Recovery @ Work

At age 29, Bob Poznanovich became vice president of a Fortune 200 company, placed in charge of hundreds of employees and hundreds of millions of dollars of accounts.

It was the 1980s and Poznanovich had never used illicit drugs and seldom drank. But when he was invited to the house of a bank president for a party with local newscasters, a Chicago Bulls player, and other celebrities, the host provided cocaine—literally on a silver platter.

The kid from the South Side of Chicago partook because he understood the drug as a rite of passage for the rich and famous. Dabbling, he realized over time that cocaine could maximize his energy and minimize his personality weaknesses. He became dependent and, though it was glaringly obvious, Poznanovich and his employer made excuses for his behavior.

“People don’t want to identify that you have a drug or alcohol problem,” says Poznanovich, now chief business growth officer at the Hazelden Betty Ford Foundation, which provides drug and alcohol addiction treatment across the United States. “But it was visible. I remember I would ask if customers wanted to get high, which in retrospect was crazy. I missed meetings and my employer tried to cover for me.

Unsure what to do, his employer eventually fired him. Had that business talked to him about his addiction and offered to get him help, Poznanovich says he would have “run to get it.” But instead, he learned later that the company held about 50 meetings about him, but none with him.

Forty years later, many companies face similar issues with employees, but involving different drugs. Among these are opioids. Of employers surveyed by the National Safety Council in 2019, 75% reported direct impacts on their operations due to opioids—including employee overdoses or arrests—but only 17% said they were well-prepared to deal with the issue. Employers are often uncertain how to recognize signs of addiction or assume it doesn’t impact their business; because of stigma, they may not know how to broach the topic with an employee; and they may worry about legal troubles if they don’t handle the issue well.

“Some employers think, ‘We don’t have addicts here because no one is using our EAP [employee assistance program] services,’” Poznanovich says. “But it is in the workplace. And preparation means knowing how to help people get treatment, how to support employees afterward, and how to provide training to management so supervisors can help people when they are struggling.”

Opioids encompass a range of medicines (such as morphine, fentanyl, and oxycodone) that attach to brain-cell receptors to block pain messages. But the drugs can also produce feelings of pleasure that can lead to addiction. The U.S. Department of Health and Human Services in 2017 declared that the spread of opioid addiction had become a public health emergency; it renewed the declaration in 2024.

Nearly 13% of U.S. workers (21 million) age 16 and older are estimated to have received at least one opioid prescription between 2007 and 2016, according to a 2021 study in the International Journal of Social Determinants of Health and Health Services. Private insurance covered half of the $2.81 billion annual costs for those medications.

Employers are paying for these drugs and managing the absenteeism and loss of productivity among personnel suffering opioid use disorder (OUD). In some industries, the epidemic has drained the available workforce. But employers can also play a huge role both in preventing and treating OUD among their employees. And insurers and employee benefit vendors can help reduce opioid prescriptions, educate employers and employees on the dangers of opioid use, and offer treatment tailored to OUD.

The Cost of Addiction

Opioid-related deaths have decreased in recent years because of increased awareness of the issue, widespread use of Naloxone to reverse overdoses, and telehealth making it easier to get treatment. But the issue is far from being solved.

In 2022, about 82,000 people died from overdoses that involved opioids, according to data from the Centers for Disease Control and Prevention (CDC). That is 10 times the number of people who died from opioid overdoses in 1999. Deaths from fentanyl and other synthetic opioids not including methadone, in particular, skyrocketed from 2013 to 2021.

There have been four phases, or waves, of deaths in the opioid epidemic, the CDC says. First was the rise in deaths due to overdoses from prescription opioids in the 1990s. Second was the impact of heroin around 2010. Around 2015, the third wave hit with overdoses increasingly seen from synthetic opioids like fentanyl. The fourth and latest wave involves polysubstance use, with overdoses when people use stimulants like cocaine combined with an opioid. Though fentanyl is the leading cause of death from opioids, deaths involving prescription drugs remain high.

Richard Frank’s son received an opioid pain-relief prescription after having his wisdom teeth removed last year.

“He had a month’s worth of pills when he should have gotten about three days,” says Frank, director of the Center on Health Policy at the Brookings Institution. “We think doctors have cut back, which they have, but there is still a lot of that [overprescribing] going on.”

Frank co-authored The Economic Impact of the Opioid Epidemic report from Brookings in 2023, which found that more than 12% of U.S. workers receive a prescription for opioids each year.

The cost of having an employee, or their dependent, with OUD on an insurance plan is high. The annual healthcare costs attributable to a substance use disorder (SUD) diagnosis for a worker receiving employer-sponsored coverage was about $15,640 in 2018, according to a 2023 article in The Journal of the American Medical Association. Those costs came from inpatient and outpatient healthcare and medications. The total cost per year for that group was $35.5 billion, with OUD accounting for $7.3 billion, the report said.

The costs to employers can extend beyond healthcare expenditures. OUD can show up in absenteeism, higher turnover, and increased disability and workers compensation claims.

A 2017 article in the Journal of Occupational and Environmental Medicine compared the softer costs employers pay for people with and without SUD. Based on data from 2012 to 2014, an average employee missed about 10 days a year due to illnesses and reasons other than vacation, according to the report. People with pain medication use disorders missed 29 days a year, mostly because of illness or injury. Forty-two percent of people misusing prescription pain medication reported having more than one employer in the past year, compared to 25% of people with no SUD. Individuals with pain medication use disorders were also more than twice as likely to be hospitalized and stayed twice as long in the hospital.

According to National Safety Council data from 2019, 38% of employers reported worker absenteeism or impaired performance because of opioid use and 31% had experienced an overdose, arrest, near-miss, or injury on the job due to employee opioid use.

The use of opioids for people on workers compensation has dropped dramatically in recent years, but still shows up in claims. In 2012, 55% of workers compensation claims that included a prescription had no less than one opioid prescription. By 2022, that number had dropped to 32%, according to data from the nongovernmental National Council on Compensation Insurance.

In a 2025 study of more than 6,000 Australian employees on workers compensation, 67% were prescribed what the authors described as “high-risk” prescriptions. This category included large opioid volumes on the first dose, high doses for more than 90 days, early use of long-acting opioids, and the co-occurring use of psychotropic prescriptions. After a year, almost 23% of the population was still using opioids. Those who received high-risk prescriptions had double the odds of still being on them when compared to the workers who had low-risk prescribing early on.

Aside from potential addiction or overdose, one of the main issues with opioids in workers compensation is the drugs tend to prolong these cases.

“When I first got to AmTrust [six years ago] that was something we were really looking at,” says Melissa Burke, head of client experience and risk control at AmTrust Financial Services, a specialty insurer offering workers compensation and other coverage. “And we put a lot of tools in place to manage the claims because the wrong medication for the patient can extend a claim.”

In 2018, the American Action Forum reported that opioids had effectively removed over 919,000 “prime-age individuals” from the domestic workforce as of 2015. That represented a loss of 12.1 billion work hours and $702.1 billion in real economic output, according to the nongovernmental organization. A 2022 report from the U.S. Government Accountability Office found that people over the age of 50 who were still in the workforce and misused opioids were about 40% less likely to be employed.

Though OUD hits all industries, it is more prevalent in sectors including construction and mining (which have high injury rates) and healthcare (where the medication is easily accessible). Others with prevalent addiction rates include the food service and personal care/support industries.

“We have heard that, in places with high rates of OUD, employers are having difficulties recruiting people and getting people to work,” says Crystal Blyler, a principal researcher at data solutions company Mathematica and co-author of the 2020 report The Role of the Workforce System in Addressing the Opioid Crisis. “The deaths were decreasing the workforce and if they had drug-free policies they couldn’t hire someone with an addiction. And if their current staff might be developing addictions, do you fire everybody?”

This issue is particularly acute in construction, where between 10% and 25% of injured workers are taking opioids at any given time, says Chris Trahan Cain, executive director of The Center for Construction Research and Training. According to the organization, there were 17,056 and 15,910 deaths from overdoses, respectively, in 2022 and 2023. A majority of those deaths—more than 80%— involved synthetic or natural opioids.

An Ounce of Prevention

Employers (and their insurers) pay a price for opioid misuse and OUD treatment, but they can also reduce those costs and have seen some positive results so far.

“As prescribing limits and Prescription Drug Monitoring Programs (PDMPs) took effect, improvements were seen broadly, with safer practices now in place even for severe injuries,” says Carmen Sharp, senior vice president of claims at The Hanover. “Prescribers have moved away from opioids, leading to increased use of alternative medications and new non-opioid pain treatments.

“Workers compensation plans have also adapted by implementing strategies such as drug formularies, proactive trend monitoring, nurse case management, predictive analytics, and consultation with medical directors and pharmacy consultants to manage opioid use and support injured workers at risk for addiction,” Sharp says.

AmTrust changed its approach to managing opioids and the number of people receiving opioid prescriptions as part of their workers compensation claim dropped from 60% in 2017 to 15% in 2021. Burke says AmTrust does not solely rely on its pharmacy benefit manager to reduce the number of opioids prescribed. It has a drug list that flags medications that could be unsafe or unnecessary. When one of these medications is prescribed, the claim is sent to a nurse to review for authorization. These nurses then reach out to the patient to determine if the medication is appropriate for their injury and if they have any risk factors that could lead to drug misuse.

“The nurse will ask about their past experiences and see if they have any comorbidities,” Burke says. “This helps them understand how to approach the situation. It’s not that we don’t want pharmacy spend, we just want the right kind of spend.”

It’s possible to become physically addicted to an opioid after just a few days of taking a prescribed medication. Many states and some insurers, including UnitedHealth and BlueCross BlueShield of Massachusetts (BCBSMA), have implemented guidelines on opioid prescriptions, most of which limit an initial prescription to three to seven days. In July 2012, BCBSMA instituted an opioid policy that included risk assessments, patient-provider agreements, pharmacy dispensing requirements, quantity limits, and prior authorizations. After implementing the policy, the monthly average rate for opioid prescriptions dropped nearly 15%, from 34 per 1,000 members to 29 per 1,000 members.

Employers may be able to prompt additional workers compensation providers to establish their own prescribing guidelines for opioid use for workers injured on the job.

“Two-thirds of Americans with private insurance have it through their employer, so employers are calling the shots,” Frank says. “It seems to me they could do common-sense things like having a contract with an insurer that prohibits them from filling prescriptions for opioids longer than a certain number of days.”

Employers can also use data to determine the potential for OUD in their workforce. Frank recommends three approaches. First, look at aggregate prescribing data to see if people are receiving prescription opioids or medications like buprenorphine to treat OUD. Second, check records of absenteeism; people misusing substances tend to have more days off that aren’t associated with vacation. Third, look at the number of injuries that are commonly treated by opioids including musculoskeletal pain and falls.

“None of these will be smoking guns for opioid misuse, but they might lead you to look further and investigate more,” Frank notes.

Another approach is education, including informing workers on non-opioid pain management medications or options like physical therapy in the event of an injury.

“Employers have a really good forum for educating people about the risk of injuries and how those can lead to using opioids and when used, they can lead to addiction,” Blyler says. “And the risk goes both ways—injuries can lead to addiction and people who are using opioids are more likely to be injured. Employers need to figure out how to have those conversations.”

Employers can also mitigate factors leading to injuries. Not all OUD is related to prescriptions, but it is a major on-ramp to the condition. In industries plagued with high injury rates, employers can improve work environments to help prevent musculoskeletal strains and sprains. For instance, a 2023 CDC report said that 67,700 injuries in elementary and secondary schools from 2015 to 2020 had been linked to people falling, slipping, or tripping. Schools could prevent some of these injuries by using non-slip flooring, installing handrails, and ensuring there are no trip hazards in hallways.

Though the technology is still relatively new, wearables are being used in some industrial workplace sites to increase safety. These include powered gloves or exoskeletons to help people lift heavy objects, smart helmets that can alert a job site when someone has fallen or let an employee know if temperatures are unsafe, and ergonomic sensors to alert a worker that their movements are unsafe.

Some workers compensation providers partner with employers to prevent injuries that could later lead to opioid prescriptions. AmTrust offers videos and written resources about staying safe in the workplace. For most of its large employer clients—and others that specifically need safety training—it offers a strategic risk team that can perform on-site walkthroughs to determine where the company may have safety issues. The team can train managers to talk to workers about safety, ensure there is a return-to-work plan for people returning from workers compensation leave, and ensure transitional duty opportunities are in place so people can get back to work as quickly and safely as possible.

“If a company has a lot of a particular injury we can recommend a tool to help prevent them, like slips and falls, we can recommend a product for the floors to help prevent or mitigate these injuries,” says Burke. “We can make sure employees are using gloves to prevent injuries when slicing meat, or make sure people are wearing nonslip shoes.”

Healthcare providers should also screen people for alcohol or opioid use disorders, Frank says. That could be done by primary care providers during annual physicals, something the independent U.S. Preventive Services Task Force recommends and for which Medicare reimburses. The screenings can simply be questions about drug and alcohol use on a form or discussed during intake by a nurse or other provider. Frank says insurers can financially penalize network physicians who don’t complete these screenings. Payers could do this by reducing payments to providers if the full set of recommended screenings aren’t documented in patients’ records. Insurers could also use something like secret shopper studies to see if providers are screening appropriately.

Lyra Health, an online mental health therapy and medication management provider, screens mental health therapy services clients for alcohol use disorder (AUD) and SUD, said Dr. Smita Das, Lyra’s vice president of psychiatry and clinical care. Even if a Lyra client isn’t in therapy for a SUD, providers do a complete bio-psycho-social assessment to understand if they may be at risk and provide comprehensive treatment.

“Employers should be proactive in screening for substance use as part of broader wellness initiatives,” Das says.

Lyra is among the handful of companies that offer alcohol and substance use disorder treatments directly to employers. In September 2024, it expanded a program focused on helping people facing mental health and alcohol use issues to encompass those struggling with substances including opioids, cannabis, stimulants, and cigarettes. Lyra Renew provides virtual therapy, group sessions, and medication-assisted treatment (MAT) with drugs like buprenorphine for opioid misuse. People have access to these services when their employer offers Lyra as part of a health benefits plan.

Employers can also help reduce the use of opioids among their workforce by increasing paid time off. When workers can’t stay home and recover, opioids may be the only thing that enables them to manage pain from a workplace injury when they have to get back on the job. A Massachusetts Department of Public Health study covering 2018 to 2020 found that workers in industries where more than 82% of people reported having paid sick leave had about 20 overdose deaths per 100,000 workers. In industries where fewer employees reported having paid sick leave coverage, the incidence of opioid-related overdose deaths was nearly five times higher—almost 100 for every 100,000 workers. California has long been a model in this space, providing five days, or 40 hours, of paid leave a year for all employees, including part-time and per-diem workers.

“The insurance industry plays a vital role in helping businesses navigate workers compensation in the context of the opioid crisis,” Sharp says. “By partnering with the right insurance carriers, agents can help businesses prioritize quality medical care, safe prescription practices, and proactive engagement with predictive analytics and nurse case management, ensuring informed decisions that benefit workforce health and overall business success. The goal should always be focused on the long-term health of the employee and affording a safe transition back to work. This is done by collaborating. Employers, insurers, and agents can make significant strides in addressing opioid use disorder, improving workplace safety, and reducing costs associated with lost productivity, health plan expenses, and workers compensation claims.”

Encouraging Treatment

Prevention is not perfect—even those in treatment for substance addictions often struggle to remain sober.

Because of the difficulty in overcoming OUD, many providers emphasize the multiple aspects to treatment success that go beyond strictly abstinence. Physicians and patients recruited for a study published in 2022 in the Journal of Substance Abuse Treatment identified several other signs suggesting treatment is succeeding, encompassing reduced use of drugs and alcohol, tapering off treatment medications, better mental health and personal relationships, and improved daily functioning.

Though employee privacy is crucial, Poznanovich, at least, says he would have welcomed his employer talking with him about his addiction and encouraging treatment. People in recovery, he adds, become resilient and are loyal employees because their job is often an important part of what keeps them sober.

“Some employers think it’s not an issue for them,” he adds. “Or that it’s not worth the kind of time and effort it would take to get a return on investment. I would say that what they are doing will save lives and that’s the ultimate bottom line.”

Treating people with OUD doesn’t only pay off in better employee health, but could pay dividends to an organization. According to the Journal of Occupational and Environmental Medicine, workers in recovery can contribute significantly to the organization. The study authors took three years of data (2012 to 2014) from the National Survey on Drug Use and Health. About 67,000 people respond to interviews for this study annually. People in recovery missed fewer workdays than any other group—9.5 days as opposed to 10.5 days among workers who never had a SUD. They had the lowest hospital use of any group, and their turnover rate was 21%, as opposed to 25% for peers with no SUD.

Because OUD is such a complex disease, employers should try to cover as many types of evidence-based care as possible through their insurance plans and EAP programs. For instance, Lyra’s broad expanse of services includes virtual therapy, medications, progress tracking, group support overseen by peer recovery specialists, and treatment of mental health disorders that might be contributing to substance misuse. The organization can refer those who need more intensive care to inpatient and outpatient care centers.

Some health plans have begun to designate substance use centers to which to refer plan participants, much like centers of excellence for other conditions. For example: BlueCross BlueShield has a list of substance use treatment providers that it recognizes as delivering high-quality care through its Blue Distinction Specialty Care program.

“We are seeing more and more of this, especially in unions because they have a higher addiction rate but also tend to spend more than they need to for rehabilitation,” Poznanovich says. “Some unions will pay for transportation to treatment, provide no copay or deductibles, and pay for 12 months of recovery, but members have to go to a center of excellence.”

Blyler recommends rethinking zero-tolerance drug policies in the workplace to encourage treatment. This may seem counterintuitive, but many of the drugs used to treat opioids are opioids. This can cause problems for workers who are not currently misusing opioids but are in recovery.

“These medications are critical for helping people stay off opioids, so you don’t want to punish people for getting treatment,” she says.

Something Trahan Cain has seen work, particularly in the construction trades, are peer support programs. Unlike community support programs, these connect people in the same industry who are also in recovery, providing a personalized approach to someone seeking help. She advocates using all tools possible to help people manage, and overcome, their addictions.

“No ways to save lives should be off the table,” she says. “There is no one good way or bad way to help.”

Part of the issue with OUD, says Lyra’s Das, is that many people don’t get treatment until they are in some kind of crisis—often when overdosing. But the goal at Lyra Renew is to make treatment accessible and reduce barriers to care. It does this by using AI-powered provider matches to connect plan participants with a provider based on the member’s specific needs. First appointments are usually available in one day, a rarity in the mental health space.

This, she says, can help people seek treatment earlier and feel comfortable with coming back at crucial times like when they are leaving rehabilitation. Lyra also provides therapy and helps connect people with network partners for outpatient, inpatient, and residential treatment. The platform combines therapy with digital tools, support between sessions, and personalized guidance.

Cultural Change

If any of the prevention or treatment options employers offer are going to work, the organization must have a culture that encourages employees to seek help.

“Employees struggling with opioid use are often afraid to ask for help because they fear judgment or repercussions at work,” Das says. “Normalizing mental health and SUD care as part of overall wellness benefits—not something separate or hidden—is key.”

Making care seamless and reducing stigma has resulted in a 60% reduction in healthcare costs for people receiving treatment through Lyra’s SUD program, according to Das. Getting people into prompt, evidence-based care reduces prescription costs and keeps people out of the hospital, which nets big healthcare savings.

“Educating employees and managers about SUD and OUD and emphasizing that recovery is possible can make all the difference,” Das says.

Establishing a culture that isn’t punitive for OUD is particularly important because people may fear coming forward if they are using illegal substances. Changing culture is the most difficult part of helping people, Frank says.

“If you want someone to reach out for help in way that is visible to the company, you have to do a really good job of convincing people it’s OK to get help and it’s OK to need support,” he adds. “Otherwise, you are never going to get them to admit it.”