces that acknowledge the potential risks of prescription drug abuse will be better able to proactively work to reduce its impact.

I would like to thank Beverly Gmerek from Peer Assistance for her leadership in the area of prescription drug abuse prevention and for the information presented at the May 14th, 2010 Colorado EAPA meeting which was used for the basis of this article.

About the Author
As a psychologist and the survivor of her brother’s suicide, Dr. Sally Spencer-Thomas addresses the issue of suicide prevention, intervention and postvention from many angles.  Currently she is the Executive Director for the Carson J Spencer Foundation (, a Colorado-based (USA) nonprofit that is dedicated to “sustaining a passion for life” through suicide prevention, social enterprise and support for emerging leaders.” In 2009, the Carson J Spencer Foundation launched the Working Minds Program (, a comprehensive suicide prevention initiative for workplaces.  As a professional speaker, she frequently presents keynotes and trainings for workplaces, campuses, and conferences around the world. In addition, she is the Executive Secretary for the National Action Alliance for Suicide Prevention, the public-private partnership advancing the Surgeon General’s National Strategy for Suicide Prevention. Finally, she is the Division Chair for Survivors of Suicide Loss for the American Association of Suicidology.  

[1] Gmerek, Beverly (2010, May 14). Prescription Drug Abuse. Presentation at the Colorado EAP Meeting. Denver, Colorado
[2] Gmerek, Beverly (2010, May 14). Prescription Drug Abuse. Presentation at the Colorado EAP Meeting. Denver, Colorado

Tuesday, January 15, 2013

Preparing for the Worst: Protocols for Community Postvention

Postvention is a difficult topic, and like many other topics that make us uncomfortable, we tend to avoid it. We want to believe our prevention and intervention efforts will be successful. But the truth is, sometimes, just like with cancer, we can do all the right things to try to save someone life and death still results. Postvention should be a part of every comprehensive approach, and predetermined protocols could link back to overall goals of prevention.
Like all guidelines, postvention protocols are living documents that help us think through tough situations but are adaptable to specific circumstances. While adopting other community protocols may be tempting, this can be tricky: many cultural sensitivities exist in each community and a one-size-fits-all approach is bound to be less than ideal.
Active Postvention, as developed by Frank Campbell and his LOSS team in Louisiana,  means that the people in charge of the critical aftermath needs are trained and ready to conduct outreach in response to any traumatic event on campus. People are well-versed in standard operating procedures for trauma, especially as it relates to suicide death.
“Community” can be defined in many ways – a school community, a workplace community, a faith community, or a local community.
When developing a postvention policy, stakeholders or coalition members should examine some critical questions:
·      Will the community be notified after a death? How will they be notified? Within what timeframe?
·      What support services will be needed? What support will be active and what should be passive?
·      How will we identify vulnerable individuals who might be prone to copycat?
·      How can we partner with the media and other messaging outlets to help ensure responsible reporting?
·      How can we honor the life of this person without putting others at risk?
·      Who are the first responders and how can we coordinate their efforts? Who is the main point person for this effort?
One of the biggest questions that communities have when developing a protocol for suicide postvention is how to manage memorialization practices. Leaders of these efforts may find themselves immobilized by the fear of copycat suicides on one hand and overwhelmed by the outpouring of grief by the survivors on the other hand. The suicide prevention field currently is in a heated debate over the best way to handle this balance. The most sensible stance I have found is to treat suicide memorials in the same way you treat other traumatic deaths in the community: one bereavement policy regardless of the cause of death. That way, when someone dies we just turn to the policy and say, “This is what we do.” When suicides are treated differently, the death is either marginalized or glamourized. When families of people who die by suicide ask to have a bench erected or a tree planted and then are told they can’t because that would be glorifying the death, they are often shocked and think, “I can’t believe you think I am trying to do that – I just want to remember my son.” With a proactive policy in place, we can just turn to the policy and say, “This is how we treat all deaths here. We don’t establish permanent markers, but rather we do X, Y, and Z to honor the deceased.”
If communities try to suppress the memorialization of people who die by suicide, the plan often backfires. Shutting down channels for grief is a bad idea. A rejecting message goes out, and the bereaved can get very vocal. They will find their own ways to memorialize their friends and family members, and their choices may be much less safe than those supported by knowledgeable suicide prevention folks. Communities often don’t realize the message they are sending when they try to squelch the memorialization efforts of the bereaved. In these circumstances, survivors of loss are likely to feel that their community doesn’t care.
“If you tell people to put their candles out, they will get angry on top of their grief,” says Frank Campbell. “They will find ways to honor their friend and the community just looks embarrassed. I ask community leaders, ‘What would you do after a car accident? Let’s start there.’”
So we have to learn to balance the safety of the community with the needs of the bereaved. This situation is not an either/or proposition. With creative thinking and careful planning, both needs can be met. To do this, several key questions should be explored:
·      What does the family want?
·      Where are the natural support groups in this community? How many social networks have been affected?
·      What is the appropriate timing for a memorial service?
·      What is a good way for the community to express grief and say goodbye that can safely be replicated for many types of death?
·      Who will attend memorialization events from community and what message will it send? Will someone from the our community speak on behalf of the deceased?
Rather than have an individual memorial service for each person who dies, some larger communities hold annual memorial services for all of these at one time. While this may seem like a reasonable idea, I don’t think it will meet the needs of people in the immediate aftermath of their loss. If their friend dies in September, they want to honor her then and not wait until a group service in April. The important thing is to be consistent. Don’t offer memorials for suicide deaths if you don’t offer them for other types of deaths on campus. If you do decide to hold a memorial service, make sure that all people who speak understand the safe messaging guidelines and the reasons why they exist.
Generally speaking, a public and permanent memorial is probably not a good idea. For one thing, it can often become a shrine that ends up inadvertently glorifying the death. Better ideas for memorial practices are to channel the grief towards something life-giving. For example, we can suggest that rather than pile flowers and cards at the deceased’s death site, we can collect pictures of and letters about the person who died to give to the family. We can make a community quilt. We can develop an awareness walk or lecture series in honor of the person’s memory. Or we can start a fund and donate it to a cause that the deceased supported.
                  Community practices for suicide postvention are a critical part of suicide prevention. When done well the bereaved feel supported and are better able to move through their grieving process and the impact of suicide is minimized for all.