What Is Opioid Use Disorder?

Opioid use disorder (OUD) occurs when a person has problematic use of opioids—natural, synthetic, or semi-synthetic chemicals that reduce perceptions of pain. People can develop OUD from taking prescription opioid medication (e.g., morphine, hydrocodone), using illicit opioids (e.g., heroin), or both.

Symptoms of OUD are outlined in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders, Text Revision. They include but are not limited to:¹

• Experiencing a craving, or strong desire or urge, to use opioids
• Having a persistent desire or unsuccessful attempts to cut down or control one’s opioid use
• Spending excessive amounts of time using opioids or recovering from its effects
• Giving up or reducing previously enjoyed activities because of one’s opioid use
• Experiencing withdrawal when stopping opioid use
• Continuing to use opioids despite experiencing negative consequences, such as health problems, difficulties at school or work, relationship struggles, or becoming involved with the legal system (e.g., being arrested because of opioid use)

Symptoms of OUD are persistent and last at least 12 months.²

Individuals with OUD and their loved ones can learn more by visiting the APA’s opioid use disorder webpage for patients and families. This page includes information about OUD symptoms, including withdrawal, overdose prevention education, and resources to learn more about its treatment.

How OUD Affects Employees and Employers

Although a rare condition, OUD can drastically alter people’s lives, affecting their health, relationships, ability to thrive at work, and more. Notably, OUD is also associated with an alarmingly high rate of death.

Physical Effects

Opioid use, overdose, and withdrawal can have several effects on the body, especially when opioids are taken by injection. These include:^1,2

• Drowsiness
• Slowed breathing
• Severe constipation
• Gastrointestinal problems
• Endocarditis (an infection in the heart valves)
• Abscesses
• Risk of contracting communicable diseases that can be transmitted via needles (e.g., hepatitis C virus, human immunodeficiency virus [HIV])
• Necrotizing fasciitis (an aggressive skin and soft tissue infection)

If taken in high amounts, opioid use can lead to overdose, which can cause a wide range of acute and chronic health conditions. The most serious of these include respiratory depression, loss of consciousness, brain damage, cardiac arrhythmias, and death.³

When someone with OUD stops taking opioids, they develop withdrawal symptoms, which can be physically uncomfortable and thus lead the person to resume opioid use to stop the withdrawal. Physical symptoms of withdrawal include:⁴

• Pain
• Stomach cramps
• Diarrhea
• Nausea and vomiting
• Insomnia

The risk of death from OUD is high. In 2021, more than 75% of all drug overdose deaths in the United States were attributed to opioids.⁵

It is unclear what proportion of opioid overdoses are attributed to suicide. However, experts believe the number is likely substantial given that OUD has been estimated to have a risk of suicide 6 times higher than in the general population (87 per 100,000 person-years vs 14 per 100,000 person-years).^6,7

Psychiatric and Functional Effects

Common psychiatric effects of opioid use or withdrawal include euphoria, confusion, anxiety, and severe cravings. By definition, OUD significantly interferes with a person’s ability to function optimally, such as disrupting their interpersonal relationships or work/school life. In a study of nearly 79,000 U.S. adults in the general population, people who reported using opioids in the past year were almost 13 times more likely to be involved in the justice system than people who did not use opioids.

Work-Related Effects

In addition to putting a worker’s health and safety at risk, OUD can impact their ability to participate fully in the workforce. Consider the following work-related outcomes associated with OUD:

• Presenteeism — People with OUD who do not receive medication treatment experience 14 lost productivity days per year.⁸
• Absenteeism — Those with OUD have 2.91 times as many workplace absences than those without.⁹ Further, those who use opioids, but do not meet criteria for OUD have 1.82 times as many absences.
• Work productivity loss — OUD led to approximately $79 billion in productivity losses from 2015–18.¹⁰
• Cost to employers — From 2016–17, employees with OUD who did not receive medication treatment cost employers approximately $25,000 per employee per year.¹⁰ In 2018, OUD cost employers $7.25 billion in medical expenses.¹¹

Tips for Employers: How You Can Help Employees With OUD

Employers can play a key role in helping people with OUD connect to treatment and stay safe. For instance, knowing the signs of opioid overdose can help one recognize an overdose and respond quickly and appropriately. OUD in the workplace can also pose a hazard to the safety of the person with the disorder and those around them. In short, by creating a work environment that is more aware of OUD and supportive of its treatment, employers can help save lives.

Tips to help employers concerned about OUD in the workplace include the following:¹²

• Establish a drug-free work environment enforced by random drug testing: Managers should develop rules with legal counsel and human resources to ensure the inclusion of risk management, injury protection, and liability information. Terms should be clearly articulated and distributed in writing to all employees. In developing the company’s drug use policy, employers also may want to include a medical review officer to evaluate the policy and results from testing.
• Help mitigate stigma by educating employees about the biological nature of addictions and the availability of effective OUD treatment: Substance use disorders, including OUD, are brain-based illnesses; they are not diseases of failed willpower or character weakness. Creating a tolerant, understanding work environment helps increase the likelihood that employees will feel comfortable seeking help.
• Train supervisors on how to identify OUD behaviors: Similarly, understanding strategies for effectively intervening and communicating with employees who may be struggling increases the likelihood of individuals receiving treatment in a timely manner.
• Establish employee wellness programs that provide valuable education about the risks associated with opioid use: Individuals taking opioids should be reminded about the health risks associated with these medications as well as contraindications with alcohol, antidepressants, sedatives, and other drugs. Consider implementing a workplace naloxone program to provide training on how to use the opioid overdose reversal drug naloxone.
• Inform employees about their rights and treatment options to create an environment more conducive to help-seeking: Employees who want help may understandably worry about whether they will lose their job while in treatment. The Americans with Disabilities Act offers some protection, as does the Family Medical Leave Act. Offering short-term and long-term disability allows employees to continue collecting an income if they need to enter rehabilitation, requiring them to take time off from work.
• Give workers non-medication options to address acute and chronic pain: Employers can help reduce workers’ exposure to prescription opioids by ensuring coverage of non-opioid pain management options, such as physical therapy, psychotherapy, and acupuncture.
• Ensure the company’s Employee Assistance Program is equipped to help direct employees to confidential treatment as needed, including inpatient detoxification, MOUD, and psychotherapy: Screening, treatment, and aftercare should be benefits covered by the company’s health plan.

Resources

Managers, supervisors, and other employers can learn more about OUD in the workplace through the following resources.

• National Safety Council (.pdf), in partnership with the University of Chicago, developed the report How Workers with Active Substance Use Disorders Impact Employer Health Care Costs, which details the economic consequences of OUD for employers.
• The Kentucky Health Collaborative (.pdf) developed an employer toolkit for preventing OUD and supporting employees with OUD.
• National Safety Council (.pdf) offers the Opioids at Work toolkit for employers to learn more about OUD and how they can help employees with or at risk for the condition.
• Minnesota Department of Health also developed a toolkit to help employers combat OUD in the workplace.
• Centers for Disease Control and Prevention offers guidance on establishing a workplace naloxone use program.