The Risks of Medicating Mental and Physical Health

While prescription medications can help treat employees’ workplace-related physical and mental health issues, they come with very real risks, according to experts in the insurance industry.

Aside from psychotherapy, the primary treatment for injured employees who experience mental health conditions such as anxiety, depression, and posttraumatic stress disorder (PTSD) is a combination of anti-anxiety benzodiazepines and SSRI (selective serotonin reuptake inhibitor) antidepressant medications. Depending on the severity and chronic nature of the injury, employees may be prescribed opioids for pain relief. Medical marijuana also may be prescribed for chronic pain, anxiety disorders, and sleep disorders.

While those drugs generally are effective at treating mental health conditions, several studies indicate the concurrent treatment of an injured employee’s chronic pain, anxiety, and depression increases workers compensation claim costs and the time it takes to close cases. For example, a 2012 study in the Journal of Occupational and Environmental Medicine analyzed 11,394 lost-time claims filed with the Louisiana Workers’ Compensation Corporation over a seven-year period and found the average claim duration for claims in which individuals were prescribed no opioids, only short-acting opioids, and long-acting opioids was 415, 930, and 2,025 days, respectively. The researchers concluded that opioid dosage escalates as claims mature.

There is also the potential for injured employees to become dependent on prescribed drugs like opioids and medical marijuana. As prescriptions expire, workers may then self-medicate with marijuana, alcohol, and natural and synthetic opioids like fentanyl. The National Institutes of Health cited a 1993 study suggesting that employees in high-risk (defined as safety sensitive) job categories who had reported an accident in the preceding year “were more than four times as likely as accident-free employees to report illicit drug use in the last year.”

More recent studies paint a similarly dire portrait. A 2024 study by the American Addiction Centers found that 22.5% of people with a job use drugs or alcohol during work hours, while 13% of employees use marijuana at work more than once a month. “Pain meds can cause issues for someone returning safely to work, requiring more vigilance and attention by claims reps and PBM [pharmacy benefit management] providers,” says Jean Feldman, senior director of managed care at Sentry Insurance.

“A well-executed drug testing program can help an organization to maintain a healthier workforce which, based on our data, could decrease the potential for accidents or other unsafe behaviors,” says forensic toxicologist Suhash Harwani, senior director of science for workforce solutions at Quest Diagnostics.

However, this vigilance and attention are undermined by increases in employee tampering with drug tests. A 2024 study by Quest found that employee tampering with employer-commissioned drug tests in 2023 was six times higher than in the prior year. The figures also represent the highest rate recorded in more than 30 years by the global provider of diagnostic insights into laboratory tests. “[S]ome American workers are going to great lengths to subvert the drug testing process,” according to Harwani.

Most concerning in Quest’s findings is the rate of drug use among safety sensitive employees such as pilots, truck drivers, heavy machinery operators, pharmacists, and construction workers. The rate of substituted urine specimens in drug tests for this class of workers increased by more than 370% in 2023 from the prior year. “Much of this goes undetected because of the ability to manufacture a product very well that can mimic human urine,” Harwani says.

He’s referring to synthetic urine, which is widely available online. While advanced drug testing methods performed by Quest and other recognized laboratories can detect evidence of synthetic urine, not all companies use accredited labs. Other ways to tamper with drug tests include substituting a urine specimen from a non-drug-using family member or friend, diluting one’s own urine specimen, using so-called cannabis “flush pills,” and detoxing urine to cleanse it of drugs.

Even if an employee is found to be using marijuana at work, the challenge for employers is discerning the level of impairment. Unlike breathalyzers used by police to measure blood alcohol concentrations, there is no set legal limit of THC, the main psychoactive ingredient in cannabis, determining impairment. “The way marijuana metabolizes, there’s no clean test to know exactly how impaired someone is,” says Jennifer Cogbill, senior vice president of GBCARE, Gallagher Bassett’s medical management platform.

In fact, a 2020 study commissioned by the U.S. Department of Justice found that the THC level in blood concentrations and its metabolites in marijuana are not sufficient to prove impairment.

That’s a challenge for workplace safety and the workers compensation system itself. Cannabis use in the 24 states with recreational marijuana laws is associated with a 10% increase in workplace accidents involving employees 20 to 34 years old, according to studies by the National Highway Traffic Safety Administration and the Journal of the American Medical Association.