Countermeasures Season 2 Episode 4 Podcast Transcript: Creating Safer Workplaces
[00:00:00] Lorraine Martin I’ll give a little story here that is firsthand for me because it’s one of my reports. Her son-in-law was at work. He hurt his knee doing whatever physical activity he does. His buddy says, I’ve got my prescription in my pocket, my painkiller here. This will help you get you through your shift. This was not someone who had a substance use disorder. They were trying to get through their shift. Their buddy gave them something they’d gotten over the Internet. It had fentanyl. The son-in-law of my employee was blue and dead in their bed that night. Thankfully, their spouse somehow woke up, was able to call 911. They got naloxone into their place. The gentleman was able to live. But this was just an employee trying to get through their shift. And what happened to him, I would call a poisoning. He took something he didn’t know what he was taking, and it caused him to potentially lose his life. Those kinds of stories when you can can bring it home either through a workplace related incident like that or a family member situation, or telling a story about someone who just was recently working for the White House and had been in recovery and had been saved several times.
[00:01:06] Narrator This is Countermeasures brought to you by Emergent, maker of NARCAN® Nasal Spray. Join us as we explore the shifting complex world of the opioid crisis. Today, opioid overdose is a leading cause of accidental death for so many families, loved ones and friends behind these lives lost. This season will continue to explore some of the communities hit the hardest by the crisis, from prisons and construction sites to schools and elderly care. We will hear from changemakers offering a new way forward. Overdose can happen anytime, anywhere, including at work. According to the CDC, workplace deaths due to accidental overdose increased by 500 percent from 2012 to 2020. Some workplaces have a higher risk than others, notably in industries where employees perform difficult or dangerous work, such as construction, extraction and hunting and fishing. However, accidental opioid overdose can happen in any workplace. There are also countless people in recovery who are reentering the workforce, maybe for the first time in years. Some workplaces have started to provide naloxone and training to employees to help them be prepared to act in the event of an opioid emergency. But there are still gaps to address when it comes to employers’ responses to the opioid crisis. Lorraine Martin is the CEO of the National Safety Council, a nonprofit safety advocate founded in 1913. They help workplaces navigate important safety issues that could be impacting employees.
[00:02:44] Lorraine Martin Our mission statement is to save lives from the workplace to any place. So we look at those things that are preventable, things that we can take action around and make sure that we create a culture of people being safe in their workplace beyond, in their communities. So literally, we can all live our fullest lives. We have more than 13,000 members that are members of the National Safety Council, including federal agencies, and that represents about 41,000 work sites around the nation. And what we do is we tackle the big issues. We look at the data, what’s causing people to get injured or to lose their life, and what can we do about it. So back in 1962, we led the National Educational Campaign about seatbelt use, and then two years later really campaigned the issue of how to drive defensively. And in the 70s, we advocated for the formation of OSHA, which is our government agency that helps make sure workplaces know what’s safe. So we’ve been looking at all of the issues and the dangers that we face in our daily lives, and they change. So today we are looking at the data and informing workplaces about the dangers of opioid overdoses and really advocating for lawmakers to pass legislation.
[00:03:53] Narrator Something the National Safety Council emphasizes is building a strong safety culture at work that includes having lifesaving tools like naloxone on job sites.
[00:04:03] Lorraine Martin So we often talk about building a strong safety culture and having your safety culture be truly of value, not a priority, because priorities can change day to day in your life, in your workplace. So really understanding that safety is the top value, that everyone has to go home safe at night or whenever their shift ends and understanding that we all play a role in making not only ourselves safe, but those around us, and that every employee feels safe not only to do their work, but to raise concerns and bring their voice. And that’s where you get to the culture issue, that you really have an environment where leaders value employees input. They respond proactively to the issues that might be putting them at risk. And there’s never any kind of blame or punitive actions. It’s all about making sure that everybody gets to live their fullest life, whatever that might be.
[00:04:53] Narrator Desiree Voshefsky is a community impact manager at Community Medical Services for Eastern Arizona. In her role, she hands out naloxone to local businesses and says that many businesses want to have the power to keep employees and community members safe.
[00:05:07] Desiree Voshefsky I think it’s important for businesses to be trained on how to use naloxone because you never know if somebody, whether it’s in the workplace or outside of the workplace is going to overdose you. You honestly just don’t know. It could be a fake pill that they thought was something else or, you know, anything like that that can happen. Again, anything could happen. As far as having that medication on hand, I think is the first step and not being afraid to have it on hand either, because I do see that a lot. We went out with the Tucson Fire Department. A lot of the businesses were grateful that we came around and handed out. We did, you know, hit some stake in my own with some people that were kind of like, why are you doing this? I’m not going to use this, that kind of thing. And, you know, just insuring them that there’s limited liability that comes around with it, that they’re able to administer it and it doesn’t have an adverse effect if somebody is not in an overdose. And just continuing with the message that it’s better to have it and not need it and need it and not have it.
[00:06:07] Narrator Cal Beyer, the senior director for SAFE Workplaces at SAFE Project, a nonprofit dedicated to helping overcome the addiction epidemic in the United States. As part of their SAFE Workplaces program, they provide employers and employees with the tools and resources necessary to address issues of behavioral health and achieve emotional well-being in the workplace. Like Lorraine, Cal believes that the culture at an organization is key to employee safety. For Cal, this begins with having open conversations about mental health. At SAFE Project, they encourage employers to create a wellness culture.
[00:06:43] Cal Beyer There’s a lot of stigma associated with mental health, and especially when you think about substance use disorder or suicide prevention. You hit barriers when you talk about mental health, suicide prevention, overdose prevention in the workplace. So this concept of building a wellness culture is a gateway, a best practice to avoid that stigma of mental health. I encourage organizations to focus on the intersection of physical health and emotional well-being, and this requires leadership support to build a caring culture, so break down that stigma. But to build that culture requires really intentional effort. It requires a strategy. It requires data from various sources. Thinking about your success with recruiting and retaining staff. And then really being intentional about building an inclusive and respectful workplace culture. I think the biggest challenge that I’ve seen and the outcomes that are driven when organizations are intentional about building in positive employee experience to give a concierge approach to the employee, to let them know that they’re seen, heard and understood in the workplace, give affirmation, give recognition. And doing that by recruiting people intentionally who are going to align with the vision and values of your organization and then take time to adequately orient a new hire and onboard them, giving them career path opportunities for future development. And if you go a step further and go to wellbeing, you’ll combine physical health, nutrition, hydration, sleep along with emotional well-being, things like resilience, mindfulness, teaching people, stress management. That’s how this becomes holistic and that’s how organizations are going to have more success driving positive outcomes.
[00:08:49] Narrator Part of a robust safety or wellness culture includes having resources for people who are in recovery or who struggle with opioid dependency. These issues don’t disappear when someone clocks in. As someone in recovery, Desiree knows what could make a workplace recovery friendly. She says it’s often about the basic things that many of us take for granted.
[00:09:09] Desiree Voshefsky I do think the stigma does affect the person that is seeking employment. A lot of it is a lot of self-doubt. You know what’s going to happen if, again, in an argument or what happens if, you know, there’s a lot that goes into it. I think when a person is coming into the workforce that’s new to recovery and things like that, there’s a lot of self doubt. There is a lot of this may be the first time in ten years that they’re looking for a job. This is the first time that they’re having to deal with other people in the workplace that may not be in recovery themselves. So it’s kind of assimilating back into normal society, as you would call it. And that can be a challenge. And there’s a lot that somebody kind of has to go through because if you think about somebody that’s been using substances since they’re 14 and they’re now 32 and they’re just starting into the workforce, there’s a lot of things that need to be backtracked on what we need to prepare them for and prepare them to do, and that could be simplest things like sending an email, writing a resume, the how to answer the phone professionally, all that kind of stuff. We’re having to kind of step back and pretty much start at the basics.
[00:10:19] Narrator Naloxone is an important tool to help prevent opioid overdose deaths in the workplace. However, both Lorraine and Cal have seen pushbacks from business leaders, sometimes due to stigma and also due to uncertainty about the legal implications of naloxone at their workplace.
[00:10:35] Lorraine Martin So what we ask workplaces to do to be ready is to make sure they get education, that they have training on what the opioid crisis is all about, and then the naloxone is a mitigating tool for you. Now you get your training. And we provide free training at nsc.org for using naloxone and having a program in your workplace, and then make sure they’re making sure that you have naloxone at your workplace as you do any other emergency response. And companies have responded well to understanding that they don’t know what they don’t know. Many businesses truly they listen. They hear me out, but they have no idea unless it’s happened to them, that this is happening at workplaces. We also know that on this issue of substance use disorders, fentanyl and opioids and the harm they cause, there’s still a lot of stigma around that issue. And then helping business leaders really understand that we’re really talking about something that could impact anyone and in many cases has already impacted someone they know. And if they understand that it impacted someone in their life outside of work, to be able to translate that to it could impact someone also at work that you’re there to take care of, just like you are for any other kind of safety risk that might be about them. So they often bring up when I had no idea that the data was that much, we lose 200 people a day, 200 people a day in our country to an unattended overdose emergency that they lose their life and we can do something about it. So the first thing is education. And I will tell you, there’s a big gap. The second is giving them the tools. Once they understand, okay, I need to lean into this. The next question is always, well, I need to get my legal counsel involved to make sure I know that I’m not going to have any kind of implications if I lean into this. We have lots of resources there as well. We’ve gotten a law firm to help us with a legal brief to address the issues of Good Samaritan laws in each of our states. But they worry about that and as they should. And truthfully, when they were asked about defibrillators and putting AEDs in their workplaces, they had those same questions. Right. But we got through them. And we now understand that having that emergency response in our workplace is an imperative. Just like I am hoping naloxone will be in the same situation going forward. Quite a few are starting to stock naloxone, which is great. Very soon we’ll be able to have a list of companies that are willing to be those first leaders and have us talk about them. So we’re just getting really close to that. And about 50 percent of employees in a recent survey that we did indicated that having naloxone onsite was something that they were interested in doing it about. Only 20 percent of worksites actually have really leaned into this. So there’s a lot of work for us to do and a lot of lives that we can still save.
[00:13:22] Cal Beyer Have I seen resistance or pushback to having naloxone in the workplace? Yes, candidly. And I understand from a risk management perspective, the entirety of my career, there was a lot of emphasis around drug testing programs, drug free workplace policies, and there was a lot of concern that maybe the perception that the presence of naloxone on a job site could encourage active drug use. But the reality is there are many ways of an overdose. So there were many dynamics that we just need to recognize. The risk is real. The Bureau of Labor Statistics has identified 10 years in a row the number of occupational fatalities attributable to an unintentional overdose is increased, and it’s now 9.5 percent of all occupational fatalities in the workplace. So in an industry like construction that has the highest rate of overdose among all other industries, we’re more likely to need naloxone on a job site to help revive an individual than we are possibly to use an AED. So we need to normalize this conversation. We need to recognize that this is part of being a prepared workplace building in naloxone training and stocking of naloxone on job sites to be able to respond appropriately to in a medical emergency and a risk management approach would show this makes good business sense. And it’s not only the right thing to do. It’s the humane thing to do. It’s the moral thing to do, but it’s the right business thing to do as well. So this should be an area of alignment. We should start seeing a lot less stigma as we educate more people about the reality and the risks and break down the myths and the disinformation or misinformation that’s been provided, and to just acknowledge let’s save lives. That’s what this is all about.
[00:15:29] Narrator Another element of preventing overdoses in the workplace is the role of government. In Ontario, Canada’s most populous province, the government has been making efforts to ensure naloxone is in the workplace. Dr. Joel Moody is the chief prevention officer and assistant deputy minister for the Ontario Ministry of Labor, Immigration, Training and Skills Development.
[00:15:51] Dr. Joel Moody June of 2023, the Ontario Occupational Health and Safety Act was modified and it required that naloxone be available in some of those workplaces where a worker has an opioid overdose or have risk to have an opioid overdose. So for employers to understand that they must provide that kit on site, an employer becomes aware or ought recently be aware, that’s the way it’s written in the legislation. They had to understand these tests. You know, first, that there to be a risk of worker opioid overdose in the workplace. Second, that the risk that the worker overdoses while in the workplace where they perform the work is for that employer. And then the work risk posed by the worker is also performed by the worker for the employer. So it provides a test that if all of those criteria are present, then the employer must comply with those Occupational Health and Safety Act requirements to provide naloxone in the workplace. So within the Ontario context, we’ve been very fortunate to work with some great members and stakeholders. So I’ll give you a little background. So the Workplace Naloxone program was launched in December of 2022. And for two years, the government provided free naloxone kits, nasal naloxone to businesses that were at high risk for opioid overdoses. It provided free training that was incorporated for their staff to equip them with the tools, the knowledge, the experience about how to respond to an opioid overdose. And the program has been very successful. If I could, you know, tell you about some of the numbers within that period of time, over 6000 workplaces participated, and that resulted in over 5600 workers being trained and delivering of over 5100 kits to workplaces. We still have a lot to do. The opioid epidemic is still very much still happening. But we want to find ways that we make a difference by reducing the stigma of individuals that may have a substance misuse problem as well as how do we ensure that in Ontario and maybe other jurisdictions, but definitely within Ontario we have both the healthy safe workforce because that does add to the productivity within the province as well.
[00:18:40] Narrator Some industries are higher risk than others for a wide variety of reasons. A major factor is manual labor. In physically demanding professions, the risk of workplace injury and a subsequent prescription for an opioid is higher.
[00:18:53] Dr. Joel Moody The profile for workplaces by risk is not the same. So when we look at the evidence or look at the data, one of the research groups that’s here in Ontario has done some work, and that is coming from the Institute for Work in Health, or IWH, they recently released a study that looked at injured workers that were found on construction sites, materials handling and processing applications. And their work, they identified that these were high risk sectors in which you saw opioid poisonings were three times higher for formerly injured construction workers compared to the general population. Another research that has also been done here in Ontario took data from Public Health Ontario, the Ontario Drug Policy Research Network, the Office of the Chief Coroner, in which they looked at data from 2018 to 2020, construction, retail trades, the transportation and warehousing sectors. And that work also identified that those were the top occupation groups among individuals who had died from an opioid poisoning. So some of the work that we’re doing is we’re taking those data and understanding better. So, for example, we know that about 1 in 13 opioid related deaths in Ontario between 2018 and 2020 occurred among construction workers. And so our Ontario Workplace Naloxone program saw the highest participation from that sector construction, and that was about 25 percent of those workplaces, 14 percent were from health care and social services, and another 12 percent were from the manufacturing sector when we ran the program December 22 to March 24. We also know that when we understand the data and understand the epidemiology, that most opioid related deaths involve a combination of opioids with other drugs and alcohol, and this is possibly reflecting upon the reliance of nonprescription opioids to manage unresolved pain. And you can see what that’s an item within the construction sector where sometimes the workplace culture, lack of job security can lead to underreporting of injuries and also wanting to get individuals back to work sooner.
[00:21:31] Cal Beyer There’s a couple of reasons why the construction industry has stood out as well as the extraction industry, but it’s been heavy, hard manual labor that does lead to an increased number of musculoskeletal injuries. And evidence shows the more likely users of opioids were individuals with those musculoskeletal injuries. And the frequency of opioid prescriptions increased with multiple repetitive musculoskeletal disorder. So that’s a really important issue. To me, that first dose prevention strategy starts with safety and injury prevention, injury reporting, injury management, and then educating employees about the risks of opioids. What I think is also important to recognize is we need to do more about workplace design and human factors engineering to reduce the repetitive motions, especially to shoulders, necks, knees and backs, using more material handling equipment on job sites to reduce repetitive lifting, lowering, twisting, turning and carrying of heavy loads. Those are some of the strategies for injury prevention that many companies are being more intentional about.
[00:22:58] Narrator Despite many of these compelling arguments, Lorraine has met with business leaders who feel that opioid use and overdose is not a workplace issue or not something that employers should be concerned with.
[00:23:09] Lorraine Martin So one of the things when I talk to leaders and I bring them the data and I start to help them understand that this is happening at workplaces is they’ll often say, well, not our employees. You know, we hire a different kind of employee. And I will say there’s also a bridge you have to get past when they may have had a situation, but it was a contractor, not one of their employees, that perhaps had this emergency. And there is all kinds of stigma wrapped into all of that regarding who this is really affecting. Give a little story here that that is firsthand for me because it’s one of my reports. Her son-in-law was at work. He hurt his knee doing whatever physical activity he does. His body says, I’ve got my prescription in my pocket, my painkiller here. This will help me get you through your shift. This was not someone who had a substance use disorder. They were trying to get through their shift. Their buddy gave them something they’d gotten over the Internet. It had fentanyl in it that the son-in-law of my employee was blue and dead in their bed that night. Thankfully, their spouse somehow woke up, was able to call 911, got naloxone into their place. The gentleman was able to live, but this was just an employee trying to get through their shift. And what happened to him? I would call a poisoning. He took something he didn’t know what he was taking, and it caused him to potentially lose his life. Those kinds of stories, when you can can bring it home either through a workplace related incident like that or a family member situation, or telling a story about someone who just was recently working for the White House and had been in recovery and had been saved several times herself. And now as a lawyer, you got to bring it home that this can hit anybody. This can hit anybody. And you don’t know what your employees are wrestling with, whether it’s, you know, an injury at work and someone gives them something that poisons them or having a substance use disorder that needs to be addressed. So stigma plays a big issue. And again, it’s about education, it’s about awareness, it’s about storytelling, and it’s about understanding that if that emergency is happening in front of you, there is no response other than having on hand the thing that can save that person’s life, period, end of story. No judgment belongs in that equation in any way, shape or form.
[00:25:26] Narrator The fact that opioid use disorder and overdose is a workplace issue is clear from some of the examples that came out of Ontario’s program. Because of the training provided, employees were able to save lives.
[00:25:38] Dr. Joel Moody Happy to to share a story that was conveyed to us as we have gone through both the program. We’re in the process of evaluating the effectiveness of that program. But a story that came to us was in the Greater Toronto area, which is what we refer to as the GTA. Within about a nine day window, there was a grocery store happen about March of 2022, two situations where naloxone training and the kits provided under the workplace naloxone program were used to save a life. And the first incident, an employee found their colleague unresponsive in a washroom. The second incident occurred at the exterior of a building. In both cases, the worker was able to, number one, identify the signs of the opioid poisoning. Number two, being able to access the naloxone that were in the kits. Number three, administer the naloxone, and they also had to provide CPR to her to revive one of the employees. And both cases, they prevented a fatality.
[00:26:50] Narrator Desiree emphasizes that people in recovery can hold jobs and are in the workforce. Like in many places touched by the opioid crisis, stigma creates barriers.
[00:27:01] Desiree Voshefsky I think a lot of it has to do with stigma, just personal, people not knowing what substance use disorder is, what opioid use disorder is, and not seeing it as a way that people that have these substance use disorders maybe still be able to hold a job. People in a recovery can still hold a job. We know people that are even actually using and call it functional substance use, they can actually have a job, too. So it can be a variety of ways and there’s different levels to substance misuse. It could be somebody that is taking prescription pain medication that kind of gets stuck and is become dependent on them now. So there’s kind of all levels to it. And I think that the more that we don’t talk about it, the more that we’re hurting the person that’s either seeking the job has a job or may need some help to continue doing their job.
[00:27:52] Narrator Cal also emphasizes that beyond providing naloxone, workplaces can become recovery friendly. Many people in recovery are still going to work or are looking for employment. Lowering barriers to being in the workplace while in recovery is good for everyone.
[00:28:07] Cal Beyer The idea of a recovery, friendly or recovery ready workplace is going to continue to expand. This has been a really positive movement. Individuals in recovery and there’s at least 21 million based on data that are in recovery. And there is evidence 70 percent of individuals with substance use disorder are in the workplace. So what a recovery-friendly workplace will do is create fewer barriers for employment, reduce the discrimination, create new career paths and give people a fresh start at a career. There is evidence that shows recovery ready workplaces are going to be more productive. They’re going to have less turnover. They’re going to have reduced health care costs. So in every angle, there’s a lot of evidence why this is important. I was one of the individuals selected by the Legislative Analysis and Public Policy Association to partner on building a model recovery ready workplace statute. There’s great information about the power of building recovery allies. And so that’s something that we’re very supportive of. But the hallmarks of a recovery ready workplace are going to be acceptance and affirmation, reducing that stigma and then the need for some flexible policies, especially around leads as individuals may need time for doctors and therapy and for ongoing recovery support. Those organizations that see the value in that flexible leave policy are going to get the benefit of more engaged workers. And then another hallmark has been peer to peer support and mentoring programs. And that even includes on site recovery meetings. But the biggest part, and it’ll be the most challenging, is going to be providing training on an ongoing basis to all employees to let them know as well people in their life may benefit from recovery, giving people a pathway to learning more, sharing resources so they can support family members or even start a recovery journey themselves. That’s what I’m excited about, this idea of recovery ready workplaces.
[00:30:34] Narrator Lorraine believes that many workplaces and members of the public have gotten to a place where overdose is seen as an emergency like any other. And just like other emergencies, like a heart attack, the tools to save someone’s life should be close by.
[00:30:48] Lorraine Martin So being trained to address it, just like we all went through our CPR training or other kinds of emergency response, I think is the place to start. And the fun or really exciting thing about any skill that you give an employee is they take it with them, right? Whether that’s how to drive safely or do CPR or be able to respond to an overdose. They take that with them. They take it with them when they’re on the battlefield, when they’re in their communities, and they save lives truthfully for those skills that you give them. And it’s traumatizing, truthfully, when someone around you as an emergency and you can’t you can’t do anything about it. We have workplace incidents like that all the time. And it’s not just the person in their family, which is traumatic and horrible. It’s everybody around that witnessed it, that knew that person, maybe didn’t know that person, but is in the organization where that valuable team member is no longer here. It’s a ripple effect. So knowing how to have this very simple tool and training is something that I hope everyone will lean into so that when that emergency happens, you can really be the person who saves a life. And the difference between saving that life and having someone perish in front of you because you didn’t have the skills or the tools is really just momentous.
[00:32:02] Narrator Through his work, Cal has worked with numerous people and groups who are making an impact on this important issue. You can learn more about them in the description of this episode. He’s generally encouraged the conversations about overdose, opioid use disorder and mental health are becoming more common in workplaces.
[00:32:20] Cal Beyer This idea of help seeking and help accepting starts with help offering. When coworkers identify that someone is not well and asks, Do you need support? How can I help you? It goes a long way to a person saying I’m going to be accepted for who I am. And this idea of no shame is filtering through many industries, many more organizations, and people are getting more help. So I’m especially encouraged by the example of the construction industry. There’s probably 40 different organizations that have provided tokens, chips that have 90 day information in the logo of organizations to say we stand in support and we’re going to support the efforts around the mental health suicide prevention crisis line. I’m just excited about more conversations becoming more natural and being more at the peer to peer level and people worrying less about the privacy confidentiality barrier that didn’t let people seek help in the past.
[00:33:29] Narrator Opioid use disorder is something that affects every aspect of someone’s life, including work. To keep everyone safe, workplaces should be providing naloxone and the training on how to administer it to employees. Additionally, creating workplaces that encourage holistic wellness and that are supportive of recovery is good for everyone at the workplace, employers included. To learn more about the work being done by the National Safety Council, SAFE Project and the Government of Ontario, please visit the episode description. We’ll also find resources for free training and information for employees and employers alike. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to help address public health challenges like the opioid crisis, visit emergentbiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.