Workplace substance use practices that set parameters and provide support, rather than harm and stigmatize

International Overdose Awareness Day (IOAD) occurs on August 31^st. IOAD is a movement intended to raise awareness about and help end overdose, reduce stigma of drug-related death, remember those who have died, and hold space for the grief of family and friends.

Overdose statistics in BC and Canada

2,224 people died in BC in 2021 (6 per day) due to overdose, a 26% increase over 2020 (1,765) and has been called the “deadliest year on record”
From January 1^st to June 30^th, 2022, preliminary data indicates that there have been 1,095 overdose/drug poisoning deaths (the most within a 6-month timeframe in BC)
5,084 people died in BC due to overdose from January 2020 through June 2022; as a point of comparison, 4,097 people in total (2020 through Aug 20^th) were reported to have died from COVID in BC
From 2016 through 2021, there were 29,052 apparent opioid toxicity deaths in Canada
Of all accidental overdose deaths in 2021, 86% involved fentanyl
Three-quarters of those who died by overdose within BC during the first third of this year were between the ages of 30 and 59, most were male (although rates of overdose among females are rising) and were in private homes, social housing, and/or shelters (none were at OD prevention sites and only 14% were using on the street or in parks)
Northern communities see the highest rate per capita

Accurate statistics on substance use are difficult to obtain because they, in part, rely upon self-disclosure. That said, Canadian statistics estimate that approximately 21% of the population will have a substance use disorder/addiction within their lifetime. Although alcohol is the most commonly used substance, the overdose statistics provided above are largely related to opioids and poisoned drugs (i.e., with fentanyl and carfentanil).

The people who use substances

Regrettably, many people continue to think of those who use drugs/substances as “others” who have made bad life decisions, have brought it on themselves, as criminals, and/or as homeless. In actuality, they are our mothers and fathers, sisters and brothers, aunts and uncles, cousins, grandparents, friends, and co-workers. Some are navigating compromised mental health and living in social housing and shelters, and some have life circumstances no different than yours or mine. Regardless of those circumstances, no person’s life should be considered “less than” because of them.

There are also many people (professionals included) who use legal and/or illicit substances regularly and are able to function well (or are only able to function well) as a result of using substances.

Substance use and impact in the workplace

When we consider the striking statistics of substance use, addiction, and overdose, it’s clear these factors will inevitably have an impact in the workplace. Alcohol alone, clearly a socially acceptable substance, has a far-reaching impact that includes hangover effects. Many organizations have attempted to address the impact/ potential impact of substance use by putting in place zero tolerance policies. This is particularly the case in safety sensitive work environments where the effects of substance use can be a matter of life or death. Although they are necessary, substance use policies can’t and won’t change the realities of addiction and dependence. As is the case for physical and mental illness, it is a common medical and health-related condition.

Many employees/employers have no problem talking about drinking alcohol, often drink together (including at lunch), and even get drunk together. In some workplaces, this is increasingly occurring with cannabis consumption as well. While our intent here isn’t to condone or criticize those acts, it is important to keep in mind how behaviour is judged based on the social acceptability of a substance.

Substance use policies

While traditional workplace substance use policies and associated procedures are necessary to set out clear parameters, depending on how they’re written or upheld, they can further stigmatize those who are already navigating significant challenges. As opposed to focusing on the impact on one’s performance and safety overall, which is/should be the point, they often rely upon the concept of ‘reasonable suspicion.’ This can be problematic, as it also relies on assumptions of what impairment looks like (and what causes impairment). Impairment refers to a state of deteriorated judgment and a decrease in a person’s physical, motor, and/or cognitive ability. Such a state can certainly be caused by substance use, but it can also be caused by compromised mental or physical health.

Traditional policies also often use language such as “substance abuse” or “abuser” which suggests that those who use substances (whether by choice or otherwise) are doing harm which places blame on them. Accordingly, referring to people who use substances as “users” or “addicts” (in addition to a variety of other slang terms) is stigmatizing, labels the person by/as their behaviour, and reduces their identity to their use of substances. Most seriously, because they often focus on testing and required treatment, these policies can push people who use substances out of the workplace, which may lead to increased risk of overdose.

Policies aside, the stigma associated with substance use is harmful in that employees fear negative consequences (discipline or termination) which prevents them from asking for support or guidance at work. This can lead to increased isolation and stress which is dangerous and can have devastating consequences.

A harm reduction approach to substance use policy

While it is important to have substance use policies and parameters within your workplace – especially if the industry and/or roles are safety-sensitive – there are approaches that can be taken to help mitigate the harmful effects of traditional policies and associated stigma. Such approaches come from the concept of harm reduction which focuses on “working with people without judgement, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.” It is focused on avoiding stigma and the idea that something is right or wrong, good or bad.

To illustrate, many substance use policies indicate that using prescription and over-the-counter medication (specifically stated) is acceptable, so long as the medication (a) was obtained legally and is being used for the prescribed purpose; (b) the use doesn’t impair one’s ability to do their work safely and productively. A harm reduction approach recognizes that if this is acceptable and prescribed medication can include sedatives, pain medication, and mood-altering substances, then other forms of substances can potentially also be safely and productively used.

Workers for Ethical Substance Use Policy have developed a policy philosophy that focuses, in part, on:

Trust and respect, as opposed to judgement
Autonomy and empowerment, not coercion
Support, rather than punishment
Managing performance, as opposed to monitoring substance use
Focusing on reducing risk and harm, not mandating abstinence
Removing rather than creating barriers
Working towards anti-discrimination and destigmatization
Understanding the roles that trauma and compromised mental health play

Accordingly, rather than addressing substance use with judgement and punishment, it’s important to observe your duty to inquire and to accommodate. In doing so, understand that substance use, dependence, and withdrawal from substance use isn’t a straight line, nor is it the same for everyone. People (whether they have a dependence or not) typically aren’t comfortable talking about their substance use – especially in the workplace. How well employers and managers foster honest conversations focused on support and well-being, rather than blame, can go as far as to save a life.

From there, you can offer support through benefit plans, employee assistance programs, helping find external resources, supporting leave, and even providing financial support for programs (with the understanding that rehabilitation isn’t possible for everyone, and that relapse is a reality). Of equal importance is helping prevent and shutting down stigma within your organization, which may, beginning at the leadership level, start with education and training on reducing stigma. Some options include: Toward the Heart: Reducing Stigma, CAMH Understanding Stigma, CCSA Pain of Stigma, Changing the Narrative.

How employers can support International Overdose Awareness Day

Start simply by acknowledging it and talking about it. Depending on the nature/organizational culture of your workplace and industry:

Support employees to take the time they need that day; don’t question requests for time off
Suggest (and/or as appropriate, make available) training sessions related to stigma and harm reduction (including training on how to use Naloxone)
Host facilitated sharing circles or groups and/or cultural gatherings – again, as appropriate to your workplace and ability to address what arises (i.e., having appropriate resources available)
Invite (without expectation) employees to share stories about friends and family either in small team meetings or designate a space where they can do so quietly and anonymously (a meeting room or online space)

Regardless of if/how you choose to acknowledge and/or do anything differently within your workplace, on August 31^st, we encourage you to take the time to reflect on the impact of overdose. It is a time to remember. A time to act.

Jouta’s HR Consultants can help you define substance use practices that align with the nature and culture of your industry/organization.

Harm Reduction Substance Policy