Opening Up the Workplace Medicine Cabinet

The phrase “drugs in the workplace” understandably elicits an alarmed reaction from employers. But the truth is the amount of substances that are considered drugs are many and varied, and many are commonplace for an employee’s daily routine.

Substance use abounds in the workplace — and that’s just legal substances. Employees roll into work and can’t get anything done without their daily dose of caffeine. Colleagues meet in the break room with cases of beer to partake in the regular happy hour. Someone anxious about an upcoming deadline picks up a CBD-infused coffee at breakfast or a CBD-infused burger for lunch. And don’t forget about that roll of antacids or bottle of ibuprofen in the desk drawer or an energy drink in the fridge for a mid-afternoon pick-me-up.

In short, regulating substance use among employees is not simple and straightforward. Drugs like caffeine and alcohol are legal, but employers may get into trouble if an employee’s alcohol consumption leads them to cause problems during the employee get-together.

Cannabis is still illegal federally in the United States as more states legalize it for medical and recreational purposes, causing confusion for employers who can’t keep compliance straight among the constant changes. And, a recent surge of “smart drugs” — substances taken to improve creativity, attention, executive function and working memory — poses major ethical questions about whether it’s OK to take a mental steroid to be productive at work.

PRODUCTIVITY

Much has been made about college students taking medication to stay productive and awake, but that habit doesn’t end at graduation.

People use cognitive enhancing drugs — also referred to as “smart drugs” — to improve their creativity, attention, executive function and memory. Much like athletes may use performance-enhancing drugs to improve speed and endurance, employees may use smart drugs to be productive at work.

“Some people start using them in college and then they’re carrying that habit with them into the workforce. And things don’t get easier when you go from college to the workforce,” said Nick Heudecker, vice president of research-data & analytics at Gartner.

The use of smart drugs isn’t limited to an industry or economic status, Heudecker said. Even though Silicon Valley workers taking microdoses of lysergic acid diethylamide — more commonly known as the hallucinogenic LSD — to stay focused has received media attention, knowledge workers aren’t the only ones taking part. “Every workforce population is engaging in cognitive enhancement in some way,” Heudecker said.

ADHD drug Adderall is by far the most common smart drug, he said, followed by Ritalin, or methylphenidate. Modafinil, a narcolepsy drug, is another common cognitive enhancer. Energy drinks and caffeine — common parts of many people’s daily routines — are also considered smart drugs, according to Heudecker. And the over-the-counter dietary supplements called nootropics claim to improve people’s cognitive abilities, as well. Nootropics alone, according to Grand View Research, Inc., is a $2.17 billion market as of 2018 and expected to be a $4.94 billion market by 2025. Meanwhile, microdosing LSD means that the user takes about 1/10th of a dose as a way to “break down cognitive barriers and help them be more creative,” Heudecker said, adding there is no research on how microdosing LSD impacts users’ health.

The nickname “smart drug” is a misnomer. “These drugs don’t make you smarter. They allow you to better use the facilities you already have,” Heudecker said. They do so by helping people stay more focused or awake. Users may have that “feeling of being in the zone” for longer. 

The use of these substances “is becoming more prevalent, not less,” he said, adding that too few employers are thinking practically about how they will address smart drug use in their workforce.

Why People Take Them: In 2018, The European Agency for Safety and Health at Work, or EU-OSHA, released the report “Managing Performance Enhancing Drugs in the Workplace: An Occupational Safety and Health Perspective” to explore the trend of smart drug use among workers.

Employees take them for “increased monitoring of employee health, stress levels, alertness and fitness,” especially when these measures are used to judge an employees’ ability to do their jobs. “It is possible to anticipate that employees under this level of scrutiny may turn to various pharmacological means to allow some control over biometric readings,” the report noted.

Workers in low-paid jobs that are not protected under standard labor laws may feel increased pressure to hit certain productivity levels, especially since they are increasingly being monitored by their employers. Not wanting to lose a job they rely on, they may turn to smart drugs. “Electronic means of monitoring employees are likely to be accompanied by an increase in the stresses on workers,” the article noted.

Employers in general don’t seem aware that this trend is happening, Heudecker said. “It’s not like someone goes out for lunch, has a few martinis, and their speech is slurred. It looks like, ‘I’ve got a really productive worker.’ You’re not going to ask questions because it’s a positive outcome,” he said.

While employers may appreciate that their employees are being more productive, if employees must turn to drugs to reach those performance goals, then the employer should consider how the company culture or policy drove them there, Heudecker said.

“There’s a lot of demand to always be on, so you need to give your employees permission to be off,” he said. His 2017 Gartner report “Cognitive Enhancement Drugs Are Changing Your Business” also explored the main reasons that push employees to take these substances. Basically, employees either view smart drugs as an opportunity to push the boundaries of what they can accomplish in the workplace or feel coerced into taking them to maintain performance and keep up with their workload.

If employees feel forced, that has the potential to get employers in trouble. “This may expose organizations to legal risk if CED users obtain drugs illegally because they felt forced by colleagues or management,” the report noted. 

Employer Response: Brian McPherson, labor and employment attorney at Florida-based law firm Gunster, has never had an employer raise the issue of smart drugs.

Medical cannabis is legal in Florida and that’s received all the attention, he said. “[Employers don’t have] the time or capacity to focus on the other issue that is brewing somewhat underneath.”

Studies support the increased use of Adderall, Ritalin and other drugs for performance, he said. Still, most employers try to stay away from getting involved in the prescription drugs employees are taking, and they assume they are complying with their physicians’ directions.

“We know it’s happening on a grand scale, at least more than it has in the past, but employers aren’t really talking about or dealing with it,” McPherson said.

Heudecker suggested policies companies can adopt to directly address smart drugs. A chief human resources officer can work with other leaders to draft a policy around cognitive enhancer use in the workforce. They also can support “non-pharmaceutical cognitive enhancement” — practices that naturally help people be more productive by “improving work-life balance, adjusting work schedules, promoting physical activity and educating employees on healthy nutrition and sleep practices,” Heudecker said.

An employer’s response also has to respect the fact that many smart drugs are prescription drugs that people need. “You don’t want to alienate people who need something for their ADHD,” Heudecker said.

THE LEGAL LANDSCAPE

The substance that employers mostly ask about is cannabis, said McPherson. Since medical cannabis is legal in the Florida, McPherson has fielded many questions about its use.

All indications point to cannabis laws continuing to progress in more states, he said. Once states approve it for medicinal purposes, the “floodgate starts to open” and there is a “general march toward recreational use.” Currently, 33 states, the District of Columbia and Puerto Rico have passed laws broadly legalizing marijuana in some form. As of Jan. 1, 2020, 11 states — Alaska, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont and Washington — and the District of Columbia have adopted laws legalizing marijuana for recreational use.

“As long as marijuana remains illegal under federal law, employers are getting a comfort level that they can still enforce the drug-free workplace tests for marijuana,” he said. “If it ever becomes legal under federal law, that will really change the landscape, and it will become a much more complex situation.”

Drug use among many U.S. sectors is growing, according to the Quest Diagnostics 2019 “Drug Testing Index.” The data involved in this analysis come from pre-employment testing for safety-sensitive positions or drug-free workplaces, said Barry Sample, senior director of science and technology at Quest Diagnostics, which has been annually analyzing workplace drug testing data since 1988.

Cannabis is the most commonly detected drug in the workplace, according to the “Drug Testing Index.” Positive tests have increased in most sectors. Meanwhile, positive test rates have declined for cocaine, heroin and opiates.

Interestingly, the inclusion of cannabis in testing panels may vary by state, the index showed. In almost all states, 95 percent of organizations still test for it when they have the option. Colorado and Washington, the states where recreational use has been legal for the longest time, saw a 4 percent decrease in organizations testing for cannabis between 2015 and 2018.

There may be differences by industry, Sample added. “Where there are generally less skilled workers, employers are having difficulties finding employees that will pass all the background screening, including drug testing,” he said. “They may be making a risk-based judgment on their part that ‘We’re going to take the chance and ignore the use of marijuana, because we really need people on board.’ ”

Meanwhile, two organizations have announced more nuanced drug tests for cannabis that may hit the market in 2020, according to Business Insurance. A research team at the Swanson School of Engineering at the University of Pittsburgh has developed a breathalyzer prototype, and Oakland, California-based Hounds Labs Inc. plans on bringing a breathalyzer to market in 2020.

Such tools could help detect marijuana use, which can stay in a person’s system up to 30 days after consumption, McPherson said. “The employers I’ve talked to about these tests are excited and hopeful about them,” he said.

Dan Harrah, senior associate at Mercer and a consultant specializing in behavioral health and health care operations, is skeptical about these tests. “The science of impairment is not settled yet. There’s a lot of subjectivity,” he said.

There will need to be a way to review these tests and see how effective they actually are, he added.

Psychedelic Legislation: While laws regarding cannabis use is moving rapidly, legislation on psychedelics is slower, said McPherson. Two cities — Oakland and Denver — have decriminalized psychedelics such as magic mushrooms, and the Chicago City Council in October 2019 approved a resolution that experts say could pave the way to decriminalizing them. The resolution uses the term “entheogenic substances,” defined as any range of natural plants or fungi “that can inspire personal and spiritual well-being,” as well as other psychological and physical benefits.

“The most alert employers are watching what’s going on with the psychedelics and they are concerned,” McPherson said.

Regardless of the substance, he advises employers to stay informed.

ADDICTION

A person with an addiction is hyper-focused on obtaining their drug of choice and getting that high, which can affect their hygiene, sleep, basic social behaviors and work performance, said Andrea Elkon, clinical psychologist and director of behavioral health for Alliance Spine and Pain Centers. This hyper-focus applies to substances such as nicotine, alcohol or opioids as well as behaviors like gambling or shopping.

An employee struggling with a serious substance addiction is fairly obvious to spot, Elkon said. They may consistently come in late, leave early or not show up to work at all, take extended lunch breaks or exhibit erratic behavior such as falling asleep at their desk or acting more emotional than usual.

In such cases, managers need to be assertive, Elkon said. It may be an uncomfortable subject, but not enough people know how to handle it, she said. Managers should learn how to take action — sooner rather than later — while still showing concern toward the addicted employee.

When an employee does not yet have a serious addiction but is on the path toward one, managers can still notice behavior patterns like absenteeism that may point to a substance problem. “That is a way to address the early signs, to focus specifically on the behaviors that are disruptive to the workplace,” Elkon said.

Also read: Boozy Workplaces Aren’t Just Trendy. They’re Potentially Dangerous

Employer Communication: Many employers have benefits programs in place to address addiction but not an environment that allows for open conversations about substance use, Harrah said.

“When it comes to behavioral health, everybody is able to talk about [how they] didn’t sleep well last night, and there’s no stigma around that. But nobody says, ‘I’m really thinking about cutting down on my drinking.’ There’s more stigma around that statement.” he said.

More employers have been taking on behavioral stigma, but there’s still work to be done. And the lack of communication around substance use benefits can lead employees down the wrong road, Harrah said. For example, if someone with an addiction realizes they need help, oftentimes the first thing they do is Google treatments. While the employer plan may include in-network carriers with good programs for addiction, a simple internet search can lead to low quality, out-of-network care, he said.

“One of the things that I caution my clients on is you can have these supportive conversations, but you better understand what programs are in place. Because once you start having those conversations, your employees start to come to you, whether for themselves or a family member,” Harrah said.

Substance abuse and mental health benefits also belong in open enrollment conversations, said Morgan Young, vice president of client services, employee benefits at insurance brokerage Holmes Murphy. Young didn’t mention mental health and substance abuse benefits in a recent open enrollment meeting, and an employee later asked if the company covered mental health benefits. Young was reminded of how important it is to share that message to employees.

Substance abuse benefits should go beyond the employee assistance program, she added. Employers consistently see low utilization of EAPs and try to convince employees to use them more, but they’re not going to be the only solution, she said.

“We need to understand that while an EAP may be a good tool for some, it’s not going to dissolve all the needs we have. We need to come up with different tools, resources and policies and make them available to employees,” she said.

Elkon suggested resources that could help employees or dependents with addictions. One of the first steps is sending them for a substance abuse risk evaluation, she said. These evaluations can tell employers about the employee’s risk of substance abuse problems and treatment options.

If an employee does have a problem, employers can respond by showing concern and having treatment resources available, Elkon said. The employee could use a leave of absence to get the necessary treatment, with the assurance that they won’t lose their job while they’re getting treatment.

“If someone is showing any signs of addiction, it’s important to show concern but be firm with that person sooner rather than later because it could spiral and affect other co-workers.” she said.