Opioid Crisis in the Workplace: The Proactive Role Employers Can Take

Opioid Crisis in the Workplace: The Proactive Role Employers Can Take


[MUSIC PLAYING] Good morning. Welcome to Lakeland
Community College. I’m Cathy Walsh, the director of
the Small Business Development Center here at Lakeland,
located on the main campus across the street. The Small Business
Development centers are, sort of, a local arm of the
Small Business Administration. So we’re here to
assist small businesses with any number of small
business counseling issues. And we also, hold educational
workshops, like the one you’re at today. So welcome. I want to thank Barb Marlowe,
for helping us put this together with Randi Ostry. And this was a lot of
coordinating and a lot of work and it’s, hopefully, going
to be a wonderful event for everybody. And I also want to thank James
DeRoche and Stuart Garson– they provided the
breakfast this morning. So other than that, I want
to introduce our moderator today, Randi M. Ostry. Randi has been an attorney
for nearly 30 years and is currently serving as the
Attorney General, Mike DeWine’s director of Statewide Substance
Use Education and Business Initiatives in the heroin unit. Randi advises the attorney
general on policy matters involving the current
opioid epidemic, focusing on prevention education
in the schools and business community. She also administers
the office’s drug use prevention grant and
works with schools and law enforcement on
curriculum development in prevention education. She is a former assistant
Cuyahoga and Lake County prosecuting attorney, with
extensive experience litigating constitutional issues and
advocating for crime victims. Her legal career
includes serving as a commissioner of
the Ohio Court of Claims Victims of Crime division,
appointed by the Ohio Supreme Court Justices. The former managing attorney of
the Cleveland regional office, appointed by Attorney
General Mike DeWine. Randi national policy work
in crime victims recovery and local education
and advocacy efforts with the opioid addicted,
enhanced the heroin units reach into the courts, the
schools, law enforcement agencies, and now, in
matters affecting businesses, their employees, and how to
train, reach, and treat them, as associated costs rise and
the health of the workforce declines. Randi, welcome. [APPLAUSE] Thank you, Cathy, and
good morning, everyone. It is an absolute
privilege to be here today. Thank you, Barbara
Marlowe for helping make this the brainchild of the
small business community here and the partnership with the
Lakeland Community College at the Holden University Center. It’s a spectacular venue. I am formerly of Lake County. I just moved to Bratenahl,
about seven years ago or so, so I could be close
to Lake County. And I see some friends here,
from around the state and also, locally– the work
that we have been able to do under Attorney
General Mike DeWine. I have been a part of the heroin
unit for a couple of years now, and one of the
things that I do– as Cathy said– is work
with the business community. We have traveled the state,
listening to businesses. Listening to the struggles. Listening to how it affects
the economy– the tax base. How it affects families. And this is an important
issue as we go forward. Ohio– as we all know– is at
the tip of the spear with us. And we need to deploy some
creative solutions to really, bring solid help to people
and help the businesses that are struggling. We have a great panel
lined up for you today, and it is my great privilege
to introduce our first speaker, which is Dr. Randy Jernejcic. He has great Lake County roots. He’s a graduate of
Mentor High School and currently serves as
the chief medical officer and attending physician at
University Hospitals, Ahuja Medical Center. He is the chairman of the UH
Patient Safety Opioid committee and also, the chairman– which
he’s going to discuss in his remarks– of the newly formed,
Northeastern Ohio Hospital Opioid Consortium. An interesting fact, he actually
served in Beijing, China, for about three years as
part of the United Family Hospital in China. And without further
ado, Dr. Jernejcic. [APPLAUSE] Good morning, everybody. Is that working? Good. I usually like to
walk around the room and I’m told that I have
to be anchored here. So we’ll see how this
goes, if I start to wonder. Looking around the room and
meeting a number of the folks this morning, I got to say,
I was a little bit undersold on what the audience
was going to be. I asked, who am I
going to speaking to? And what would
they like to hear? And they said, it’s going
to be a great crowd, and actually, that’s not true. It’s a phenomenal crowd. Look at the folks
around the room and just the talent and the
things that you all represent. So I’m really proud to
be here this morning, to be talking about
something that I’ve become very passionate about. I’m not a psychiatrist. I’m not an addiction
medicine physician. But what I am is, I have a long
history of both primary care and emergency medicine, and
I’ve seen the opioid crisis from those perspectives. And how devastating it can
be for many different levels and seeing it affect
patients directly and families in our communities. I’ve also, been a physician
leader for a number of years, and as chief medical officer, I
see that from a very different perspective. And so, I was very
proud to be asked to lead the UH response
across our system, to the opioid crisis. And it’s become a
real passion for me, and I am hoping today, to share
with you, to build the case that we are in a crisis. That there’s hope. And that we have a
lot of opportunity to work together to
help solve this crisis. So I look forward
to sharing with you, over about the next half hour,
some of what we have today. So that’s me, and
again, I’m really excited to be talking not only
about this, as a physician leader, but really, as a
member of this community because it hits
all of us so hard. Some objectives– I’ve
already talked a little bit about that– but some
basic recognition of the opioid crisis and what
that really means for us. I think, you’ll find some
of this to be very shocking. I know I read a lot
about the opioid crisis, but never put it
in context until I saw some of these numbers. To understand it,
I’m going to share a little bit about what
University Hospital’s doing, not as an
advertisement, but just to show what I know in
a little bit of detail, in ways that we can all
communicate because this is not one of us working together
in one business or one area. Really, I hope to tell you
that this is a community response we have to have. And then, when I actually
do some of this presentation to my physician colleagues, they
want to, where are we going, and how are we
going to get there? And I will tell you, I was just
in Baltimore a few weeks ago and there is no
clear destination of where we’re going. Nobody has a roadmap to figure
this out around the country. So we are going on a
journey without a roadmap to help solve this,
but we can’t stop. And we can’t wait
for that to occur so I’m going to share a
little of that with you, also. So 2016, in October, the
US Senate Finance Committee called Ohio, the face of the
nation’s opioid epidemic. Not a surprise, but a shock. And not a place
where, I think, Ohio wants to be remembered, as the
face of the opioid epidemic. But what does that mean? And what is an epidemic? And what’s an opioid
epidemic mean? A lot of people think of
this as the opioid epidemic– the rock stars. I guess, I could put
Tom Petty up here and a few others recently. But as a practicing
physician, these are not the people that I see. These are the
people that I see . These are the folks– these
are real folks, people. And all the pictures
you’ll see, are people that have been a
victim of the opioid crisis. But when I look
at these pictures, I see neighbors, colleagues,
coworkers, friends. You can even see an uncle, a
brother, a sister up there. You can even see a little
bit of yourself up there. These are real people. And this is what our
community and this is what our opioid crisis looks like. So to define an
opioid crisis, first, you have to define what an
opioid is, and I promise you, that this is going to be very
little– this is probably, the only clinical part you’re
going to hear from me here– I hope. Call me out if I do
get any more clinical. But what is an opioid? You look down the
one side, there’s a whole list of medications–
generic and name brands. Many of them are prescription. Most of the drugs on there,
I can write a prescription for you right now. But some of them are
illegal– like down on the bottom– heroin. But all of these are opioids
and work in very similar ways to what we’ll talk about. But what is the opioid? Well, it’s a class of drugs that
block receptors in your nerves that stop signals from going
your brain, like pain signals. That’s actually,
pretty good, right? You’re having surgery,
you want that. But at the same
time, it also can produce a bit of a euphoria. And in a time of crisis
and a time of pain, that’s actually, not a
bad thing either, right? The problem becomes is that
over time, if you take it at high and high
enough doses, it also stops your brain from
realizing you have to breathe. And it shuts down
your breathing. And you die of
suffocation, and that’s where all the opioid
overdoses come from. And that is obviously,
why we have this crisis. It also leads to the
addiction aspect, that we’ll talk about,
that leads to that. So some definitions, I thought
it was fair because there’s a lot of definitions out there. Tolerance– we all
hear about tolerance, but this is really
what a user needs to get more and more substance
to receive an effect. And what I want to be
really clear about is, we are not just
talking about addicts. I remember growing up and my
grandma always telling me, don’t go downtown Cleveland. There’s all these
addicts down there. That’s where I got in
Mentor, but this is also, you build tolerance
if you’re using these medications for pain. You got chronic cancer pain,
you have to have more and more, oftentimes, to get the pain
relief that you’re looking for. It builds up tolerance, and
that’s how these drugs work. Physical dependence. You need more and more
of the drug or else, you start to get withdrawal
symptoms from it. That can happen if you’re
using it and abusing it as in an addiction. It can also happen if you’re
using it for chronic pain, for legitimate medical reasons. It can start to lead to
psychological dependence, where I need the drug or else,
I’m not feeling like myself. That’s a little bit different
than not having the pain. And this is where we start
going down this slope. I’m not an addiction
specialist– we’ve got other folks that
are– but really, this is to start setting some
definitions for you. And then, withdraw–
physical or psychological. You start to have a reaction
when you don’t have that drug or medication with you,
regardless of the reason why you’re using it. So this pathway to addiction–
this is just very simple. You start to use
the drug– again, whether it’s recreationally or
for legitimate medical reasons. You start to build a tolerance. You need more and more to
produce the effect that you were originally getting. You start to get
dependent and so that means you start to
get withdrawal from it when you stop having the drug. Guess what that means,
you want more of the drug. And pretty soon, over time–
and not for everybody, not everybody becomes
addicted– but over time, it can lead to addiction,
where, really, you lose your control of that habit. You got to get more and more
of that drug for whatever, to fight that withdraw. And to help with the
symptoms or the feelings that you were trying to
use the medication for. I kind of like this cartoon
a little bit better. This shows kind
of normal balance. You’ve got a lot of things
going on in your head that you’re thinking about–
your family, your food, your television, your
school, your work, your kids. And over time, as it
starts getting down that progression of
the previous slide, that’s all that’s
really going on. Your thoughts are
more and more– how do I get that
connection over time? I don’t know about you,
but I love my ice cream, and I can’t turn
that down, sometimes. And I can’t imagine
how overpowering this can be for
people and just put it in a little bit of perspective. How fast does it take? When you go to bed,
nobody goes to bed, well, I’m going to wake up
tomorrow as a heroin addict. I can tell you
that, nobody does. But six to 12 hours
when you start getting these
symptoms of nausea, and vomiting, and bad symptoms
withdraw when you wake up in the morning, first thing
you’re starting to think about is, how am I going to
get that next dose so I don’t go through withdrawal? Because why? Because it’s scary. It’s the worst flu you
ever had in your life. Think about that,
well times 1,000. It’s really bad for folks. And so, you can see why this
is a cycle people get on, and it’s very hard to
get off, whether they’re on it for legitimate reasons– i.e. medical stuff,
pain control. Or start to use it. This is a disease, just like
anybody here that’s a diabetic, you said I want to be
a diabetic tomorrow? No. You said I don’t want to
be a diabetic tomorrow? That’s true. Most addicts do not want
to be an addict tomorrow, but we’ve got to
really start thinking about this differently. It’s not a choice,
unfortunately. And we’ll talk a little bit
about that here, later on. Well, let’s put it a little
bit into context, if you will. So I told you a
little bit about– I said, an opioid epidemic. I talked a little bit
about what an opioid is. But does that mean
we have an epidemic? And I’m hoping that over
the next few slides, you’re going to agree with me,
that we’re in an epidemic here. This is a death toll. This is across the
United States alone. Mind you, the United States
only, not internationally. And this is the curve
from 2002 to 2016, of the deaths that have
occurred across the country. And you can see that, that curve
is nowhere near going down. It’s going in the
wrong direction. 42,249 deaths in 2016
in the United States. We’re starting to get some of
the real numbers from 2017, [INAUDIBLE] a little bit and
I didn’t update this slide, but the numbers– I will tell you– have continued to go along
that trajectory of that curve. If you think about
that, what would happen if a 747 dropped
out of the sky tomorrow? What would happen if
one every 3.5 days fell out of the sky in
the United States tomorrow or over the next year? That’s what that represents,
is 108 jumbo jets or one every 325 days. In the United States of
America, what would we do if that was happening here? That’s what’s happening in
the opioid crisis today. So I trained– I trained
during the AIDS epidemic and I wanted to put this
into a little bit of context. This is– I took that
42,249 and I compared that to an AIDS deaths
statistic that happened, and again, this was just
in the United States. We have now, surpassed
the number of deaths at our peak year in the AIDS
epidemic in the United States. We were at 41,699
back in the 1995 time, and we’ve now surpassed that. And as I told you before,
that curve is not going down. Look what happened
to the AIDS curve, how we got ahead of this. Some misconceptions. Who does this affect? About 58% male, 42% female. Not surprisingly, some
of the younger folks out there in the community– 69%-70% in the 25
to 54 age range. But I find the shocking
statistic at nearly a quarter are in the 55 plus age range. I have taken care of
patients in their 80s who have been utilizing
these medications and have been addicted to it. Well, Ohio has
the distinct honor of being the face of
the opioid nation. We have some other
dubious honors, also. Up until not too long ago–
if you saw on my first slide– I was very on purpose, that
that slide was very Caucasian. Because up until
several years ago, that this was really affecting
much more of the Caucasian part of our communities. And Cleveland has one of the
dubious reputations as one of the epicenters in
the country of where the African-American
community is growing very rapidly in this crisis. And so, therefore,
it’s really hitting– there’s no boundaries to this
epidemic and this crisis. I’m sure nobody has
missed this, this was out in the press
a few years ago. I was actually, in
China back visiting and this made the
newspaper there. Shocking, these grandparents
that were in the car, both passed out with the
child in the back seat. But overdose’s 42,249
deaths are tangible. I can count a death. I can count when somebody comes
in my emergency room and dies. I can count somebody
at the morgue. What I can’t count as all
the other significant impacts on life, outside of that. Over 2.1 million
addicts in the country, and it’s just not the addicts
that are affected, correct? It’s the losses of family. It’s what happens to
the family members. It’s the loss– and this
really hits home to you– what happens to businesses? I was talking to our
snowplow driver and lawn guy the other day
and he was saying, he just can’t hire
people right now to drive because there’s
so many people that can’t pass drug tests. I see a lot of heads nodding–
you all see this, right? The economic effect of this and
your ability to run businesses and to lost productivity. In the health care
society, in the sector, we’re seeing increasing
diversion of drugs. It’s a huge issue
in health care, but that’s not the only
area where we’re seeing this affecting our society. I have another slide that
I’ll show a little bit more on that in a moment, but this
is just bringing it down closer to Ohio. This was, again, a
little bit outdated– 4,235 deaths in just
the state of Ohio, and again, this curve goes
up as dramatically as before. But what I want to do is I like
this curve a little bit better. This is the same blue as you
saw in the previous one– the deaths. What this has is, in the
yellow, are all the overdoses that don’t lead to deaths. So about five to six overdoses
leading to one death. This doesn’t count for
all the other people that have the addiction. And this is where it’s
projected to go in Ohio, if we continue to go. Actually, there’s
a revised curve. It actually looks worse now,
with last year’s numbers in, but a revised curve shows
we could potentially, be reaching 18,000– 18,000 deaths in
the state of Ohio alone, if we continue
on this trajectory. So the overdose rate
per capita, per county– this goes to show you,
2011, 2014, and 2016. As you can see,
doesn’t take a lot to read that we are in the
epicenter of the crisis in the state, along with
down the southwestern part of the state. This slide I now, think about– I just added this last night. I should have put it in a
slightly different order– but this goes back to
that economic issue. From 2001 to 2016,
$1 trillion impact on the country, when you look
at both health care costs– what I see in the hospital, the
ICU, the neonatal, the NICU, the children born
with addiction– to lost revenue,
lost employment, lost productivity
out in the workforce. $1 trillion, it’s estimated. And look at that
curve at the end, in four years, it’s projected
to be half that, again, $500 billion. I hope at this point,
I’ve convinced you of what an opioid is, and that
we clearly have an epidemic. Hard to ignore those numbers. But this is the part in the
talk I always like to stop and say, wait a minute. As a physician, I
remember our president at University
Hospitals, Mr. Tom Zenty asked me back in September
to lead the opioid response for University Hospitals. And I said OK, well,
what does that mean? What do we want to do? And how do we want
to approach this? And I’ll tell you, the initial
knee jerk reaction everybody has is to just stop
prescribing the pills. But this is why I want to
stop here and recognize, that for as life
damaging, potentially, these medications have been,
they’re also life-saving. Modern surgery, modern
advances in medicine could not have been had
without these medications. I think of the
patients that I care for who have chronic cancer
pain, who are living lives because of these medications. And so, the idea
that we have taken and the approach
that we’ve taken is that, we have to
respect these medications. We do risky things every day in
health care– delivery babies, surgery– whatever we do, we
have to look at that and be respectful of
what the risks are with these medications. And to use them and to
prescribe them appropriately. And make sure
they’re only getting in the hands of the people who
need them, when they need them. That’s a lot more difficult than
just stopping writing them– I’ll tell you that. But I always like
to take the pause and remind people that
these medications are important medications. I told you, everybody
in this slide is real. So causes of the crisis. I’ve sat in a number of
different communities and different settings– health
care workers, et cetera– and I’ve talked about, what’s
the reason for the crisis? Why are we in this crisis? And there’s just
some words up there that I’ve thrown up there. And the answer is,
everybody’s probably right. If it was one simple thing– I always say, if we had
one magic pill to solve this crisis, we
would have given it. And there’s a ton
of different reasons why we’re in this
crisis that we are in. And my message to my
physician colleagues is, I don’t really
care at this point. We have to own it. And we have to solve it. We have to help lead this. It’s true that 75%
of heroin users started off with a
prescription medication. Now, that might not have
been one I wrote for you. It might have been one you
got off the street somewhere, that got diverted. But the fact is, prescription
medications are part of this. They’re not the
only part of this, but they are part of this. And where does our community
go to, when they’re sick? It doesn’t matter. When they’re sick, they
come to health care and so I want my challenge
to our hospital system and to our physicians, is for
us to be leaders in this crisis. But we can’t do it alone,
and I’ll share that with you. The vast majority of
addiction overdoses are related to
prescription opioids. Again, not necessarily the
ones you were written for. They get diverted
frequently, and I’ll share a little bit about that
with you here, towards the end. 75% of heroin
users, I mentioned. There’s a lot of concern out
there that the government had– the centers for
Medicare and Medicaid, had actually tied
hospital compensation to patient experience,
which also, included, how did I control your pain? And I will tell you, I can’t get
your pain to zero all the time, and I shouldn’t be
driving it that way. Interestingly enough,
they’ve recently changed that, which is good. And we all have heard
about pill mills, but I’ll tell you, that’s
not the leading issue here. Major pharma– couldn’t
really have a conversation without talking about that. A $17.1 billion
industry nationally– billion dollar. There’s a lot of
things, and I’m not going to try to stand up
here and argue whether it was legitimate or not. But I remember in my training,
when Oxycontin first came out– I dated myself or
any of you that might be physicians in the room– but I remember
being told, doctor, you want to treat your
patients pain, don’t you? Absolutely. Who would say no? Which physician would
want to say no to that? And then, I remember being
told that there’s less than 1% chance of addiction to these
medications because they’re new and proven to be safe. Right? Every doctor out there that I
know, wants to help somebody. How can you argue with,
I can help somebody now that I couldn’t help before? And so, it was a bit misleading. The drug cartels– everybody
thinks about Mexico and South America, but I’ll tell you that,
I worked in China for a number of years and so I have
strong connections there, but the Chinese synthetic
fentanyl that comes, that is now absolutely
devastating Ohio– again, another
horrible place where we are leading the country. But you can get on your
smartphone right now, you get on your computer
at work or at home– I wouldn’t recommend that
you do either of those– but you can order
fentanyl from those places and have it shipped via the
US Postal Service nicely to your home, kind of like
the Amazon of drug dealing. But that’s certainly,
part of this, and this is what’s killing a lot
of people right now. And then, the list
can go on and on. And like I said, you know what? The answer is probably, yes. There’s all kinds of things
that are leading towards that. And we’ve got wonderful
folks like, like Randi here, and what they’re doing at the
Attorney General’s office, and they’re trying to lead
different aspects of this. But it really takes a community
to lead towards this crisis. I like this curve because
this really summarizes– I think– the last one. And this talks about how the
US consumes more than 80% of the global opioid production,
while we are only about 5% of the world’s population. That’s just stunning. And I have not only
worked in China– I led a hospital in
China for three years and practiced there– but I’ve
also done work in health care in Africa and South America, and
it is really, a different story about how we approach opioids. It’s just, it’s shocking. So just very briefly, again– I’m not here to be
a commercial for UH, but I want to tell a little
bit of a personal story, about how we’re trying to
lead this and what it is. And I’ll tell you,
when we first started having these conversations, we
knew we had to do something. We knew we had to step up. And the challenge was, we want
to be leaders in this area. And I was just in
Baltimore because we were recognized as leading
some of this work nationally. Tom Zenty our president,
gave the keynote speech at a symposium. But this has really
been a challenge, and our evolution has been,
how we’ve been thinking about how we want to do it. And I tell you, early on,
we thought we could do this, and we’re just going to stop
writing for medications. And we were very naive early
on because these medications are so important. And we can’t do it ourselves. Really, we have to
partner with folks throughout the communities
and throughout the region, and we are doing that. The Northeastern Ohio
Hospital Opioid Consortium– as was mentioned in my intro– is, I think, fairly unique. You see up there, the
University Hospitals, the Veterans Administration,
Cleveland Clinic, Metro, and St. Vincent’s– all
considered competitors. But as Tom Zenty said, this
is not about market share. This is about what’s doing
right for our community. And I’m fortunate to
be the inaugural chair. We just got this up and launched
over late October, November. And I think we’re
actually, really starting to get some traction
under our feet in coming together about how
we go ahead and approach this. Because frankly, patients
go back and forth between all of our
systems and we should be sending the same message. And so, we’re working on
those areas to partner. Within the University
Hospitals, I told you initially, we
were looking at opioids– and this is not quite
ready for prime time, what I’m showing you here
yet, but it’s really, where our evolution
of our thoughts are– it’s no longer
just about opioids. It’s about, how do we
manage people in pain? Whether it’s physical pain. Whether it’s psychological pain. Or a combination, which
is oftentimes, the case. But we’re really, trying to look
at taking a holistic approach to this, and we’re developing
an institute, which is what we do to address
patients in pain, no matter where they are. Our ICUs, our surgical centers,
our family practice centers– wherever they present– and try
to take that holistic approach to these patients. And I was the interim
director to get this up and started for this,
and I’ve actually, because of a few
changes in my career that I’ve been doing lately,
have actually handed this off to somebody who, I
think, is a little bit better suited to do this. But to show what
we’re doing, we’ve actually put a
psychiatrist involved in running this institute, as
opposed to an anesthesiologist because I think that, that
mental health component of what we do for our patients in these
areas is so, so, so important. And these are just some
of our guiding principles. The highest quality care
system-wide Mr. Zenty said, everywhere we touch a patient,
and I mean everywhere. And that’s where we’re
trying to shoot for. That’s a big, tall order. And that’s what our
institute model comes from. Looking at departments
across the system. Believe it or not, it’s not very
uncommon in large institutions, where people don’t always
communicate very well at that good– because we’re
geographically spread out, how do we make sure
we’re communicating well to get that good handoff of
the patient in the right place? Focusing on making sure that
is the best patient experience as we do this. System-wide– I mentioned this. And to me, the important
part is community, community, community. So how can you help? And I put this in here
fairly generically because I knew a little
bit about the makeup of the audience. I said a phenomenal
audience in the beginning, but I made this a little bit
more just community because I think you’re going to hear from
some other folks on the panel here today, but I wanted
to be, just as a member– I’m a member of
your community, too. And so, how can I help, not
just as a chief medical officer and leading the opioids,
but how can any of us help? I’m going through a
couple of the slides, and I’m almost done here. Recognize that it may
be in your neighborhood, your place of employment. Take opioids only
when you need them. Dispose of opioids properly. Advocate for more access
to addiction treatment and mental health. And be a part of the solution. It takes a community. We can’t do this by ourselves. So I’m going to touch on a
couple of those very quickly. Recognize that it may
be in your neighborhood, your place of employment. One of the biggest
issues to this is the stigma and
trying to make sure, you did not choose
to be a diabetic. You did not choose
to be an addict. Yes, maybe, you did take the
medication recreationally the first time, but most people
do not continue to do that. We need to get rid
of that stigma, and we need to
help support this. One of the things
that we’re working on is, we’re working on, what
happens when its your state license that’s involved in it? And how do we help folks? Because we want to make sure
that we are keeping them caring for patients
safely and appropriately, but not stigmatizing
them in the workforce. More than one in five Americans
are affected from this crisis, and when I say that, it’s either
through personal addiction. A close family member– I’m not talking about
your eighth cousin. And/or a very close
friend, and I’m not talking about the pizza
guy who delivered. I’m talking about a close, close
person in your inner circle, are affected with this. I think, it’s probably,
more one in four, but recognize, it’s around you. I live in Bainbridge,
it is there. Think about this as
a chronic disease. As I mentioned,
diabetes– it’s not your choice to be a diabetic. It is your choice to
control your diabetes. Heroin users do not
wake up wanting to or go to bed doing it. They wake up because
they have a withdraw and they need to be taken
care of this illness. Ask questions if you
suspect a problem. Sometimes, that’s
just the beginning, to make sure you’re
getting it out. How can you help? Talk to your doctor, dentist. My uncle had surgery
the other day. He’s not a chronic opioid user. He only used opioids just
in the first hour or two after the procedure. He was in the hospital
for two days afterwards. And they sent him home with
90 Percocet prescription. I said, uh-uh. I’ll take that. Threw that away. Be an advocate. Talk to them. I had a friend who
talked to her dentist and said, why do I need 20? Can you just get
me home with three? And they did. So advocate and talk about that. We have a hard time
predicting sometimes, what you’re going to need,
but have that dialogue. As a physician, I
ask you to do that. Are there other alternatives? We have our Conner
Integrative Medicine program at UH, which focuses on
imagery, yoga, acupuncture. All kinds of other issues that
while if it may not take away your need for an
opioid, hopefully, it greatly reduces
your need for that. And that’s very tightly inner
wound in our pain institute model that we’re developing. Do you really need
so many pills– I mentioned that. Know the RX– this is actually,
a local Cleveland thing, and there’s a website
there that you can have, but they have some really
good interesting information on there about things
you can do as just a member of the
community, regardless what your profession or
background or skill is. And is no pain an expectation? I will do everything to take
care of your pain, when you’re under my care, but I also,
have to recognize a broken leg will sometimes, be a
little bit uncomfortable. Zero pain is not,
not reasonable, and we have to change
that conversation. More ways you can do– dispose
of your opioids properly. I talked about,
many of the drugs that are out there
are not out there because I wrote them for you. What we find frequently is
they sit in grandma’s medicine cabinet and somebody comes
by and they pilfer them and they end up on the street. So dispose of them properly. I’m sure the fish
in Lake Erie might like you to flush
them down the toilet because they’d be happy fish. But I ask you, not to do that. There are ways to
get rid of them. And this one is from
Cuyahoga County. I wasn’t quite sure where the
audience exactly would be. Lake County was probably,
I should have gotten. But there are similar
things from Lake County, that there are safe
drug drop boxes around. We have people bringing
them in all the time. It’s hard because
of legal issues. I take them in, what
do I do in my office? So we try not get
our doctors offices to be taken these medications
because obviously, they’re at risk for being pilfered, and
taken, and stolen, and that. But there are safe ways you
can dispose of medications out there. And then, advocate
for more open access. I know we got representation
from the ADAMHS Board, here. I can’t say this
enough, that over 50% of folks who have
addiction, also have issues with depression
and other kinds of forms of issues that need to be
addressed in that area. So break down the stigma. Advocate for mental health. Access in our communities,
it’s a real struggle. And we really need to do that. Finally, I don’t get
royalties for this book, but I always like
to talk about this. This is called Dreamland. And it’s a well-written book. It’s a couple of years
old, and it’s already date outdated because it doesn’t
talk about the fentanyl. But Dreamland– I won’t tell
the story totally for you– but Dreamland comes from a
park down on the southern Ohio border, along the Ohio
River, of a park that used to be where families did
a lot of their recreation. And it’s no longer that place. And it talks about,
not only nationally, but it focuses a lot
on the state of Ohio, about why we are the
epicenter of this. And I think it’s a
fascinating read, if it’s something you want to educate
yourself about because it’s stunning, some of the things. I trained during a lot of what
happened, and looking back– I trained in Columbus–
looking back now, we didn’t really know
what was happening. But looking back and
seeing the chronicle and how he puts this out,
I start to say, yeah, I recognize that now. That was what was going on. So it’s a great read, if
you’re interested in this. And finally, this is Tyler. Tyler grew up in a
suburb of Columbus. And Tyler– I struggle
with this picture because this is
not personal, but I interacted with this family. This family does a lot of
speaking around the country and really tries
to help with this, but Tyler it was a promising
young college student athlete. Tyler and one of his
co-athletes on his team, at a collegiate level, both
died of opioid overdoses. And his family has
made it their mission to get out there and
spread that word. Thank you for your time. Thank you for your interest. Please, be part
of the community. Please, be part of the
situation that helps solve this. We are not going
to do this alone, and I’ll be honest with
you, somebody once told me that they don’t think
our curve– that curve I showed you, that death
curve– is going to start to plateauing until at least,
2020 because of the trajectory we’re on. But we can’t hide from this. We’ve got to do this
together, and only together, will we solve this. Thank you for your time. [APPLAUSE] Thank you, Dr. Jernejcic,
that was absolutely excellent. Our community is very
fortunate and privileged to have someone like you, with
the caliber of you as a person, the caliber of you
as a professional, and your experience leading up
as the chief medical officer for the Hoosier
Medical Center, truly. So thank you for
the information. Thank you for your passion,
and sharing it with us today. Our next speaker
is Karen Pierce. Someone who is very near
and dear to me and my work professionally, as
we travel the state. Karen Pierce is the managing
director of policy development and training for a
local company of Ohio, called Working Partners. Working Partners is not only a
strategic partner and alliance with the Ohio Attorney
General’s Office heroin unit through our business
work, but it’s a training and consulting
firm, specializing in helping workplaces
minimize the risks associated with substance abuse. Karen has served as the director
of the Drug-Free Workplace Community Initiative, which is
a private/public partnership with the Ohio Department of
Mental Health and Addiction Services, to address the
economic threat of substance abuse by employees and job
seekers in our state, which is the absolute heart of
what this seminar is about. Karen has worked in the
alcohol and drug professions since 1982. I consider Karen Pierce
and her colleague, Dean Mason of Working
Partners, really, a state-wide treasure
in this arena. Karen’s devoted the past
25 years of her career to drug-free workplace issues. She currently
serves on the board of directors of the
Prevention Action Alliance and the Alcohol Drug
Abuse Prevention Association of Ohio’s
Prevention Think Tank. She has received several
distinctions for her work in the prevention field,
including the Alcohol Drug Abuse Prevention Association
of Ohio’s Excellence and Prevention and
Prevention Advocate Awards. Interestingly, we just partnered
together with the Ohio Chamber for the Ohio Employer
Opioid Toolkit, which is a free online set of five
modules that offers free of charge, to any business
in the state of Ohio, very solid, practical steps
you can take as a business owner, which includes policies,
procedures, second chance agreements, and PDFs that
are drawn down– hopefully, Karen will be able to
share that with you. And it’s found, free of
charge, at ohiochamber.com– a partnership with Working
Partners, the Ohio Attorney General’s Office, and Anthem. And without further ado,
here’s Karen Pierce. [APPLAUSE] I always gets get
nervous when she says how long I’ve been in
the drug and alcohol field. It’s been a really long time. I started out doing
treatment work, and I was terrible at that. Thank you to all the
treatment professionals out there [INAUDIBLE]
with your organization. I just was not great at it. And I started doing
prevention work, but it was back in the Just
Say No era, where we really didn’t have a lot of
evidence behind us to really know
what we were doing. And that’s changed
a lot, but I have devoted the last 26 years to
doing work in the workplaces. And I got to tell you,
I’m incredibly biased, but I really believe
two very powerful places we can wrap our
hands around this issue, is in my family– I really believe I had a lot
of impact with my two children. And in the workplace. Businesses, you are powerful to
be able to address this issue. How many of you in this room
administer your organization’s drug-free workplace program? Handful of you? Before I forget, I
never mention resources that I bring so
opioid infograph out on the table, that talks about
workplace specific statistics. An infographic about the
Ohio Chambers toolkit. I’ll talk a little bit
about that, but make sure you grab this. That gives you
information on that. I want you to put your business
glasses on because we’re really going to be looking
at this issue, really, through the
eyes of business. I’m giving you some
statistics, also. Hopefully, not too many of
them will be duplicative, but I really want to look
at workplace, in particular. So let’s look at a
couple of things. First of all, Working Partners– Randi already mentioned this. We’re a small training
and consulting firm. We do do a lot of projects,
but a lot of our work is geared directly
with the employer to help them minimize risks
associated with the harmful use of substances. I do need to tell you
coming out of this chute, that when we look at
drug-free workplace issues, it really is a
combination, for me, of things that are
legally sound and things that are operationally sound. So particularly
with prescriptions– which we’re going to
talk about in a moment, the legal side of that– we have to be respectful in the
workplace about what we legally can and can’t do around
prescription medications. And equally, we need to be sure
that things are operational. So a policy may
say, legally, here are the situations in
which, as the employer, can ask you what you’re taking
or expecting you to take me– that’s the legal part. But the operational part is,
if I have a supervisor out in the field and the
employer comes up and says, hey, supervisor,
here’s what I’m taking. I thought you should know. I think I’m supposed
to tell you. What’s this supervisor
supposed to do with that? Operationally, how
does that look? I will tell you loud
and clear, that I am not an attorney so I’m
not going to be speaking at the legal issues. I’ll talk more operations. I do have a legal
partner that works with Littler, who
makes me tell you, loud and clear, a three-bullet
slide disclaiming, that I am not an attorney. Any questions about that– this truly, is just for
informational purposes. If something that
I say makes you wonder how it applies
to your workplace, that’s when it’s appropriate
to pick up your phone and consult with your attorney
on some of those legal issues. Disclaimer, done. I need to start with the
big picture, first of all. We’re going to talk and
zero in about opiates, but I need you to take a
look at the big picture of harmful use of substances
on the workplace right now. These are not
workplace specifics, this is in general,
when we talk about who is using illicit drugs and
what is the trend right now. When you take a look
at 12 and older– so that’s everyone that took
this survey– the question was, have you taken an illicit
drug, including marijuana, in the past month? 12 and older, you will
see, right now 10%. That number is going up. 12 to 17, the number
is going down. Why is that? People typically say,
well, prevention. Well, it’s more than prevention. It’s evidence-based
prevention happening in the schools, et cetera. But look at the employment age. When you look at 18
to 25-26 or older, again, those numbers
are going up. And that’s an illicit drug in
the past year, or past month. We know that 70% of people
involved in the harmful use of substances are working. They’re not hanging
out in the streets. They’re working. Now, there is a data
source– unfortunately, I don’t have a lot
of data sources that look directly at workplace,
but the one data source I do have is to take a look
at drug test results. It gives me a little bit of a
fingerprint of what’s happening directly in the workplace. Let me give you a
couple of things. First, the bad news. I will tell you that Quest
Diagnostics– are you familiar with Quest? Obviously, for medical testing. Also, one of the largest
providers of workplace drug testing. When I started in this
field, in the late ’80s, if you take a look
at the chart and look at the rate of
positive tests, it has been phenomenal that
that rate has decreased significantly, from
the late ’80s when they started collecting the data. We saw a little uptick
in 2003, with the rate of positive tests. I’m not sure why that
rate went right back down. But in 2012, it was
at a 30-year low. 2013, we saw the second
uptick that they’d ever seen since collecting
the data, and that was an increase of 4.3% positives. The first year– this had
never happened before. Two years in a row,
increase of positive tests. Year over year,
another 9.3% increase. Third year in a row,
fourth year in a row. We’ve never seen that. So when Randi talks about
employers across the state that are saying, we can’t find
workers who can test negative, we’ve got the data
to support that. Unprecedented increase. The research just came
out last week, about 2017. It has leveled off so we
didn’t see an increase in 2017, but this is unprecedented. So the first question
you have to ask– I think– are, who
are the culprits? And this may be a little
surprising to you– who are the culprits? Or what are the culprits? What drugs are causing
this drastic increase? Hang on because we’re not
going to be talking about opioids quite yet. Number one is marijuana. The rate of positive
marijuana tests increased for the
fifth consecutive year. And there are
striking increases, as quoted by Quest
Diagnostics, in those states, in 2016, that put recreational
statutes into place. But we are seeing an increase
in marijuana positives. Cocaine, increase for the
fifth consecutive year. ’15 to ’16, we
saw a 12% increase in the rate of positives. And then, another 7% last year. And look at meth– I do need to land on this one
for a moment– methamphetamine increased between 9%
and 25% last year, and there are some
regional trends. Guess where the
danger spots are. Ohio, Indiana, Illinois,
and West Virginia, where we’ve seen 167%
increase in positive tests from methamphetamine,
from ’13 to ’17. So one of my messages
here is, we really need to take a look at big picture. There are a lot of things
happening in the workplace that are a little frightening. So you say, well, what
about opiates and opioids? Let’s talk about that. Of course, that’s
why we’re here. I have to start with a little
bit of good news, if I can. And that is, good news is
that when you’re talking about particularly,
prescription medications as it relates to the workplace–
and please understand, that some of the
workplace trends might not mirror community
trends so I just want to focus. We’ve made some progress
in the workplace as far as prescription pain
medications are concerned. Overall, Quest
Diagnostics number again– rate of
positives– overall, the rate of opiate positives
have decreased by 17%, and that was ’16 to ’17. Oxycodone decreased. Hydrocodone, which is
Vicodin, decreased. Hydromorphone decreased. And even heroin decreased
the rate of positives a bit. You can’t help but wonder,
what can we hang that on? Because we know
some things work, as far as being able
to change the milieu, some things do work. And we’re doing– Ohio, I think, we may be
a leader in the problem, but we’re also, a leader
in the solutions, as well. Let me mention a
couple of initiatives. One, you probably are familiar
with the OARRS reporting system. OARRS is a system where the
pharmacies will register what a patient is getting– the drugs. Doctors can go in
and check OARRS. There has been over
the years, a 4,900% increase in OARRS inquiries,
meaning that doctors are going to check. 28.4% decrease in the
opioid doses dispensed. And we’ve seen an 88%
decrease in doctor shopping with prescription meds. Does that taking care
of the whole problem? No. You ever been to the county
fair and played Whack-A-Mole, where you hit one mole on the
head and another comes up? We’ve seen that with
some illicit types of opioids and opiates. But we are seeing
some changes in what’s happening with doctor
shopping, et cetera. The Bureau of Workers
Compensation– I’m not sure if you’re going to
speak about this– but in 2011, they took a look at their
workplace data and realized, from the prescriptions that
they were funding to employees, that– what’s my number here– 8,000 people were
dependent on opioids from the medications that
were paid for by the Bureau. They put a pain management
program into place and that number has
been cut in half, as far as what employees are using. So we are seeing some
areas of some progress. Quest Diagnostics– hang with
me with this long quote– but they say that, “the depth
of our large-scale analysis supports the possibility that
efforts made by policymakers, employers, and the
medical community to decrease the availability
of opioid prescriptions and curtail the opioid crisis
is working to reduce their use.” I do believe we have to look at
some things that are working so that we can model more
programs, to see more success. But, of course, there
is the bad news, and I don’t ever
know whether to start with the bad news or
the good news first. But the bad news. The overdose deaths
are out of control. We know that. Especially, related
to illicit drugs. Couple of statistics. Nationally, the rate of
overdose deaths, up over 14%. Leading cause of
accidental death. In Ohio, our death
rate was up 39%, between ’16 and ’17, and that
makes us only the third– we had the third largest
increase among the states– number three on the
list of increases. 14 people a day. 80% of the folks that were
involved in overdose deaths had a history of prescription
drug use, including opioids. And the impact of the
available workforce– because I really think
that’s significant when you’re looking
at employers, you can look at applicants, you
can look at current employees, but then, you have workforce
of potential employees. And if you take a look just at
the ages of the people in Ohio, they are of employment age. 750 people, last year in
2016, between 44 and 54– 915. So people that could be in
the workforce that are not because of overdose deaths. Couple of folks at OSU doing
some really interesting work, trying to measure the impact
of opioids on the workplace. Quoted saying,
“one way of looking at the estimates for
opioid abuse and dependency is that it could account for
one third to more than one half of the decline in workplace
participation since 2017.” That’s a very
significant impact. And when you look at
that available workforce issue, plus employers
saying, we can’t find applicants that
can test negative, we’ve got some
issues to deal with. Financial implications–
there are lots of those. I’m just going to mention a few. There are a few more on the
opioid infographic here. A study that just came out
was taking a look at how much employers are spending
on prescription opioids, and that spending
actually, is down. Interestingly, however, the
spending for treatment– what employers are paying for
treatment increased sharply. And another interesting
thing about the statistic is, it wasn’t
necessarily, the employer that was going into treatment. Over half of the costs
were associated with what? The employer’s family members– children going
through treatment. Again, a workforce
of the future issue. Overall, the cost of the
nation’s opioid crisis has exceeded $1 trillion. You probably read
that not too long ago and doctor mentioned
it, a moment ago. So what’s an employer to
do despite the current drug trends? And I think, this
is really important to take a look at that, is
that there is an antidote that workplaces can
administer to address any kind of harmful
use of substance. No matter what the drug is. Some of you may have
seen this picture before, but any time we’re
talking about trying to wrap our hands around the
harmful use of substances and addiction, the
response has to be varied. We call it, the
continuum of care. So we have to do things
on the left hand side. We have to do health promotion. Wellness promotion. We need to do prevention,
and prevention does include
education, but it also, includes things at
the micro level, like public policy that
can influence people not even starting to use. So we need to do promotion
work, prevention work. Obviously, we need
to do treatment work. And we need to support
people in recovery. We can’t focus on just
one slice of the pie. We really have to have efforts
that go across the continuum. We need to do that in our
communities for sure– and Kim will probably
speak of that– but we also, need to mirror
this continuum in the workplace. And doing prevention with
adults is not too late. There are things we
can educate adults about that really,
can prevent them from needing treatment or
needing to be in recovery. Not Karen Pierce,
not Working Partners, but the best strategy for
addressing both prevention and responding is a
comprehensive drug-free workplace program
that is current. So five elements of
a drug-free workplace that employers can put into
place to prevent and respond. First of all, involves
a policy and operations. We’ve got to educate
our employees. Need to do supervisor training. Testing in whatever
doses are appropriate for the particular workforce. And finally, assistance. Last year, Randi
mentioned, we were involved in a very large
scale project across the state for workplaces. We did a survey involving
over 3,000 businesses. You might have
taken this survey, but I’ve got a couple
of survey results to show you in
this next section. Number one is, that
one in three employers don’t administer any
of the five components of a drug-m free workplace. So this truly is an antidote. This is something the workplace
can do, but a lot of us still aren’t doing that. I will put a plug in
briefly, for the Bureau of Workers Compensation
Drug-Free Safety Program, in that if an
employer will do those five components of a
drug-free workplace, they may be eligible for
a rebate on their worker’s compensation and grant money
to help them do the do. To help them write a policy. To help them do their
education and training. Quite an opportunity. So let me just touch on each
of these five things quickly. Policy plus operations– the
policy needs to be written. Needs to be customized
for the organization. And it needs to be
legally sound, of course. We need to have
written operations so that the supervisor
does know what to do if somebody presents
them with information about a prescription. We need to have
appropriate forms. It needs to be consistent with
other practices and policies. Obviously, we need to
have union blessing. And it does need to
be state specific. One of the things we know
about drug-free workplaces is that the states around all
kinds of different drug issues, can vary from state to state. The second component of
a drug-free workplace is education, and
I really believe that for current employees
and their children, the workplace is a
pretty amazing place to be able to do some
real prevention education. Employees need to be given
notice about the policy and sign off. It’s not easy to pull
employees off the job and teach them things, but doing
that annually is important. It’s got to be relevant because
education really can motivate and it can prevent. When you take a look at just
the opiate epidemic, when you consider that four out
of five new heroin users started out misusing
prescription painkillers, the workplace is a
perfect opportunity to educate employers about
safe and responsible medicine practices. We also know that
kids of parents who talk to them about drugs
are 50% more likely to use. I think, again, the workplace
is a perfect opportunity to give tools to
parents so that they can talk to their children. With supervisor
training, it does need to be annual, as well. Supervisors have a lot of power. They’re the eyes and
ears of the organization. But barriers do exist. They’re uncomfortable
confronting people. Sometimes, their own
use gets in the way of them being able to confront. So when we do training, we
need to give them the skills. We need to support them. And most importantly,
we need to give them procedures for how to respond. I know back in the old days,
when I was doing drug-free workplace supervisor
training a long time ago– true confession–
I would run around to the workplace with my
little suitcase of fake drugs. And I would hold up the
suitcase and I would point out, here’s what the different
drugs look like. Here is what the
employee looks like, if they’re under the influence. But I’ve got to tell you, that’s
not the information supervisors need. They need to know what
to do if they see it. And they need to be motivated
to do that, as well. Testing– a couple of
important things about testing. We need in our policies, to talk
about when we’re going to test. How we’re going to test. And most importantly, what
we’re going to test for. The survey that I
talked about before, when you focus on the
issue that the test– hang with me, this
is a tongue twister– the test only tests what
you tell it to test for. Employers need to know
exactly what their drug tests are looking for. Now, the survey results. The survey that we did said
that only a third of businesses don’t know what
they’re testing for. Take a look at
this real quickly. In the old days, if you’ve
heard of a 5 panel drug test– these are the only drugs
that were picked up in the drug test. Amphetamines, which are ups. Cocaine, marijuana,
PCP, and opiates. And opiates, in the purest sense
of this word for this test, only meant organic opiates– heroin, codeine, morphine. That’s it. Not testing for Oxycontin, not
testing for Vicodin, et cetera. Earlier this year, the
Department of Transportation said, that for Department
of Transportation testing, they now had to include
those expanded opiates– the hydros and the oxys. And a lot of other
employers are testing for these additional drugs. There are a lot of
our clients, even to date, that aren’t testing
for six, seven, eight, and nine. They think they’re testing
for them, but they’re not. So employers really need
to pick up the phone, call your drug
testing vendor, get a list of what you’re testing
for so you can adjust that, if you need to. The fifth and final area of
a drug-free workplace program is assistance. A lot of employers are spending
time trying to figure out, do I terminate if
somebody tests positive? Or do I offer a second chance? And I will tell you, as the
workforce availability changes, employers are more challenged
with whether to terminate the person and look
for somebody else or try to keep the employee. Ohio employers, if you take
a look at best practice second chance, only
about 30% of them are doing best practice, which
means, you test positive. You’re off the job until
two things happen– a counselor blesses you coming
back and you test negative. Only about a third of
employers are doing that. And another 27%, terminating. I really believe– and we’ll
probably hear this word from every speaker– the stigma issue
really influences employers unwillingness,
sometimes, to offer a second chance. We’re still hearing people who
are dealing with the disease as being junkies, and druggies,
and stoners, and entitled. And I really believe
from a policy standpoint, that stigma keeps us, sometimes,
from being willing to offer a second chance. Addiction– I think in this
situation, not necessarily the drug, is the primary issue. One more positive
note before I stop– and we are in the land
of opportunity right now. First of all, there are people
coming together like never before. This type of diverse panel,
this type of diverse audience would not have happened
five years ago. I believe we are
challenging the stigma. We’re hearing it from the mouths
of doctors, and attorneys, and treatment providers. I do think we are turning
the tide in looking at this as the health issue that
it is versus the moral issue. And we are starting to
focus more on prevention, which I think, really,
is an opportunity now. A couple of resources. Randi mentioned
the opioid toolkit. It is a dandy resource. There is a course for employers. It’s a computer-based
course, five modules. Walk you through what
should be in a policy. How and when you should test. What different assistance
options look like. And there’s also, a course
for employees that is free, on being a safe and critical
consumer of prescription medications. I wish employers would make
this mandatory education. Our website, we have a monthly
eBlast with information that comes out every month. If anybody is interested
in that or my slides, let me know and I can
send those to you. And I think, I’m out of time. Thank you. [APPLAUSE] Well, thank you, Karen. Again, another excellent
presentation with some really profound
results and research. It is encouraging to see
that there is some good news to report. The efforts that
we’ve taken in Ohio are working, as it
relates to opioid use. I think that the
overdose deaths, though, have come from fentanyl and
carfentanil and that new wave coming in from China. But we are doing a good job. Things are working. And one thing that I wanted to
underscore that Karen has said, with related to prevention
and a culture shift. We roundtable this that the
attorney general’s office. We have looked at how the
culture has shifted with regard to tobacco, with smoking. And how can we effect that
same kind of cultural shift when it comes, to
substance use, drug use. And so, we’re looking at ways
that we can impact the culture and with a diverse panel like
this and getting the word out. And all of us that
have previously been siloed, working
together to spread a message. Having the physician
community involved. The social service community. Drug-free workplace
and certainly, the business community. We see it at the
attorney general’s office as one line of prevention. We are very passionate
about prevention and moving from K through
12 prevention education. We’re working with colleges. More and more colleges
and universities are putting in
prevention programs. Sober courses, sober
classes, and platforms. And the third component
is the business community. The business community
are employees, are captive audiences, and they
can affect their family members by what they hear. And so, it is absolutely crucial
that businesses understand this and see the value in it. And possibly, sign up
for the BWC rebate, that we’re going to
hear about later, with John Wilton’s
presentation on the panel. So our next speaker then,
on this fabulous lineup this morning is Kimberly Fraser. Kimberly Fraser is
the executive director of the Lake County Alcohol Drug
Addiction and Mental Health Services Board– otherwise known as
the ADAMHS Board. Kim first joined
the board in 1999, and held the position of
director of quality improvement before being named
executive director in 2007. Prior to her move
to the board, Kim held both clinical and
management positions at the agency and
the ADAMHS network. The mentor resident is
an independently licensed behavioral health
professional, who did her master’s and
postmaster’s work at John Carroll University. Kim is currently, a
state board member of the Mental Health
and Addiction Advocacy Coalition and is past
president of the Ohio Association of County
Behavioral Health Authorities. Kim has run a very steady
ship here locally– I know that personally. And is certainly, a force
for good in this area, in Lake County. And I’ve had the privilege of
working with her about 10 years ago now, time flies. Kim, welcome to the podium. [APPLAUSE] Good Morning, everybody. First of all, thank you for
taking your morning to be here. It’s the Wednesday
before a holiday weekend Hollie Strano says, it’s
going to be beautiful out, and you will have elected to
spend your morning talking about opiates. We get that that is maybe,
not the most uplifting way to start your day, but
this is a vitally important conversation. So thank you for
taking the time. I’m here to talk a little
bit about local resources. I will tell you– first and foremost–
if you’re going to have an addiction
disorder, Northeast Ohio is the place to be. We have some of the best
treatment and prevention services available right here. So I’m going to talk a
little bit about that. I’ve got some stats. I might blow
through some of this quickly because it might
be a bit repetitive. But to start with, if
you’re not familiar with us, ADAMHS Board are the
Alcohol, Drug Addiction and Mental Health Services
Boards for the counties. We actually exist
by state statute. The state of Ohio says,
that every county will have an ADAMHS Board
and essentially, our job is to plan, fund,
monitor, and evaluate the county’s mental health and
addiction recovery services. So we’re sort of that
behavioral health safety net. Our job is to make sure
any person in our county– regardless of age, regardless
of gender, regardless of their ability to pay– has access to the best mental
health and addiction services, when and where they
want to receive those. And we actually, deliver those
through a network of agencies. So each ADAMHS Board
contracts with a network of agencies
throughout the county, to be our provider
of those services. We have existed
for over 50 years. For 50 years, ADAMHS Boards
have had this responsibility. As you can probably imagine,
in the last couple of years, the majority of
our time has been spent on this opiate epidemic. Talking to, dealing with
individuals, families, who are impacted by opiates. And a lot of what we also do,
is go out and talk about this. I go out literally, a
couple of times a week and talk to businesses, talk to
social service organizations, talk to schools, about
how this epidemic is impacting our community. One of the things I often do
is I start with asking folks– completely voluntary– but how
many people in the room know someone– a friend, a family
member, a loved one– whose life has been impacted
by this opiate epidemic? That’s what happens. When I ask that, usually,
every hand goes up. Certainly, when I think
about this epidemic, I think about the
clients that we serve. I think about the people
who come through our doors at our agencies. I also, think about my cousin,
who, about 10 years ago, came back from Afghanistan with
a horrific leg injury, on copious amounts of opiates. And now, today, he doesn’t
get out of bed in the morning without popping his pills. He lives and breathes by
his little white pills. He can’t hold a job. He can’t be a part
of the family. This is his life. I also, think about my niece,
who lives out in Sandusky. Who was working a double shift
one night at a restaurant and was tired and dragging
and a coworker said, hey, take this little pill. This will really pick you up. And now, three years
later, she’s lost her job. She’s lost her home. She’s lost custody of
her three children. And every single day, she
takes a cab from Sandusky to downtown Cleveland, to
go to the methadone clinic– except for the days when she’s
scoring heroin on the streets. That’s my reality. I am from a nice family,
in a nice suburb, in a nice community,
and that’s my reality. And I think, we have to frame
the conversation like that because this is not an
us versus them disease. This is not an
inner city problem. This is not a rural problem. This is a problem that’s
happening within the walls of your organization. And that’s why we need
to educate ourselves and we need to
educate our employees, about what’s available. About the reality of this. And about how to get help. So I’m going to talk very
briefly, about the scope of this problem. There’s a reason that you
can’t open up a magazine, or turn on the television,
or turn on the internet without hearing about opiates. The reach is unbelievable. Today, unintentional
drug overdose death is the leading cause of
accidental death in Ohio. More people are dying
from drug overdoses than from car accidents. And in fact– we heard earlier– 14 people are going to die today
in Ohio, from drug overdoses– 14 people. I’ve been talking
about this endlessly. In the last nine months, I’ve
had to update this slide twice. Nine months ago, that
number was eight. Five months ago,
that number was 11. Today, it’s 14. And we are going
the wrong direction. We know that one
in five teens say they know someone who is
abusing prescription drugs, and that number is
probably, much higher. That means my
14-year-old daughter, who graduates from
eighth grade tomorrow, probably knows
somebody– a classmate– who’s playing around
with prescriptions. And we also know that
alcohol and drug abuse is among the top three
leading causes of death for our 16 to 24-year-olds. So it is hitting
our young people. But make no mistake,
this is hitting every single demographic. We know that substance
abuse affects 700,000 children in Ohio. Of those, nearly
14,000 of them end up in the custody of children
services due to parental drug abuse. That means this morning,
when your alarm went off and you woke up in your
bed, and you thought about, what do I have to do today and
you climbed out of your bed, 14,000 children in our state
woke up, opened their eyes, and didn’t see mom and dad. Maybe they saw grandma. Maybe they saw an aunt. Maybe they saw a stranger. Because of this epidemic. In Lake County alone,
we have 89 children in the custody of
children services. And we have more than
1,000 grandparents raising their grandchildren. That means, that your employees
may be waking up in the morning and struggling between,
do I go to work? Or do I get my grandchild to
their doctor’s appointment because this is now
my responsibility? We also know that overdose
deaths are rising. And in Lake County alone,
we had 42 deaths in 2015. That more than doubled in 2016. We don’t have the
final numbers for 2017, but we know that
it’s higher still– you’ve heard that twice already. We are going the
wrong direction. Some projections say that with
the trajectory that we are on, if nothing changes, this
epidemic will not burn out– and by burnout, they mean level
off to where death rates were in the mid ’80s– until 2032. How many more lives are
going to be lost, if we don’t do something to intervene? We know that stigma is
an enormous barrier. One in 10 people in
the United States has a substance use disorder,
but of those, only 10% will actually
receive treatment– 10%. That means nine out of 10 people
dealing with this disease, are going it alone. They’re not talking
to their employer. They’re not talking to
their family member. They’re not getting
connected with treatment. We know that addiction and
abuse are not age-specific, nor are they gender-specific. Here in Lake County, in our
nice, wealthy, suburban county, nearly every single
city and township has lost somebody
to an overdose. Last year in Lake County,
we lost a 14-year-old and we lost an 89-year-old
and everything in between. And we know that fentanyl
is increasing dramatically. We’re talking about
opiates, but truly, this is a moving target for us. And make no mistake,
the individuals who died from overdoses where
fentanyl was involved, did not know they
were taking fentanyl. They did not know that was laced
in with what they were taking. So let’s talk about
workplace impacts. We know this number is
now higher, but estimated that American employees
lose over $80 billion a year in productivity,
absenteeism, accidents, health care costs because of addiction. That means every single
employer in our state and in our country, probably,
has their bottom line impacted because of this epidemic. We know that 2/3 of those
using prescription meds, say they’re doing so while
on the company payroll. Health care costs are
three times higher for employees who are
abusing are addicted. 9.1% of full-time employees
acknowledge that they’re illicit drug users. 13.7% are part-time employees. And of those who admit
to using drugs illegally, 44% walked into your shop and
sold those drugs to a coworker. 64% said, yeah, this is
impacting how I do my job. 18% stole from their coworkers
to support their habit. This impact on your bottom line
is coming from every direction. The good news is that there
are resources available. We are responding locally. In 2010, we started the Lake
County Opiate Task Force. We pulled together partners from
social services, health care, the coroner’s office,
law enforcement, and criminal justice,
to talk about how we could collectively, begin
to impact this epidemic. We had two major areas
of focus in our county. The first was on
prescription drug disposal and the second was
on public education. If you live in Lake
County, you should know that there are
seven permanent drug drop boxes throughout our county. We were– I’m actually,
very proud to say– we were, I believe, the
first county in the state to establish permanent
drug drop boxes. So you can walk into a
local police department and you’ll see
something that looks like a green or gray mailbox. You can anonymously
dispose of any medication. It’s time for us all to clean
out our medicine cabinets. We’ve got to get these drugs
out of our medicine cabinets and out of the hands of
our kids, or our neighbors, or the guy who comes
to fix the sink. We’ve got to dispose of these. To date, here in
Lake County alone, we’ve disposed of
31,000 pounds of unused or expired medications. That’s 31,000 pounds
of pills that are not in the hands of our kids. And that’s a resource that’s
available for your employees. The other thing that we focused
on was public education. We know that our very best
defense against this epidemic is conversations. It’s talking about it. It’s lifting the
veil off of this and being willing
to talk about how it can impact our kids, our
adults, our senior citizens. So we create literature. You’ll see on the table out
there, tons of literature. We’ll make it available
to any business, anyone throughout the county. We know the more
we talk about it, the better our chances
at combating this. This is our newest
initiative, and this is a resource that is
available for employers throughout our county. This is a partnership between
the Lake County ADAMHS Board, our Opiate Task Force,
and leadership Lake County. I mentioned, we’ve been
going out and talking to anybody who will listen. I will tell you, the
hardest nut to crack has been the business community. Getting folks to let
us in their doors, to talk to their employees. So back in the
fall, we partnered with Leadership
Lake County, which has the leaders in the
business community. And we said, help us open doors. Help us get into businesses–
small businesses, large businesses, anybody– to talk about, what’s
the reality of this. To talk about what
services are available. And they agreed to
partner with us, and I will tell you, that the
response has been unbelievable. To date, we’ve done
over 100 presentations. We’ve reached over 3,000
employees in this county. And it’s very simple. We come into your
business and we do an hour-long presentation,
completely free. We talk about the
nature of addiction. The fact that this is a disease. This is not human weakness. This is not a character flaw. This is not a failure to pull
yourself up by your bootstraps. This is a disease. Like heart disease. Like diabetes. Like asthma. And it’s also, a
treatable disease. We talk about warning
signs, red flags. We talk about things
like Skittles parties. If you don’t know what
a Skittles party is, Skittles party is when a
group of teens get together and they know that
they can’t get any beer and they know they
can’t score any pot. So they all go home and go to
their parents medicine cabinet and they pinch some pills
out of a prescription bottle because our kids know, if
a doctor prescribed it, it must be safe, right? And they take them to a party
and they put them in the bowl. And the game is, you
take a red and a blue. And you take a
green and a yellow. And I’ll take a
pink and a white. And we’re just going
to see what happens. And this is how our kids are
playing around with drugs. And this is not urban myth. This is not a legend. This is happening. And if your employees
know about this, then they know to
have their guard up. They know to be watching
for things like Skittles parties or pharm parties. But that’s what we do,
we educate your employees about what those
warning signs are. We talk about ways
to fight back. The importance of purging
those medicine cabinets. We talk about treatment options. We know that sometimes,
an employee doesn’t want to go to their
boss and say, hey, I think I have a problem. I need treatment. And there are ways
that individuals can get connected with
treatment, free of charge and anonymously. We want to make
every door open when somebody is ready to get help. We talk about resources
and how to access them. These presentations are
available to any business in our community. So I mentioned, we’ve done
over 100 presentations. I have discovered Lake County
in the last six months. I have gone into
manufacturing companies that I’ve only driven
by, on Tyler Boulevard. I’ve gone into hairdressers. We’ve talked to small
businesses, large businesses. Anybody who will listen. If it’s something
that sounds like it would be a benefit to your
business, give us a call. We will come out
and talk to anyone. And we’ll talk to any shift. We’ve gone out and done talks
at 5 o’clock in the morning, to catch the tail end
of the overnight shift. But this is a tremendous
opportunity for you to help educate your
employees, without you having to be the
one saying, hey, do you want to talk about drugs? That’s a tough
conversation to have. If we come in, it’s
amazing how people are suddenly, willing
and able to open up to those conversations. I want to mention briefly,
that recovery and treatment options are available
here in Lake County. We have, in our county, one
of the best and richest arrays of behavioral health services
anywhere in the state. Folks in Columbus look to us
to say, what kind of treatment is working? So I’m not going to
go into great detail, but I will tell you that we
are continually exploring new treatment options. One of the challenges that
we’re facing in this epidemic is that there is
no silver bullet. If we knew exactly what kind of
treatment worked for everybody, we would be doing it. Unfortunately,
there is no miracle. There is no silver bullet. So we try new things. We explore new opportunities. We create new programs. Our services are
available to anybody. Again, regardless of
their ability to pay. We have programming available
for children, adolescents, adults, senior citizens. A couple that I want to
touch on very briefly, the first is our Opiate
Recovery Transition Program. So five years ago, if you
had an opiate addiction and you felt like you really
needed help in getting off your opiates, and you went
to the emergency department and you said, I need
to be in a hospital. Nobody would pay for it. Private insurance
wouldn’t pay for it. Medicaid wouldn’t pay for it. The local system
wouldn’t pay for it. Why? Because the physicians
would tell you that it’s not a medically
dangerous detox. You can detox at home. We know that doesn’t work. So today, insurances,
more and more, are willing to pay for
some level of detox. We’ve also invested locally. We know that even if insurance
pays for that two or three days of inpatient
detox, a person is at their most
vulnerable, if they go through three days
of inpatient detox and walk out of the hospital. Because on day four, they’re
still going to be craving and they’re going to overdose. That’s when people are dying. So we created this program. If a Lake County
resident comes into one of our emergency departments– Lake West or TriPoint– and they are ready and
seeking treatment for opiates, we can get them
into a seven to 10 day inpatient stay at
Windsor Laurelwood Hospital. During that time, our
outpatient providers are going in and
talking to them. Getting to know them. Talking about what
recovery can look like. On that last day
in the hospital, they receive of if a
VIVITROL injection. VIVITROL is a
medication-assisted treatment. It is an opiate blocker so if
I get a VIVITROL injection, for the next 30 days, if I
take opiates, I won’t get high. It will have no impact. This is not a
replacement for the drug. This buys us some time. It gives us that
time to help get somebody involved in treatment. Get them recognizing what
recovery can look like. So they get that injection
and then, we literally, put them in our car and drive
them to outpatient treatment, whether it’s
residential treatment or intensive outpatient. We want this to be seamless. We know that there are so many
opportunities for somebody with a substance use disorder,
to fall through the cracks when they’re trying to get help. So this is our program to
help people seamlessly get into treatment. We also, offer residential
treatment in our county, and we’re expanding that
opportunity here in the county. We’re beginning to
offer recovery housing. We know when somebody is
done with their residential treatment, done with
their treatment regimen, sometimes they just need
a safe place to live, and we get them there. We also have aftercare services
and supports for the family. Supports for the
family even when that person with the addiction
is not ready for treatment because we know that
families struggle with this. I want to mention one more
thing about treatment. With epidemic, often
comes opportunists. And what we are seeing in Ohio
and throughout the country, is opportunists. People looking to
capitalize on this epidemic. Have you heard of the person
coming into your church group and saying, you know what? I know your loved
one is struggling, and I got to tell you,
there’s no good treatment here in Lake County. But if you have insurance,
I will personally buy you a plane
ticket and get you to a treatment
facility in Florida. State-of-the-art. Best treatment you can get. And those are scams. People are falling for this. They’re sending their
loved ones down to Florida, to go to treatment
facilities that don’t really provide any treatment. Simply milk the Medicaid
for all it, and then, leave people to die on the streets. We’re losing Lake
County residents on the streets of
Florida because of this. And this is happening
pervasively. They’re targeting our
state, and they’re shipping people out of
state, and they’re making money off of this epidemic. We also see things
like when you see the billboards for things like
the addiction treatment center. Cash and carry suboxone clinics. You walk in with $250 and you’ll
get a script for suboxone. And your treatment
is, don’t do drugs. Come back in a month. There are opportunists
at every corner so it is so important for us,
as individuals and as employers, to check out and make sure
that the treatment that’s being offered is legitimate. And I’m going to give you
a great shortcut to that. Before I do, let me
talk very quickly, about our latest program, which
is our Quick Response Team. We know that every single
day in our county, folks are calling 911 because
somebody’s overdosing. And so the emergency squad goes
out and they administer NARCAN. If you don’t know
what that is, you shove it up somebody’s nose. It immediately
reverses the overdose. They put them on the squad. They take them to the
emergency department. And despite the fact that we
have psychiatric social workers 24-hours a day,
seven days a week in both of our emergency
departments, 99 times out of 100, that person gets to
the ED, gets up off the gurney, and runs out the back door. Because they’re scared. Because they’re in shock. Because they don’t
know what’s going on. They’re afraid they’re
going to get in trouble. We’re just not able
to connect people with treatment at that point. So our Quick Response Team– which is a partnership between
our Lake County Sheriff’s Office Detectives Bureau,
our behavioral health system, and our firefighters and first
responders in the county– go out as a team, ideally,
three to five days after that individual overdoses. A Sheriff’s detective, a
behavioral health professional, and a first responder in plain
clothes, in an unmarked car, go to that person’s house. They knock on the door. And they don’t say,
you just broke the law. They don’t say, we want
to search your house. They say, you almost died. And we might not get here
in time the next time. Please, let us help you. And they talk to that
person about treatment, and if the person’s willing,
they put them in the car and take them
directly to treatment. If the person’s
not home, they’ll talk to their family members. They’ll talk about what’s
available in our county. We’ve just piloted this program. To date, we’ve done
about 100 runs. About 50% of the time,
people are receptive, and that’s a huge success number
when it comes to this epidemic. So that’s one more
resource available to us. I mentioned the short cut. In Lake County, we have our
Lake County Compass Line. This is sort of the 211
for behavioral health. It’s Monday through
Friday, 8:00 to 4:30. It’s housed right in
our ADAMHS Board office. A call to The Compass
Line gets you connected to a triage specialist. If you have an employee
who you think needs help and you call The Compass Line–
and it’s completely anonymous– she’s not going to say, call
Signature, call Lake Geauga Recovery Centers. She’s going to help you
navigate the system. She’s going to talk about,
what kind of insurance does that person have? Where do they live? Do they have access
to transportation? Is this an individual
problem or a family problem? We have a massive database that
has every single provider, not just ADAMHS-funded providers,
but every provider in Lake County. Where they are. What their hours are. When they have
open appointments. She helps you
navigate the system. She can even set
up three-way calls to get somebody immediately
linked to services. So that’s a resource
that’s available to any one of your employees
in Lake County. To any one of you. To your family members. A call to The Compass
Line is your very best way to get connected with
treatment and resources. It is also, the way to
access Operation Resolve. If you want us to come into your
business and do presentations, call The Compass Line and
ask for Operation Resolve. That is an enormous amount
of information in 25 minutes, isn’t it? We are your resource. Our job is to be here
for any Lake County resident, any business. And again, there
are ADAMHS Boards in every single county
in this state so we should be your point of entry. And I word about
those opportunists. If you hear about something and
it sounds too good to be true, call our Compass Line. We’ll let you know
if they’re licensed. If they’re certified. If they’re legitimate. Or if they’re scamming you. And with that, thank you
very much for your attention. [APPLAUSE] Thank you, Kim. I think that these speakers
just keep outdoing themselves as we’re going
along on the panel. For those of you who
haven’t met Kim Fraser or had interactions
with her, I’m sure that she’s
convinced you that what I said in the
introduction of her, that she is a force for
good in Lake County. She certainly is. And while I’ve had done more
work much more in the law than I have in
policy, I can tell you that the work that Kim Fraser
is doing with the ADAMHS Board and breaking barriers in
the business community is unprecedented. And so thank you. And on behalf of Attorney
General Mike DeWine, thank you so much. And we would like to
highlight your work state-wide and possibly, make it a pilot. I did not know that you were
doing that here in Lake County. So thank you. That work is needed. And it’s really,
breakthrough work. So thank you. I have the privilege next,
to introducing Attorney Grant Keating. I see that in my former
life of being a prosecutor, not only in Lake County–
and I see some former Lake County prosecuting attorney
colleagues and law school colleagues. Also Carol Shockley, from the
Cuyahoga County Prosecutor’s Office, of work
many, many years ago. I have the privilege
of introducing to you, Grant Keating, also
formerly of the Lake County Prosecutor’s Office. But Grant currently works
at Dworken and Bernstein, and great Lake County firm. Grant works in the business
law and commercial litigation group at Dworken and
Bernstein, where his practice has addressed issues
from ecommerce to professional negligence. He has been recognized
as a super lawyer rising star six times in
the last eight years, which is no surprise to
me because he was one of my law clerks at the
Lake County Prosecutor’s Office and certainly, a rising
star there, as well. Grant’s practice now
focuses on business law and commercial litigation. During his career,
he has successfully represented a wide variety
of business clients at trials, appeals, and
alternate dispute resolutions. And Grant is going to speak to
the employer/employee liability issues in the
substance abuse arena. So Grant. [APPLAUSE] Good morning, everyone. Thank you for being here. I’m filling in for Rick Selby
today and Kristen Kraus, who lead our employment
practice group. Regrettably, they’re
in trial today. They would have liked to
be here to talk about this. But obviously, from
the speakers who’ve spoken so eloquently
before me, we’re dealing with a very challenging
issue for employers, and the thrust of
my presentation is to try to help employers
make sure they’re in compliance with employment laws, as they
deal with this great challenge. So one of the laws
I want to talk about is the Americans with
Disabilities Act. How many people are
here with companies that have more than 15 employees? If you have more
than 15 employees, the ADA is going
to apply to you. So the act was enacted to
prevent folks from disabilities from being discriminated at the
workplace, in the community. So the starting point with
any analysis under the act is whether or not the
condition is a disability. Disability is
defined as anything that substantially interferes
with a major life activity. Major life activities can be as
simple as things like eating, breathing, walking. And get as complex
as ideas like working or being able to concentrate. I think that we can all take
from the prior presentations, that opioid use and
substance abuse, addiction problems
is probably, going to fall into what is classified
as a disability, under the act. Now, there is one
exception, and that’s for employees that are
currently using an illegal drug. When the act was enacted, the
legislators put that in there, to allow employers to
take adverse employment action against anybody
who is currently using an illegal drug. So what’s current? Current is kind of
a complex analysis. And all of this is
fact-based and has to be analyzed on
the individual basis. But they kind of say, you
know it when you see it. One thing is for sure, in
one of the cases I read, dealt with a nurse who had been
stealing prescription drugs who was later terminated, who
said that the termination was in violation of the ADA because
she had a substance abuse problem. In that case, the court said,
no, you fall under the– even though that she
was clean at the time that she was terminated,
she was terminated. The reason that she was
taking the drugs at the time. And the judge said
that employers don’t need to catch their
employees with a syringe in their arm or
their mouth on a bong to determine whether or
not they’re currently using the drug. So one surefire way to determine
whether someone is currently using the drug is if they
test positive on a drug test. The analysis changes if
it’s a former use of drug or former drug addiction. The ADA is going
to protect people that have been rehabilitated
or completed a rehabilitation program so long as they’re
not currently using drugs. So you can’t take any
adverse employment action against those people, if
they’re not currently using and they’ve been rehabilitated. With opioids, there’s
also an additional issue is whether or not, the drug
use is legal versus illegal. Obviously, a number
of these people are taking these drugs as
prescriptions in accordance with the directions
that they were prescribed from their doctor. If that is the case, that’s
a lawful taking of the drug. If they’re using the drugs
outside of the directions that they were
prescribed in, that’s going to be determined
to be unlawful use. And in addition, if they’re
taking any street drugs or anything that’s on the
National Controlled Substances Act, that’s also
going to be illegal, and they’re not going
to get any protection under the ADA for that. So when you’re
dealing with employees that are taking drugs
that are being prescribed by their doctors– even if their effects
from those drugs that are having an adverse
effect on their performance of their job duties– they’re still going to
be covered by the ADA. So anytime there’s a
disability and it’s affecting the essential
functions of their job, you have to engage in
an interactive analysis with your employee to
determine whether or not a reasonable
accommodation can be made to allow those persons
to continue to work. A reasonable
accommodation is anything that’s not going to cause
undue hardship on the business. So an example that I can think
of is, if someone has surgery and they’re taking
painkillers, and because of their
painkillers, they’re not able to get from
their home to the office, one potential
reasonable accommodation would be to allow them
to work from home. Or potentially, have a
different start time. Or allow them to take additional
breaks during the day. If you can have that
reasonable accommodation, you can’t take adverse
employment action against them, just based on their
use of lawfully taking prescription drugs. There is an exception
to that, and that is even if they’re lawfully
taking the prescription drugs, if they pose a substantial
risk to the health or safety of other
people in the workplace, that direct threat exception
will allow you to take adverse employment
action against them, if a reasonable
accommodation can’t be met. So when you’re
doing that analysis, it’s important to focus
on, what is this person actually doing for me? And what is their
job description? So for instance,
your bookkeeper, he might have the possibility
of stapling his hand, if he’s under the influence
of prescription drugs, but that’s not a substantial
threat to the health and safety of your other employees. As opposed to someone
that is operating the forklift in the warehouse or
utilizing a commercial driver’s license. So again, you’re going to want
to do a fact-based analysis, Get. Your employment
lawyer on the phone, when you’re making
that determination. But if they’re a
direct threat, you can take that adverse
employment action against them. Another statute that
I want to address is the Family Medical Leave Act. The Family Medical
Leave Act is going to affect those of us that
employ more than 50 employees, within the 75 mile
radius with each other. So for instance, Dworken and
Bernstein has two offices– one in Painesville,
one in Cleveland– our total employees total them
more than 75 at both locations. And because of that, we are
governed under the Family Medical Leave Act. So take that into account. A lot of people get confused. They think, well, I
only have an office that has 35 people
but their satellite or other offices around them,
get that number over 75. So they don’t realize that
the act applies to them, when it actually does. So eligible employees
under the act are employees that have
worked at the business for over a year. And have worked for 1,250
hours for the employer during that year. If they’re eligible, they’re
entitled to 12 weeks of leave to deal with serious mental
conditions affecting them or serious medical conditions
affecting a family member that they need the care for. Advance notice should be
given when requesting leave, but it’s not
necessary that you do, if it’s a medical emergency. You also– this is a point of
confusion with many employers– when an employee comes
to you to take leave, they don’t need to
say, I’m requesting leave under the Family
Medical Leave Act in order to be covered under it. If they come to you
and they ask for leave, you need to instruct
them to comply with the requirements that
are hopefully, included in your employee handbook,
that deal with what needs to be done to
get leave approved. An employer has
the right to obtain medical certification,
a doctor’s note, that is justifying the
leave before they allow it. And again, if it’s
a medical emergency and it can’t be
provided in advance, the determination
is whether it was provided in a reasonable basis. So substance abuse
is generally, going to be considered to be a serious
medical condition that you can request leave for, whether it’s
you that are seeking treatment or one of your family members
that you need to care for. There is one exception,
though, in order to get leave under the act,
the substance abuse treatment needs to be administered by
a health care professional. So if you have an
employee come in and they indicate to you, that
they have a problem with heroin or opioids– generally– and they just
need to clear their and take a couple of weeks
off, that’s not going to be sufficient to
cover them under the FMLA. Now, of course, these are
the minimum requirements of what I’m talking about. If you want to give
them the leave, that’s well within
your rights to do so. But in order for them to
be eligible for the leave and the protections of
FMLA, that treatment needs to be something
that’s prescribed by a doctor, or health
care professional, or a referral out to a
health care professional. Again, another thing that
I want to talk about– and this goes with
the ADA and FMLA– whether it’s a disability or
a serious medical condition, those are going to be
protected under those acts, whereas employee misconduct
will not necessarily, be protected by those acts. So I was talking to
someone earlier today, who indicated that
one of her employees was absent from
work quite a bit, and she ended up having to
let that employee go because of violation of their
progressive policy discipline, which is fine. You’re entitled to do that. She later found out, it
was because this person was addicted to opiates. The mere fact that someone
is addicted to opiates isn’t going to give them
preferential treatment under your corporate policies. So if you’re having
problems with employees, especially with absenteeism–
that’s where it shows up a lot– you can take that
discipline against them in accordance with
your policies that you would with any other employee. There isn’t a safe
harbor for people who are suffering
from these issues. Now, again, you may
not want to do that. I know a lot of us here are
especially receptive to trying to help our employees,
but your lawyers concern is going to be keeping you
in compliance with the law. And I think it’s
important, if you are going to give a reason
for termination or suspension, that you make sure when
you’re giving that reason, it’s related to the
actual misconduct. And make sure you’re
not addressing it towards a disability
or an addiction issue because that could be held
against you in a later legal proceeding. I think as these
issues come up, they can be murky areas
and especially, if you find yourself in
a courthouse one day, litigating them. There are going to be
two sides of the story. Obviously, the employee
that’s been affected by this is going to present
the case, no, they took this action against
me because I’m a recovering addict. As opposed to the employer’s
going say, no, we actually took this because you’ve
missed six days of work. So whether or not there’s
a reasonable suspicion, you’ve got to be
careful in what you do. And you want to have
that interactive analysis with your employee
to determine, what are the causes of
these problems, to make sure that you have
everything documented right. And that you’re acting within
your own corporate policies in taking your
disciplinary action. Mr. [INAUDIBLE]. Grant, you mentioned first, that
if someone has an active drug problem, illicit drugs,
you can let them go because they’re illicit drugs. That’s a really good
question, and this is something that comes up a lot. Maybe I’m hanging
around the wrong people, but every once in a while,
I’ll be at a cocktail party and someone will say, well,
if I ever had a problem– I missed a week of work because
I was on a bender or something, I’d just go to my boss
and before they’d fire me, I’m going to tell
them, I’m an alcoholic. And then, if they
try to fire me, then I’m going to be covered
under the ADA or the FMLA. That’s not the case. Again, there’s a big difference
between the misconduct and the disability,
and how that’s going to be treated under the law. So again, if you are being
disciplined for anything that’s in violation of your
corporate policy, that’s going to be appropriate. You can’t go after the
fact and say, well, I know I missed a week
of work, but it’s because I’m a heroin addict. You’re not going to be
able to fall into it. So the misconduct is different. So I’m having a hard time
envisioning the situation when someone could come
in and say, I need FMLA. I’m a heroin addict. That was a year ago,
and I’m recovered, then why do you need it? So the FMLA is for
treatment so you can use it for treatment-based leave. Now, there’s a lot
of people we all– I think most of the
people in this room understand that recovery
is an ongoing process, and people are going
to have relapses. One of the issues
is whether or not you have a drug-free
workplace policy. There are some employers that
have a policy that just say, substance abuse is not allowed. It’s perfectly legal
to have that policy. And if there’s a
violation of that policy– whether or not you found
out about it because someone was taking leave, you can
take adverse employment action against them for
violating that policy. But you can’t take adverse
employment action in response to someone requesting the leave. So it is a very
complicated issue. Again, as it arises,
my recommendation is for you to get on the phone
and talk to your employment lawyer to deal with
that issue, to make sure that you’re following
the proper steps and dealing with your
employees issues the way that they need to be dealt with. One other thing that
I wanted to talk about before we get into our panel
discussion, is drug testing. The state of Ohio doesn’t
really have any specific laws as to when you can test. So mostly, you’re going to
be restricted by the guidance under the ADA. And the ADA is a little bit
more restrictive as to when you can make medical
inquiries of your employees. They deal it with three
different stages of employment. There’s the pre-offer
stage, when you’re just taking applications. The post-offer stage,
when you found a candidate and you’re going
to offer them a job conditioned upon
some sort of testing. And then, there’s testing
during employment. During the pre-offer stage,
you cannot make any inquiries as to whether or not
someone is disabled. No disability questions. You can’t ask anybody about
what prescription drugs they’re taking or else, you
can be in violation of the ADA. But again, illegal
drugs are specifically excluded so if you want to ask
any candidates whether or not they’re taking illegal
drugs and they answer, yes, there’s probably
a lot of reasons why you don’t want to hire them. But if they do answer yes,
that’s completely appropriate. And you can also do drug
screening for illegal drugs at that time. And if it comes up on the
test that it’s illegal drugs, you can decline to offer any
employment to that person. Obviously, this gets a
little bit complicated– and this sort of builds on
what Karen was talking about– is when you’re dealing with
opioids, if you don’t know what you’re testing
for, it can be very difficult to differentiate
between street drugs and prescription drugs. So again, you have
to be very careful that you’re testing
for illegal drugs, if you’re doing it in
pre-employment testing. After you’ve made
an offer, there’s a lot more flexibility
about what you can ask. You can have people
do medical exams. You can have people
test for illegal drugs or lawfully prescribed drugs. But that testing needs to
be consistent with the job that you’re offering,
and it needs to be applied consistently,
to everyone that is seeking that category of jobs. Post-employment, one
thing that you can do is put in your company policy,
your employee handbook, that you’re allowed to do
drug testing at any time, and if you put that
in your handbook, that’s going to be enforceable. If you don’t have something
like that in your handbook, there’s two different
tests or analysis that an employer can
use, as to when they test their employees for drugs. The EEOC– the Equal Employment
Opportunity Commission– has a test where
employers are allowed to test their employees if
there’s any objective evidence that the test needs to occur. So again, if an employee
is not showing up to work, excessive absenteeism,
you can implement the test. There’s a different
standard, that’s a little bit broader,
that’s been presented by a number of courts
that dealt with the issue, that if an employer has any
articulable basis for testing an employee, that’s sufficient
to pull that employee out and test them. So if you see an
employee falling asleep at work, or if there
were an accident, or any other number
of reasons, as long as you can articulate a basis
for testing an employee, that’s going to be
OK under the ADA. I know that there’s been some
discussion about the Bureau Worker’s Compensation Drug-Free
Workplace Safety Program, that is not a mandatory program,
but it provides an incentive to employers to insist that
their workforce is drug-free. If that’s implemented,
there are certain times where you must test. I think, there’s
mandatory testing, pre-employment under
that plan, and you need to engage in testing
after any accident, to ensure that you get
that discount– to be eligible for the discount. And additionally, under
the BWC, if an employee has an accident at
work and you do testing and they show up positive
for illegal drug use, they’re not going to be entitled
to any worker’s compensation benefits at that time, too. So that’s just a little blurb
on testing in the workplace, and that’s all the
material I have. I want to tell you
guys, again, what we’re talking about here is
compliance with the employment laws. These are minimum compliance. So if you want to offer your
employees a second chance and help them work through
some of these problems, you are well within
your rights to do that. And I think, I would agree
with the other panelists that, that’s probably, the
best practice approach, as this issue gets more
complicated as we go on. Thank you. [APPLAUSE] Thank you so much, Grant,
for giving us that overview. It is an exceptionally
complex legal set of issues, that really requires
counsel in these areas. But it is interesting to see
that there are so many more people, more professionals
advocating for second chance agreements, when we
would not have seen that, even just about two years ago. So thank you, Grant. Our next speaker, she is last
for speaking, but certainly, not least, is my dear friend
and tremendous colleague, Kimm Leininger. Kimm is a community builder. She certainly does
that and has done that for many decades,
who utilizes partnerships and collaboration to address
local needs and issues faced by Geauga County residents. Kimm is a strong believer
in social justice and strives for a positive
community change, really, on a daily basis. As the executive director
of the United Way Services of Geauga County
since 2003, Kimm has been able to leverage
relationships with community leaders and professionals,
to really, redefine our vision for United
Way that is innovative and forward thinking. Prior to her tenure
at United Way, she served as the
executive director of WomenSafe, a
domestic violence shelter and resource center. And as a hospital social worker. Kimm is an active member of the
Geauga Family First Council, she is vice chair. Leadership Geauga Board of
Directors, the youth program chair. And she serves on the University
Hospitals Geauga Medical Center Board of Directors. And a number of other
boards, as well. I have the privilege
of working with Kimm for a few years in the aftermath
of the Chardon High School shootings with the
crime victims services section of the attorney
general’s office. She not only worked to steady
that ship as the community was torn apart as a result
of Chardon shootings. It was a very tumultuous
and gut-wrenching time. She led the Chardon
Healing Fund. Led services to the families. And really was a key in
helping the community recover and was looked
to on a national level. And so, it is
really, my privilege to introduce our next
speaker, Kimm Leininger. She’s going to say a few
words on behalf of her work and in Geauga County. Thank you. [APPLAUSE] So I’m not going to talk
about United Way specifically, but just a quick
touch point on that. In Geauga County, we really
are researching, and learning, and understanding
what the needs are. Trying to pull together
collaborative and diverse partners that develop
strategies to help individuals and families
toward self-sufficiency. So that’s our focus in Geauga
County, where Kim mentioned, they’re really looking
at mental health. We’re really looking
at self-sufficiency and what are those barriers
that exist for individuals and families in the community? I did grow up– I was born and raised
in Lake County, and I am a graduate
of Riverside. But how many of you
are from Geauga County? I didn’t think there are many of
us in the room, but that’s OK. Because 211– as I talk a
little bit about this signature program that we operate
through our United Way, it will give you
an idea of how you are going to be able to
connect to your employees and their families to services. So the example
was given already, about an employee who, maybe,
is raising their grandchildren and running into issues
and barriers along the way. And 211 is a service
that can help with that. Hopefully, you’ve
all heard of 211. I did leave brochures,
posters, some pencils and pens out at the table so please,
grab them when you walk out. But 211 really is a
three-digit number– very easy to remember. Just as you would dial 811
before you dig in your yard, you’re going to dial 211, when
you need access and navigation with health and human services. The services in the health
and human service field are very complicated. As you heard, evidence-based
programs, well, what does that mean? Hours are different. Things are changing every
day and very quickly, as to what’s available
in the community. 211 is really, the experts
at understanding what is available in the community. And how to navigate people
through those services. About 93%-94% of our country is
covered by a 211 service area. I will tell you, the
part of Ohio that is not, is our Southeast
corridor, that really lacks the 211 infrastructure. This chart– I know
it’s hard to see– but the darker
areas show you areas where 211 is at 100% coverage. Down to the gray areas,
where there’s less than 20% coverage with a 211. And I’m going to go kind
of fast because I really wanted to show you this
video, which gives you just a peek into the navigation
services that happen with 211. [VIDEO PLAYBACK] [MUSIC PLAYING] – 211 one is a service where
people can call 24-hours a day, seven days a week, with almost
any concern or need that they have. And we will try to
find resources out there in the community
that can help them. There really isn’t anyone else
out there, who does what we do. We have some researchers
that do an amazing job of keeping connected with
all of the resources that are out there. Keeping it up-to-date. – It would be very
detrimental to people who would spend their
last dime on a bus trip somewhere when
something is closed or they don’t qualify
for the service. So we put a lot of effort into
the quality of that database. – Two years ago, I was at
TriCity Upward Bound program and a gentleman raises his hand. And I said, do you
have a question? And he goes, this
man saved my life. He had called on January 20th. He had lost his job. He had been in a
domestic dispute with his significant other. And she had kicked
him out of house. He spent the night
in the door frame. It was about,
minus 9 that night. The buses in Cuyahoga
County were free that day. I told him to get
on a bus and go to 7000 Euclid Avenue,
where the VA has their homeless drop-in center. I told them, you need
to get back into school, to see if I can
get a better job. Two days before he graduated
from TriCity’s Upward Bound, he got a new job. On July 1, he moved back
into his own apartment. – 211 informs the
community, and United Way, about what people need. Where there are gaps. Where there’s unmet needs. That information can then, be
used to make funding decisions. And to help bring
people together and United Way is
perfectly positioned to convene and to fund. I was talking to a
young lady one day and she had initially
called and said that, she was looking
for help with furniture. And I said, OK, well, I
can help you with that. And I gave her some
information on how to access some help with furniture. But then, I asked that next
question, what’s going on? So she said to me
that, over the weekend, that her husband was arrested
for domestic violence. He had been abusing
her for many years. This was the last straw,
and she needed to get out. And so she found a place, and
she scraped up every last penny that she had, for first
month’s rent and deposit for a new place, for
her and her child. After we’re having
this conversation, she started to really
open up, and she told me, the reason that I stay with
him is because I have diabetes and I’m insulin-dependent. And even though I work, I
can’t get health insurance through my job, and
I’m on his insurance. So the only way that I can
access medication and health care is by staying married to
him and using his insurance. So I asked her a few
more questions about, what her income was
and as it turned out, she was eligible for Medicaid. And she had no idea. So I gave her information
on how to access that, and she started to cry. And said, you just took away the
only reason that I had to stay, and now I know, that I
can manage on my my own. It moves me, to know
that I was able to help change this woman’s life
and get her in a safe place that she was able to make that
change after feeling trapped for so many years. – When somebody calls you
up uncontrollably sobbing and by the end of the
call, they have a plan. – And now that I do this–
and my dad was a vet– I know he would be
proud of what I’m doing. [MUSIC PLAYING] [END PLAYBACK] So I thought that was a
really important video to show because it shows
the navigation services. We, in Geauga, I could see
the writing on the wall. It’s a very expensive service
to maintain– very expensive– because of number one, the
technology that has to go behind it– the telephone
systems that are required– and the database, upkeep. In 2007, I went to United Way
of Greater Cleveland and said, how could we partner our 211’s? So we did that,
and now, there are 26 counties in
the state of Ohio, that also partner
with the United Way of Greater Cleveland. So we have a shared
infrastructure. They hire people locally,
in local communities so they cover Toledo, but
people are based in Toledo, providing that service. So we were able to
really, save and cut down on some infrastructure costs. Basically, I think this
is really important, it’s the complexity
of social needs. So somebody in your workforce
is dealing with an opiate issue, there are probably, a lot
of other things happening in their lives. So the example you saw, the
woman called about a furniture need, but it led
to a conversation, as they dug a little bit
deeper into domestic violence. The issue of the
diabetes and why she was in this relationship and
staying in this relationship. To the opportunity
for her to take a step towards self-sufficiency. Getting onto Medicaid. She was working– it wasn’t
that she wasn’t working, she’s working– but she qualified for
Medicaid and that allowed her the opportunity to begin to make
a different plan for her life, than she would
have had otherwise. Just really quickly
on the database, there are over
4,000 social service agencies in the database when. I talk to social
workers and they say, I know where to send people. I laugh because
there is absolutely no way somebody knows what every
service those 4,000 agencies are providing because they
have over 24,000 programs. So in Geauga, our Hunger
Task Force Pantries are linked through 211. So the pantries, if they
have to close– many of them are in churches– if
they have to close because of a funeral that day,
they call 211 and let 211 know, we are not providing
services today. So if you don’t call 211, you’re
going to go to that pantry thinking you’re
going to get food and you will not be served. So 211, it’s really,
really important. Annually, they make over
100,000 updates to the database. The database is
updated annually. As you heard a little bit,
every agency is contacted and they go over
every element that we have listed in that database,
and they have the opportunity to update that. There’s also interim updates
when our staff are out at meetings or sometimes, a
client will call back and say, you know what? That didn’t work. That service wasn’t
available anymore. Or agencies will call,
as they change things. Very much like libraries use
the Dewey Decimal system– I know most of us will remember
that or in the health field, the ICD-9 codes, the disease
classification codes– we use taxonomy codes for health
and human services, as well. This allows us to not
only look at and pull data based on what needs
we were able to meet, but also, what needs
in the community go unmet, which is really
important, as we’re really trying to plan and strategize
services in the community. This just gives you
a quick sample entry. There’s a definition
for every service. And also, terms in ways
that those services can be looked up. Nationwide, there’s
about 13 million calls to 211’s across the country. The number one need is housing
and utility assistance. But the second need, two
million calls a year, around health and mental
health services and needs. We know in Geauga County– and this is the exact same
list, at least number one, and the others are in a
little bit different order for Lake County– but food pantries, number one
need in both Lake and Geauga Counties. Our unmet need, in Geauga, we
do not have a homeless shelter, but quite ironically,
Lake County does. And it’s also, the number one
unmet need in Lake County, is a homeless shelter. About 47% of the individuals
who call 211 in Geauga, are 49 years of age or younger. That 50 and over
population is about 57%– it’s 43% and 57%. What’s interesting–
and I think, from a workforce
standpoint– is being able to take care of
your employees now and their families. In Geauga, our
over 60 population is going to grow from
22% to 30%, by 2030. Our under 19 and
underpopulation, is going to drop to 19% or less. So we’re going to have
less folks that we’re going to be able to prepare
to get out into the workforce so taking care of your employees
now and their families, is really, really important in
connecting them to services. This just gives a
quick run through of where we get the most
out of our calls from. When someone calls 211,
we search by zip code so that we can give them the
closest services in proximity to where they live. Should they say, I don’t want
to go to that food pantry because that’s my
church, then we’ll go to another food pantry. But this database is not
only local resources– now, 26 counties worth of
resources– but state and federal resources, as well. So there’s things that are just
beyond our local communities. So you can call 211, our 211
has a chat feature at 211oh.org, which we have that available
during our business hours, from 9:00 to 5:00. So someone can go on
and chat with 211. Here in Lake County,
they do have a way that you can go on the
websites up there, where you can actually search
for services and resources in the community. This is a challenge so if that
woman would have gone on here and looked for furniture, she
would have found furniture, but she probably, wouldn’t have
gotten the other resources. So having that navigation
feature is really important. There’s also, 211.org. So if you have employees
who have family members that live out of out-of-state
or out of town, you can go on here
to 211.org and get connected to the 211 that
covers their community. Just wanted to touch on
some special initiatives because I think this always
sparks some ideas for people and how they can
partner with 211. Bank of America, during the
height of the foreclosure crisis, partnered
with 211 so they could work with individuals who
were really transitioning out of homeownership. The Centers for Disease Control
had a contract with 211, when we had the
flu epidemic scare so that they would be able to
triage individuals and families so people weren’t walking
into a doctor’s office sick. They could actually, do that
over the phone with 211. Recently, United Way
of Greater Cleveland just received an Accountable
Health Community grant through Medicaid,
and they are working with hospitals in
the Cleveland area, to look at embedding navigation
specialists into the hospitals. Joining the UH board has been
incredibly eye-opening for me, in that, in our US
health care system, our hospitals spend more money
on the social needs and issues because people are
coming back because of environmental issues. Inability to access
healthy food. Inability to purchase
their medications. And so, we’re spending more
money in our hospital systems on those types of things,
that could keep people healthy if they had solutions
to those issues. So that’s exactly what this
project is going to do– really look at, can the
navigation specialists help individuals access
the resources and services that they need, to
help them stay healthy? Locally– I’m just going
to touch on really quick– reentry project– we have a
navigation specialist embedded in our jail in Geauga County. This is a new project, and
the Cleveland Foundation is funding this with us. It’s been amazing
because we have been able to work with treatment
providers in the community. Individuals come into jail,
they get jail treatment by our wonderful,
wonderful organization– Lake Geauga Recovery Centers. They get that service, and
then, when they leave the jail and want to go to inpatient
treatment, oftentimes, inpatient treatments
will not take a patient who requires
an injectable medication. So if you have diabetes
and you need insulin, you’re probably not getting
into a treatment center. Because of this program, we were
able to work with a treatment center to advocate on
behalf of a client, work with their physician. They were able to
work out an agreement, and we were able to get this
individual into treatment. It was huge– a huge step. [MUSIC PLAYING] That’s all I have.

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