What the Upstate New York Poison Center does; a workplace perspective on opioid misuse: Upstate Medical University's HealthLink on Air for Sunday, Jan. 2, 2022
The Upstate New York Poison Center's medical director, Vincent Calleo, MD, gives an overview of the center and the cases it handles. Jeanette Zoeckler, PhD, discusses the role of the workplace in opioid use disorder; she is director of preventive services for Upstate’s Occupational Health Clinical Center.
Host Amber Smith: Coming up next on Upstate's HealthLink on Air, the medical director of the Upstate New York Poison Center talks about the types of help his team provides to callers from 54 counties in New York state.
Vincent Calleo, MD: "What we do here is provide invaluable services for managing people. After they've been exposed to medications or substances, either recreationally, occupationally, or in a number of other ways."
Host Amber Smith: and what role might your workplace have in preventing and treating opioid use disorder? We'll discuss this with the director of preventive services for Upstate's occupational health clinical center.
Jeanette Zoeckler, PhD: "A one-size-fits-all approach is not going to be useful. So a very good workplace recovery program would allow for a wider variety of possibilities for recovery."
Host Amber Smith: All that, and a visit from The Healing Muse coming up after the news.
Host Amber Smith: This is Upstate Medical University's HealthLink on Air, your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, the director of preventive services for Upstate Occupational Health Clinical Center discusses the role workplaces may play in preventing and treating opioid use disorder. But first, we'll meet the new director of the Upstate New York Poison Center. And he'll tell us about some of the research he's done.
Host Amber Smith: From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is HealthLink on Air. My guest today is the medical director of the Upstate New York Poison Center. Dr. Vincent Calleo is also an assistant professor of emergency medicine and also a pediatric. Thank you for making time for this interview, Dr. Calleo.
Vincent Calleo, MD: It's my pleasure to be here, Amber. Thanks so much for having me on this morning.
Host Amber Smith: Well, I know you did your undergraduate work at Binghamton University, and then medical school here at Upstate. And you then did an emergency medicine residency, followed by a pediatric emergency medicine fellowship at Upstate, and you also spent the last two years as a medical toxicology fellow. Can you tell us what you drew you to medicine to begin with, in general? And then why did you decide to focus on emergency medicine and toxicology?
Vincent Calleo, MD: Yeah, boy, that's a, that's a long story, but I'll try to keep it relatively short for you. So going back, into my high school years, I always was really drawn to the sciences, biology and chemistry in particular. And I really liked to see how they interacted with human physiology. So when I was an undergrad, I started to do a little bit more work and take some anatomy classes, physiology, et cetera. And I really liked the way that, I was able to apply the basic sciences to help learn more about the human body and conditions that hopefully we can help to cure. And that kind of brought me through to medical school. In terms of what kind of kept me at Upstate and in the Upstate New York region, I'm a native from the Binghamton area. So I come from a pretty large family and everyone's pretty much centered in the Binghamton area. And I was actually the outlier of the family. I went an entire hour north to Syracuse, and it's been great to be up here. And so I think I was always really drawn to Upstate for its academics from the medical school, and that's really what drew me here. But what's kept me here all this time has been the phenomenal people that I've had the pleasure and the opportunity to work with and learn from in the emergency department. And that's really what drew me to residency here and subsequently, with my pediatric emergency medicine, followed by my toxicology fellowship. You know, I always tell people it's the location that got me here, and it's been the people that have kept me.
Host Amber Smith: Well, what are your days as poison center medical director like?
Vincent Calleo, MD: It varies from day to day. I feel like there are some days where a lot of it tends to be more administrative work, going ahead and helping to develop different guidelines, to try to help manage various complaints that we get brought to us from different healthcare providers via the emergency medicine setting, from inpatient or even sometimes from home callers. One of the roles that I perform is helping to streamline and come up with ways to help guide the management of these cases. I do a pretty good number of administrative meetings as well, to try to help grow the poison center. And in addition to that, I get the pleasure of interacting with our poison specialists and our educators here, who really provide a lot of the direct outreach to the community, either from helping to educate them to prevent poisonings or to help deal with them when they arise. So those tend to be the majority of the days. And, depending on the times during the week, very commonly, I, or a number of my other clinical or medical toxicology colleagues, we'll go ahead and we also see patients at University Hospital and do direct rounding and patient care in that setting as well.
Host Amber Smith: I was going to ask if you ever see patients face to face.
Vincent Calleo, MD: Yep. We do pretty commonly, so I'm really lucky to be in a group of some great toxicologists. And there are about four to five of us that routinely will go ahead and trade services as we're going through, and round on the patients in the hospital. And we also do a lot of education with a number of different medical students from Upstate mainly, as well as a number of different pharmacy students, medical residents from the emergency medicine department from internal medicine, pediatrics. We do a lot of different interaction and teaching both at the bedside and didactics with simulations, journal clubs and things of that sort to try to help to get people to recognize some of the subtleties with toxicology that frankly, we may not get taught all that much about in medical school or in typical residency. So I'm really lucky to be able to do those things.
Host Amber Smith: Well, I know the poison center is a 24-hour operation. What percent of your calls happen outside of regular business hours?
Vincent Calleo, MD: If I'm defining normal business hours as, we'll say, nine to five. I would say probably at least 60% of them are happening outside of business hours, with a good majority occurring, probably I'd say between the hours of maybe 12 in the afternoon right up through 10 or 11 o'clock at night. Those tend to be more of our peak hours in terms of when the volumes are highest, though it certainly as you know, can fluctuate from day to day with some of them coming much more heavily in the early morning hours, or even the late night hours. So we do get that fluctuation, but I'd say in general, our peaks tend to be in the later afternoon to evening.
Host Amber Smith: And I know the poison center serves the whole Central New York region from the Canadian border to the Pennsylvania border. Do you have an idea of where the calls are coming from?
Vincent Calleo, MD: We do serve a very, very wide geographic area covering 54 counties for the Upstate New York Poison Center. And I'd say that in general, the highest number of calls we get, tend to come from the areas where the populations are the most dense, and those tend to be some of the bigger cities. In terms of some of the ones geographically, we get a lot of calls from the Onondaga County area, and I think that's partially because we have the poison center physically located here, and people are much more aware of the services that we have available, but we also do get a lot of calls from areas like Rochester and Buffalo and the surrounding counties in that area. A number of the other areas we serve are a lot smaller. So it's just, based on the sheer number. We're going to probably hear less from them because they don't have as many patients coming in as a whole. But there are a lot of times we hear from some of these smaller, outlying hospitals with really sick patients that do come in as well. So, it's great that we have the ability to help provide guidance to them. When those calls come into us.
Host Amber Smith: How many of the calls relate to children versus how many relate to adults?
Vincent Calleo, MD: So I'd say in terms of the overall number, I'd say maybe roughly 50 to 60% are probably related to children, if I'm defining that age range as 19 year old or younger for the pediatric population. And it's a pretty large percentage. Now with that being said, I think it's important to recognize that a good number of the calls that we get that are related to pediatric exposure fortunately are ones that we are able to provide guidance for the families too, and help them manage at home, thus avoiding an ED (emergency department) visit or stay, particularly now when ED wait times across the state and really across the country are so high, given the number of COVID cases, staffing, shortages, bed shortages. So it's great when we're able to provide that for families. I'd say in terms of the overall number of calls we get for people that are hospitalized or really sick, the number tends to be more skewed towards adults where intentional ingestions are more common than they are for the accidental pediatric exposures we commonly get called about. But in terms of absolute number of calls, I'd say that it actually skews a little bit more toward the pediatric population where kids may accidentally get exposed to one or two pills or substances, or even some plants or other things that we can, in some cases help provide safe guidance at home.
Host Amber Smith: What would you say are the top sources for unintentional poisonings among children?
Vincent Calleo, MD: I feel like it's pretty consistent from year to year. If you look at both our data, as well as some of the national data that we have, with the majority of the highest numbers of exposures being with over--the-counter medications, and some of the ones that we see most commonly are going to be things like ibuprofen and acetaminophen, simply because they are very readily available, and it's not uncommon for a parent to turn their head, even for a millisecond, and then the small child decides that are going to go and snag a bottle and get into a pill or two or have a sip of liquid formulation, too.
Host Amber Smith: You're listening to Upstate's HealthLink on Air. I'm your host, Amber Smith talking with Dr. Vincent Calleo, who is the medical director of the Upstate New York Poison Center. Before I ask you anything else, I want to make sure listeners know the number of the poison center: 1 800-2 22-1222. Now, you've written about quite a few cases for the medical literature. So I wanted to ask you about some of the topics you've delved into. Can you tell us about the work you've done on naloxone administration by untrained community members?
Vincent Calleo, MD: Yeah, sure. And so this was something that I did with one of my, well, now colleagues, but former attendings, Dr. Willie Eggleston, who is a brilliant toxicologist. One of the things that we found in the medical literature is that in terms of naloxone administration, we found that people who have been trained, even if they're lay people without a significant amount of medical training, are able to adequately and safely deliver Naloxone. But in terms of things going forward, one of the questions that we had was whether or not participants could administer different types of naloxone more successfully than others. There are several different things that people can use to administer this on the market, including some different nasal sprays or atomizer kits. And there's also an intramuscular form that you can give too. And so one thing that we wanted to figure out was are people able to give these different types without training, and if so is one type more successful than another? So we ended up going to the State Fair a few years ago. This was a pre-COVID time. And just having people recruited into the study to try to get a sense of which one is more easily available to someone without training. And what we found at least in our study was that we found that the nasal sprays and the intramuscular injections were more successfully administered within a certain time period we defined then the atomizer kit. And I think a lot of it just had to do with the kit took a little bit longer to put together and had a couple more pieces to the puzzle, so to speak. So that's the experience we found with that, but it was a great way to look at that, to help guide what may happen going forward in terms of the different ways that people can get trained, or different things people can use to help try to save a life.
Host Amber Smith: And, correct me if I'm wrong, but the opioid situation is still a big concern in this community, right?
Vincent Calleo, MD: Yeah. You know, it's both in our community locally and nationally. The opioid crisis is still raging. I feel like we don't hear about it as much as we d pre pandemic simply because we have other things on the radar now, too. But, you know, we do have a good number of opioid deaths, both locally, as well as nationally. And I think the last statistic I looked at nationally, I want to say in 2021, had about 75,000 deaths nationally from opioids. I might be slightly off of those numbers, but I think I'm probably pretty close. It's still quite a systemic problem and, hopefully administration and meloxone can help to reduce that number.
Host Amber Smith: Have you seen naloxone save someone's life?
Vincent Calleo, MD: Yeah, I certainly have. And so in terms of my emergency medicine background, it's a medication that we give not infrequently in the emergency department, very commonly for people that come in who have signs of an overdose. We frequently will give it to help people restore their breathing. And in many cases, if they have a significant change in their mental status and can't protect their airway, if they were to vomit. Those are a couple of the times we will give it, but there have been many times I've had patients come in, completely blue, not breathing at all. We've given them the medication, and it's helped to save a life certainly in those cases too.
Host Amber Smith: Now you've also helped develop training for how to treat overdoses of antidiabetic medication. Why is that important?
Vincent Calleo, MD: So there are a number of different antidiabetic medications out there on the market, right now. And one of the ones that we do see exposures to, and sometimes in the pediatric population, are going to be a class of medicines called sulphonylureas. And essentially what they do is they increase the amount of insulin that your body has available or releasing from the pancreas and can cause your blood sugar to drop very, very low. I think that's a really important topic for me, particularly with my interest in toxicology and pediatric emergency medicine. Simply because if a patient like this comes in and is profoundly hypoglycemic, and you're concerned that they may have some bad outcomes from that, knowing how to properly treat that's going to be really important. And in fact, I went ahead and created a simulation for our rotators here to kind of go through that helps mimic that and helps them to recognize what medications and what treatments they need to do to help reverse the effects of some of these medicines, how long to watch them for and how to manage them throughout the course of their time in the hospital.
Host Amber Smith: Are you seeing more cases of children, particularly, I'm overdosing on these medications? Because I know there's been an increase in recent years in the number of kids with type two diabetes.
As a general rule as you've already mentioned, the number of cases of diabetes nationally has been continuing to rise. And as such, it stands to reason that there are more anti-diabetics out on the market now. So I think that, in terms of the absolute numbers, while I may not have them there, one concern I do have is that as medications become more available, there are certainly a lot more potential for kids in particular, to get exposed to these medicines and potentially have a bad outcome. So increasing awareness in terms of how to manage these cases when they occur, I think is really important. So that's one of the big reasons I wanted to develop something like that.
Host Amber Smith: Well, I want to ask you about one other paper that has your name on it. What can you tell us about camel bites and how they compare to dog bites?
Vincent Calleo, MD: Sure. So i, so this was a case that I actually had when I was an emergency medicine resident a few years ago. And you would think you may not see a camel bite in Upstate New York, which for the most part is very true. So that's part of the reason I found this to be such an interesting one, but there was a case we had locally. In terms of camel bites versus dog bites, there can be a lot of differences between the two. And one of the things that's different is that camels have a different set of teeth, compared to dogs, obviously. And they have very, very strong jaws, which I didn't recognize at the time. So there are a lot of cases in the literature where camel bites can cause significant problems in terms of both the soft tissue injuries, but sometimes even causing injuries to the bones too. It's not uncommon to have fractures that occur from camel bites, as well as these penetrating injuries from the bite itself. And in addition to that, there are a number of different bacteria that are within a camel's mouth that make it very, very, potentially dangerous in terms of some of the different infections it can cause. Now a lot of these bacteria are similar to those that are in a dog's mouth, but I think it's really important to recognize that these patients who have these camel bites really need to have aggressive decontamination and cleaning, as well as strongly considering putting them on some special antibiotics, it can really help to decrease the likelihood of them developing systemic infections or even those localized bone infections too. So while it was something I wasn't terribly familiar with at the time, it was one that I certainly learned a lot about when writing that paper.
Host Amber Smith: Well, getting back to the poison center. Do you have ideas about how it may evolve in the coming years? Are there new types of services that you are seeing an increase in demand for?
Vincent Calleo, MD: Um, in terms of things going forward, I always tell people I'm really bad at predicting the future because my crystal ball broke. But with that being said, I think one thing that we've been trying to do looking forward is increasing the amount of public health outreach that we do. What we do here is provide invaluable services for managing people after they've been exposed to medications or substances, either recreationally, occupationally, or in a number of other ways. But one thing that we really are trying to look to do is increase our public health outreach. And fortunately we have a wonderful public education team and a great leadership team here as we're trying to work through that. So we're really hoping that we can increase our presence within the areas that we serve and really help to be proactive rather than reactive for a lot of things. And that's always been a mission of the poison center, but that's certainly one thing that we're going to try to continue to work on and grow going forward, trying to increase that public outreach presence. And we are trying to look at doing additional different types of things both within our poison center and collaborating with our counterpart down in New York City and as well as some of the other poison centers nationally to try and establish really good trends for different types of exposures in different things that we may need to go ahead and keep an eye out for as we go forward. So I think those are a couple of the biggest things that I see as we're looking into the future, and certainly continuing to provide a lot of high quality care for a particularly these sick cases, because what we found over the last few years is that the acuity of the cases we've been seeing really has been going up. We do see a lot of really sick patients or hear about a lot of really sick patients when we're taking calls. And fortunately we have a team of very highly trained poison specialists take those initial calls and help to provide guidance and reach out to the toxicology attending group if they have any questions for things that may be a little bit more complex. But fortunately we have a really highly trained, specialized group that's great at fielding those calls and helping to provide great recommendations in the meantime. So we're going to continue to try to keep that up in the meantime and provide great outreach.
Host Amber Smith: Thank you. My guest has been Dr. Vincent Calleo, an assistant professor of emergency medicine and of pediatrics at Upstate and also the medical director of the Upstate New York Poison Center with the phone number 1-800-222-1222.
Host Amber Smith: I'm Amber Smith for Upstate's HealthLink on
Host Amber Smith: Drug use and the role of the workplace -- next on Upstate's HealthLink on Air.
Music: From Upstate
Host Amber Smith: Medical University in Syracuse, New York, I'm Amber Smith. This is HealthLink on Air. What can employers do to help curtail opioid use disorders among workers? Let's explore this topic with Jeanette Zoeckler. She's the director of preventive services for Upstate's Occupational Health Clinical Center, and she was one of the editors of a special issue of the Journal of Environmental and Occupational Health Policy devoted to opioids in the workplace. Welcome back to HealthLink on Air, Dr. Zoeckler.
Jeanette Zoeckler, PhD: Hi, thanks for having me.
Amber Smith: The National institute on Drug Abuse reported nearly 50,000 people in the U.S. Died from opioid involved overdoses in 2019. And I've read of more than 100,000 overdose deaths between April 2020 and April 2021. And I also know there's concern about a growing number of people who die from opioids, laced with fentanyl. So what is the connection to the workplace?
Jeanette Zoeckler, PhD: Well, we're really glad to think this through because the opioid misuse and overdose problem is serious, and it's not isolated to the home environment or community environment.
Jeanette Zoeckler, PhD: We see that the workplace has a major role. That's even been recognized by the surgeon general, Vivek Murthy, as he's looking into mental health, he's looking into a lot of these kinds of issues and identifying the workplace as a source of health problems or a source of health promotion. And so the workplace is a super important place to think about this.
Jeanette Zoeckler, PhD: And so what we see here in the clinic -- and by the way, I just want to mention that the clinic here in Syracuse is part of a network of clinics statewide that is designed to fill in a gap in healthcare services for workers who end up needing to seek workers' compensation for how they are paying for their work-related injuries and illnesses. Who we see in our clinic are people for whom the workplace has become some kind of exposure has happened in the workplace. And then they end up being patients here. So what we think about in terms of injuries, in terms of work-related stress, those are the risk factors that lead to opioid use. So you can imagine you have work that causes you to have some kind of injury or chronic pain use. You get treated for that. You begin to take pain medication to address that. Perhaps you're prescribed opioids, narcotics and those consequences can lead one to addiction. Those risk factors, then, in the workplace are things like unsafe jobs that lead to accidents in the workplace that have injuries. So slips, trips falls, anything like that, or heavy workloads that will lead a person to have pain and then seek out a way to ameliorate their pain, which is a natural response, right?
Jeanette Zoeckler, PhD: So another set of risk factors that we find that connect work to opioids is around jobs, stress job insecurity and the potential for job loss. All of those factors can also be happening at the same time. I'd like to say a little bit more about job stress if I might at this moment, because job-related stress sounds like a vague idea. It sounds like, "oh, the work is stressful. Well, isn't work stressful? I mean, how much is too much?" So we've been, in our field of occupational health, have been studying work-related stress for quite a long time. And we have created definitions whereby people end up having health effects. That definition that's most commonly used and most substantiated in the literature is around high demands, low control, and the lack of support on the job. When you have those three factors in place, the job more likely can produce health effects, including cardiovascular disease, reduced immune function and then this potential for having injuries because you're stressed. There's a greater chance for injury in the workplace.
Host Amber Smith: Well, let me ask you, because you just described jobs that are demanding, but that a worker wouldn't have much control over. That's a lot of jobs, a wide range of types of jobs, too.
Jeanette Zoeckler, PhD: It really is. It's found in every type of industry and occupation. And of course, really right before the pandemic, we were hot on the opioid misuse and overdose issue. It was super important. It was center focus because of these large numbers you describe of deaths and, you know, the pandemic has only complicated the stressors in the workplace. In many cases, we see that the job stress that I described is uniquely peaked around healthcare workers and the pandemic, around others that are exposed. The so-called essential workers, now we've described workers as essential. We knew they were essential before, but it became even more heightened.
Jeanette Zoeckler, PhD: They can't quit their job. They can't go home and work from home. They work in the public. So these demands and loss of control and the danger of the possibility of contracting COVID have added to the stressors. We think of teachers a lot in this specific circumstance. And they're on their feet a lot, so they end up with pain, physical pain too. And the possibility of injury around teachers can center on worry about the COVID exposure, possibly having to move large books or furniture around, even though maybe they're not supposed to do, they're supposed to call maintenance, but they're in a hurry and they need to do this right now. They ended up using their bodies in ways that can bring injury. So every occupation I can highlight in this journal that I was able to participate in. We even looked at fishermen in certain villages and how they had a four times more likely chance of misusing opioids than anyone else in their villages. That occupation. So we focused in on that specific occupation for what is that story? And I could tell you that every occupation in different industries could be thought about for what is their connection. It's not going to be all the same every time. Each occupation has its unique stressors, the unique opportunities for injuries and the unique ways in which opioids become a part of that work-related health picture.
Host Amber Smith: Let me ask you a workers' comp question. If someone is prescribed opioids after an, on-the-job injury, and then they develop an addiction, is that addiction treatment going to be covered by workers comp?
Jeanette Zoeckler, PhD: That is a great question that I put to our social worker here. And I also put to a worker's comp attorney that participates on our board as well. And I got two different answers and that's not really surprising. And that's because it's difficult to get many work-related cases through the comp system. We have to advocate for our patients. We have to make a case for the causality of their illness. Their illness has to be proven to be work-related. So when I spoke with the comp attorney who has experience in this, he was saying that if you can draw the exact causal chain, which would mean like, suppose your knee was injured at work and maybe there was a bunch of delays and you weren't able to get it taken care of very quickly. Then you might be prescribed opioids. Then maybe you become addicted. If that all can be chained back to the knee injury in a direct causal link, then worker's comp is covering, but that's like something you've got to accomplish. Your doctor and your attorney have to accomplish creating the case. Then our social worker felt that the more common path for people to, to get the addiction treatment that they need will be that patient will come in, develops, opioid addiction. And then we will refer to pain management. And from the pain management, which workers' comp will cover, they can take it from there in terms of getting addiction services for the patients.
Jeanette Zoeckler, PhD: So it looks to me like it's not always clear, you know, it's not always a clear pathway in the worker's comp system, but that making that case is important. In other words, someone will come in and argue, "well, is this really work-related you were predisposed to addiction for some other reason." very often workers are considered... They have to prove a lot of times, above and beyond what you would think, in order to make their claims stick. So those, those claims have to be fought for.
Host Amber Smith: We have to take a short break, but Upstate's HealthLink on Air. We'll be back soon with Jeanette Zoeckler from Upstate's Occupational Health Clinical Center.
Host Amber Smith: You're listening to Upstate HealthLink on Air. I'm your host, Amber Smith talking with Jeanette Zoeckler from Upstate's Occupational Health Clinical Center. Our topic is opioid use disorder and the workplace. Can you give me an overview of workplace policies on employee opioid use?
Jeanette Zoeckler, PhD: So the main problem is a lot of workplaces just don't have a special, separate policy on this. They haven't been thinking about it. They have a workplace culture, whatever it is, and this would be considered part of their employee assistance program. And most places have those. And so what we find is, that's a good thing that those are in place and various employers approach this differently, but where the strength comes, where we could strengthen those employee assistance programs and create a stronger policies, that would be a key feature of improving the opioid misuse and overdose problem. So I'd like to describe what some have found to be the most important factors in strengthening what employers can do. There's a significant stigma that when people misuse or overdose on opioids, it's considered a moral failure. And when we move away from that into more of a biomedical approach where we say, this is something that needs treatment, you can get better. It's not a personal moral failure to have become addicted to these drugs. They need to be not prescribed as frequently. We need to look at that as an upstream way of preventing it. The employer programs that focus on opening these difficult conversations, being a place of where you can go in and admit that you've got this problem and you need help with it, without feeling like you're going to lose your job or feeling like you are some kind of second class worker now, that's really important.
Jeanette Zoeckler, PhD: And so that kind of employer's responsibility to create a safe and healthy workplace would include this kind of cultural shift. It's super important because people will continue to try to work through pain and continue to try to work through pain by using medications. And so when they do that, they're trying to protect their jobs. And very often, it's part of the workplace culture to support people, not working sick, not working in pain and let them go out and get the healing that they need as opposed to having to press through all the time. Employers should be promoting those kinds of shifts through awareness in their programing.
Host Amber Smith: Let me ask you, are there legal protections for someone to keep their job if they become addicted to opioids?
Jeanette Zoeckler, PhD: Yeah, when you have a work-related illness or injury, and this is established as a work-related problem, seeking treatment and being treated to be thought of like any other illness or injury. There should be and are legal protections for you. But I think what happens, and I think this is what's less often spoken about is that even if there are legal rights and protections, these are harder to achieve than at first glance. I mean, you have to know how to use your right and your legal protection.
Jeanette Zoeckler, PhD: You have to be kind of savvy about it because there will be ways in which somehow you end up being the one who gets on the losing end of the stick. Anyway, even though the legal protections are there. And so we want to make sure people know how to seek treatment and be supported in that seeking of treatment when they run into this problem, so that we can prevent their death or overdose or chronic drug addiction.
Host Amber Smith: Now, one of the articles in the journal advocates primary prevention in the workplace. What is that? And how would it work?
Jeanette Zoeckler, PhD: Primary prevention, from a public health perspective, is to always look upstream, to find out where can we cut this off at the source, rather than putting a bandaid on things and when it's late in the game, we want to try to cut things off. So there's a good example in the journal of a company that tried to put everything together to do, to enact primary prevention. And one of their efforts was around stopping this over prescribing of opioids in the first place. So the company decided to really think about the medical management of their workers, how many were being prescribed these, and try to reduce that and find other methods for addressing pain. And I think when we look at primary prevention, that's a good place to cut it off, cut off the so much prescribing. Another really important point which I've been driving toward in this discussion so far is the training and the awareness has to be very sensitive. It can't be just rote. We have to develop customized training that raises awareness in the workplace that reduces stigma and makes folks very aware that it's not a moral failure, that it's something that cuts across all socioeconomic levels. We're all interested in how to stop this. Some of the more effective programs really have top-down buy-in, and very often, sadly, that happens because a CEO or someone in a powerful position's family has been affected by the addiction and possibly even death. And that stimulates the top-down approach to really support continuous awareness raising among all the workers and not letting it just drop. So an ongoing look. Some of the better education efforts have centered on having workers who've been through it themselves come back to talk to other workers about how to avoid these traps. And getting those workers involved has been significant because there's nothing like a person who's been through it themselves to speak to it rather than an educator coming in and just giving lots of facts and figures. And unions are often good at this-- bringing out the uncomfortable conversation, sitting in focus groups or small groups and letting people's hair down a bit and saying, "Hey, we've got a problem on our hands. Let's admit it. Let's man up, if you will, and say, we're going to face this rather than keep it stigmatized and quiet." And so people have had success in doing that by bringing in key workers, who've been through the struggle and succeeded and gotten better. So that way it brings hope into those programs.
Jeanette Zoeckler, PhD: So those would be the kinds of programs and the kinds of efforts, that we would look for for primary prevention, to prevent people from ever, ever getting into this problem in the first place.
Host Amber Smith: And when you mentioned prescribers, if you're really targeting workers, you're having to teach workers to ask questions of their prescriber. If they're facing a surgery, say, maybe they need to ask the surgeon or the team about pain control that maybe doesn't involve opioids, or maybe a short course?
Jeanette Zoeckler, PhD: Right. They need to understand the danger of becoming addicted and how to avoid that. But also one thing, when we mentioned that, is the responsible medical prescription prescribing practices really are important. Because we don't also at the same time, want to see workers who need to address their pain and chronic pain going undertreated. You know, people are so afraid to even touch any kind of pain medication. We want to make sure they have the appropriate and supervised use of, because they really do need to alleviate their pain. And I think too, um, getting back to the primary prevention.
Jeanette Zoeckler, PhD: When we talk about work-related stress and also injury prevention, those are two key areas that need serious attention. One of the articles brought out in the journal brought out an entire set of manager practices that lead people to be stressed at work. And this is prior to the pandemic, but they might as well have been describing managerial practices in the pandemic, where people are having thin staffing, and low pay, and people are devalued at times, and there's a whole long list here of when low morale and burnout and turnover. When managers emphasize standard practices and don't make allowances for different styles, that basically can give control back to the worker for how they're going to do their work. Those things really need attention. And there's a lot of workplace incivility and harassment and bullying that leads people to feel despair and to sense that they're not respected or cared about. So those kinds of manager attention to the management level of how things are conducted in a workplace can go a long way to preventing people from having the need to reach toward drugs, to solve, to self-medicate their stressors.
Host Amber Smith: What does addiction recovery look like from an employer's point of view? If someone is in recovery does that affect their job?
Jeanette Zoeckler, PhD: But one thing that we have to think about with. Workplaces that support recovery programs. We have to think about that a one-size-fits-all approach is not going to be useful. So a very good workplace recovery program would allow for a wider variety of possibilities for recovery. In the best of all possible worlds, we'd be reducing the stigma. We would have a person able to go out to get the treatment they need, if they need to go out of work for their substance abuse treatment, addiction treatment. And then, we're going to have qualified occupational health care providers that would know how to make these case-by-case determinations. We'd need to have education, support, resources, and stigma reduction, kind of all working together to create the kind of recovery that returns a person to their work free of addiction to substances and ready to be returned in a full, full way.
Jeanette Zoeckler, PhD: And that's going to look different depending on occupation and industry. And I think when we see this in the clinic, we're able to have the sensitivities around when a person has an occupational illness or injury, we know kind of what they're going through. We can provide the kind of support that they need. Many times people are going through this without that sort of nuanced healthcare provider in front of them. They don't have the extra special thought about work-related health. So that's the main thing about what a good recovery would look like. Person's able to go out without stigma. People aren't allowed to gossip about them and have a big problem. They don't lose their job over it. They don't get demoted. And they are able to go out just as though they had cancer or they had any other kind of injury or surgery where they needed to go out. It should be treated in the same vein.
Host Amber Smith: I know that this is important in so-called white collar jobs, as well as in skilled labor or unskilled labor. It crosses a path across all sorts of occupations, but it is going to look different depending on if you have an office job or a factory job, or whether you're, out in the field. So it's gotta be challenging to come up with policies that will apply across the board to everyone.
Jeanette Zoeckler, PhD: Agreed. I mean, the story of this is that the substance abuse disorder is crossing all boundaries. So you think of it as a white collar. Very often, maybe in movies, we see it that way. But really we're seeing this opioid problem go across just every strata that we can think of. And I think that's why it gets the attention that it deserves, because we do see it not only affecting certain types of workers but everywhere. And you can see that people are using substances to perform their job. Many times they're using substances to cope with their job, or they're using substances after a work-related injury. It impacts their work. Sometimes they have a kind of job like bus drivers or firefighters, pilots. I mean, it's disastrous for them to be on some kind of substance, and it impacts the way their job works and how productive they can be. If they're intoxicated at work, it's a lot more of a big deal, right? And then, people have to have the access to medical treatment. In order to get access, a lot of times, a lot of people aren't ready for that shift. They need to stop using. They may not be fully ready to do that. Sometimes they don't have the coverage, their job does not afford them the coverage. So in a third of the cases, when they interviewed people in a statewide New York state interview, 32% of people that did not feel they could afford the cost of the treatments, or didn't have enough health coverage to cover an addiction treatment. 21% didn't even know where to get treatment. And people felt that, 17% felt it would hace a negative effect on their job. People even felt, 15% felt, that it would cause their neighbors and community to have a negative opinion of them if they got treatment. So there's a lot of barriers to people getting the treatment. And so we have to work on whatever we can do to reduce those barriers.
Host Amber Smith: And the treatment you mentioned does that include mental health care? Because I know that's part of this.
Jeanette Zoeckler, PhD: Certainly, I think addiction recovery is about getting off of the substance that you're dependent on, but thinking about what led to the dependence in the first place will look at mental health. And that's of course its own ball of wax for stigma, but I'd like to point out that many workers have short periods of strain where their mental health is affected and it's not thought of as a lifelong mental health condition necessarily. It's very often that they are going through a struggle. They need the mental health care to get through that. But it's not as though that indicates they're going to have a lifelong battle with mental illness, serious mental illness. So very often we will see that a short course of therapy and counseling really does get people through the tough spots for how do they get addicted? The powerful physical addiction on the drug may not have as much to do with a serious mental illness as it has to do with, getting through a tough period.
Host Amber Smith: If you could speak directly to any bosses or managers that may be listening, what would you tell them that they could do? What concrete steps could they take to make their workplace better, in terms of reducing opioid addictions?
Jeanette Zoeckler, PhD: The first thing they can do is to develop a policy, to face it, to face that every workplace in this country might have an exposure to opioids. Every, every workforce can have the problem of drug, misuse and overdose. It can happen to you. Believe that, and decide to have a policy. And in that policy, you would have this customized, thoughtful approach to the education and awareness raising that you would be doing among your workers. There's a lot of good information at the NIEHS website, https://www.niehs.nih.gov, the clinic here, we're happy to provide more resources for developing such programs that would be customized according to the workers you have in front of you, thinking through their real problems. One of the best ways to conduct education is to bring workers together either in Zoom or in a room, however, you can do it with your COVID protocols and allow them to speak to the issue and hear what they have to say, and find out how to customize the education piece that you're planning to provide for your workplace. And then, support the workers through an EAP program that is nuanced enough to understand this particular problem. Among a number of other problems that EAP programs should be able to handle such as alcoholism or tobacco. We want to have smoking cessation through EAP. You want to have a number of things that really matter to people's health, but this one should be available and strengthened through the EAP programs that you probably already have in your workplace.
Jeanette Zoeckler, PhD: When people have addressed it, they report being so relieved that finally the elephant in the room was opened up and that it didn't have to be shrouded in this sort of shame that people experience. And people, unions have had really profound culture shifts. And so I think that every employer should seek to have that kind of culture shift go on in their place of employment, so folks can get the help they need without it being such an area of darkness and shame.
Host Amber Smith: Thank you. My guest has been Jeanette Zoeckler. She's the director of preventive services for Upstate's Occupational Health Clinical Center, and she helped edit a special issue of the Journal of Environmental and Occupational Health Policy that was devoted to opioids in the workplace.
Host Amber Smith: I'm Amber Smith for Upstate's HealthLink on Air
Host Amber Smith: And now Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, the Healing Muse, with this week's selection.
Deirdre Neilen, PhD: Slavena Salve Nissan is a medical student at Mount Sinai in New York City. Her work has appeared already in Hektoen International and The Pharos. She sent us a poem, Candy Store, and it predates the pandemic, but it nicely illustrates the dedication and exhaustion of our frontline workers by describing their very particular candy counter purchases.
Deirdre Neilen, PhD: Candy Store, for Andy Efros
Deirdre Neilen, PhD: At three o'clock or so they start coming in first, slowly than a whole stream in need of an extra kick to get through, all very particular. Mini chocolate chip cookies for the NICU nurse. The ones in that green package, please, tell me that you have them. We lost two babies today. Mint gum for the medic. I'm working way too much overtime. Wait, what day is it? I think I have a date in three hours. A caramel pretzel, hazelnut, chocolate bar, sticky, salty nutty for the vascular surgeon who just repaired three ruptured aneurysms. I dreamt of blood last night again. Three diet sodas for the cardiology fellow. Hey, at least it's diet. I need to keep the weight off. I'm getting married on Sunday. And as for me, I'm partial to those little candies, you know, the blue ones, sweet, sour, childhood.
Host Amber Smith: This has been Upstate's HealthLink on Air brought to you each week by Upstate Medical University in Syracuse, New York. Next week on HealthLink on Air: what life is like after weight loss surgery, and some crossword clues from a puzzle constructor who works at Upstate. If you missed any of today's show or for more information on a variety of health, science and medical topics, visit our website at HealthLink on Air dot O R G.
Host Amber Smith: Upstate's HealthLink on Air is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.