U.S. GOVERNMENT PUBLISHING OFFICE

28–575 PDF WASHINGTON : 2018

THE OPIOIDS EPIDEMIC: IMPLICATIONS FOR 

AMERICA’S WORKPLACES 

JOINT HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH, 

EMPLOYMENT, LABOR, AND PENSIONS 

AND THE

SUBCOMMITTEE ON WORKFORCE PROTECTIONS 

OF THE

COMMITTEE ON EDUCATION 

AND THE WORKFORCE 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FIFTEENTH CONGRESS 

SECOND SESSION 

HEARING HELD IN WASHINGTON, DC, FEBRUARY 15, 2018 

Serial No. 115–35 

Printed for the use of the Committee on Education and the Workforce 

( 

Available via the World Wide Web: www.gpo.gov/fdsys/browse/ 

committee.action?chamber=house&committee=education 

or 

Committee address: http://edworkforce.house.gov 

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(II) 

COMMITTEE ON EDUCATION AND THE WORKFORCE 

VIRGINIA FOXX, North Carolina, Chairwoman 

Joe Wilson, South Carolina 

Duncan Hunter, California 

David P. Roe, Tennessee 

Glenn ‘‘GT’’ Thompson, Pennsylvania 

Tim Walberg, Michigan 

Brett Guthrie, Kentucky 

Todd Rokita, Indiana 

Lou Barletta, Pennsylvania 

Luke Messer, Indiana 

Bradley Byrne, Alabama 

David Brat, Virginia 

Glenn Grothman, Wisconsin 

Elise Stefanik, New York 

Rick W. Allen, Georgia 

Jason Lewis, Minnesota 

Francis Rooney, Florida 

Paul Mitchell, Michigan 

Tom Garrett, Jr., Virginia 

Lloyd K. Smucker, Pennsylvania 

A. Drew Ferguson, IV, Georgia 

Ron Estes, Kansas 

Karen Handel, Georgia 

Robert C. ‘‘Bobby’’ Scott, Virginia 

Ranking Member 

Susan A. Davis, California 

Rau ́l M. Grijalva, Arizona 

Joe Courtney, Connecticut 

Marcia L. Fudge, Ohio 

Jared Polis, Colorado 

Gregorio Kilili Camacho Sablan, 

Northern Mariana Islands 

Frederica S. Wilson, Florida 

Suzanne Bonamici, Oregon 

Mark Takano, California 

Alma S. Adams, North Carolina 

Mark DeSaulnier, California 

Donald Norcross, New Jersey 

Lisa Blunt Rochester, Delaware 

Raja Krishnamoorthi, Illinois 

Carol Shea-Porter, New Hampshire 

Adriano Espaillat, New York 

Brandon Renz, Staff Director 

Denise Forte, Minority Staff Director 

SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS 

TIM WALBERG, Michigan, Chairman 

Joe Wilson, South Carolina 

David P. Roe, Tennessee 

Todd Rokita, Indiana 

Lou Barletta, Pennsylvania 

Rick W. Allen, Georgia 

Jason Lewis, Minnesota 

Francis Rooney, Florida 

Paul Mitchell, Michigan 

Lloyd K. Smucker, Pennsylvania 

A. Drew Ferguson, IV, Georgia 

Ron Estes, Kansas 

Gregorio Kilili Camacho Sablan, 

Northern Mariana Islands 

Ranking Member 

Frederica S. Wilson, Florida 

Donald Norcross, New Jersey 

Lisa Blunt Rochester, Delaware 

Carol Shea-Porter, New Hampshire 

Adriano Espaillat, New York 

Joe Courtney, Connecticut 

Marcia L. Fudge, Ohio 

Suzanne Bonamici, Oregon 

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SUBCOMMITTEE ON WORKFORCE PROTECTIONS 

BRADLEY BYRNE, Alabama, Chairman 

Joe Wilson, South Carolina 

Duncan Hunter, California 

David Brat, Virginia 

Glenn Grothman, Wisconsin 

Elise Stefanik, New York 

Francis Rooney, Florida 

A. Drew Ferguson, IV, Georgia 

Karen Handel, Georgia 

Mark Takano, California, 

Ranking Member 

Rau ́l M. Grijalva, Arizona 

Alma S. Adams, North Carolina 

Mark DeSaulnier, California 

Donald Norcross, New Jersey 

Raja Krishnamoorthi, Illinois 

Carol Shea-Porter, New Hampshire 

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C O N T E N T S 

Page 

Hearing held on February 15, 2018 ....................................................................... 1 

Statement of Members: 

Byrne, Hon. Bradley, Chairman, Subcommittee on Workforce Protections 52 

Prepared statement of ............................................................................... 54 

Sablan, Hon. Gregorio Kilili Camacho, Ranking Member, a Representative in Congress from the Northern Mariana Islands ............................... 4 

Prepared statement of ............................................................................... 6 

Takano, Hon. Mark, Ranking Member, Subcommittee on Workforce Protections ........................................................................................................... 70 

Prepared statement of ............................................................................... 72 

Walberg, Hon. Tim, Chairman, Subcommittee on Health, Employment, 

Labor, and Pensions ..................................................................................... 2 

Prepared statement of ............................................................................... 4 

Statement of Witnesses: 

Allen, Ms. Lisa, President and CEO, Ziegenfelder Company ....................... 16 

Prepared statement of ............................................................................... 18 

Andrews, Dr. Christina M., PhD, Assistant Professor, University of South 

Carolina ......................................................................................................... 33 

Prepared statement of ............................................................................... 35 

Rhyan, Mr. Corwin, MPP, Senior Health Care Analyst, Altarum Institute ................................................................................................................. 7 

Prepared statement of ............................................................................... 9 

Russo, Ms. Kathryn J., Principal, Jackson Lewis P.C. ................................. 41 

Prepared statement of ............................................................................... 43 

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THE OPIOIDS EPIDEMIC: IMPLICATIONS FOR 

AMERICA’S WORKPLACES 

Thursday, February 15, 2018 

House of Representatives 

Committee on Education and the Workforce, 

Subcommittee on Health, Employment, Labor, and Pensions 

joint with the 

Subcommittee on Workforce Protections 

Washington, D.C. 

The subcommittees met, pursuant to call, at 10:02 a.m., in Room 

2175, Rayburn House Office Building. Hon. Tim Walberg [chairman of the Subcommittee on Health, Employment, Labor, and Pensions] presiding. 

Present: Representatives Walberg, Byrne, Wilson of South Carolina, Rokita, Brat, Grothman, Stefanik, Allen, Lewis, Mitchell, 

Smucker, Ferguson, Estes, Handel, Sablan, Takano, Fudge, 

Bonamici, Adams, Blunt Rochester, Krishnamoorthi, and Shea-Porter. 

Also Present: Representatives Foxx, Thompson, Guthrie, and 

Scott. 

Staff Present: Marty Boughton, Deputy Press Secretary; Courtney Butcher, Director of Member Services and Coalitions; Michael 

Comer, Deputy Press Secretary; Rob Green, Director of Workforce 

Policy; Callie Harman, Professional Staff Member; Amy Raaf 

Jones, Director of Education and Human Resources Policy; Nancy 

Locke, Chief Clerk; John Martin, Workforce Policy Counsel; Kelley 

McNabb, Communications Director; Rachel Mondl, Professional 

Staff Member/Counsel; James Mullen, Director of Information 

Technology; Alexis Murray, Professional Staff Member; Krisann 

Pearce, General Counsel; Benjamin Ridder, Legislative Assistant; 

Molly McLaughlin Salmi, Deputy Director of Workforce Policy; 

Olivia Voslow, Legislative Assistant; Joseph Wheeler, Professional 

Staff Member; Lauren Williams, Professional Staff Member; Michael Woeste, Deputy Press Secretary; Tylease Alli, Minority Clerk/ 

Intern and Fellow Coordinator; Christine Godinez, Minority Labor 

Policy Associate; Carolyn Hughes, Minority Director Health Policy/ 

Senior Labor Policy Advisor; Eunice Ikene, Minority Labor Policy 

Advisor; Stephanie Lalle, Minority Digital Press Secretary; Andre 

Lindsay, Office Assistant; Richard Miller, Minority Labor Policy Director; Jacque Mosely, Minority Director of Education Policy; 

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Udochi Onwubiko, Minority Labor Policy Counsel; and Veronique 

Pluviose, Minority Staff Director. 

Chairman WALBERG. We welcome each of you to today’s joint 

committee hearing of the Subcommittee on Health, Employment, 

Labor, and Pensions and the Subcommittee on Workforce Protections; a joint hearing today. I would like to thank our witnesses for 

joining us for this important discussion on how the opioid epidemic 

is impacting work places, workers, and family members from across 

the country. 

Before I go on any further, I think it is important for a Committee that has responsibility for education and the workforce to 

not miss some of the current events that take place. To come this 

morning and to see this headline and these pictures of grieving 

parents, students, in this unbelievably evil killing of 17 in Florida. 

It is not something that we can pass or should pass up easily. 

We are having this hearing because there is deep suffering in our 

communities relative to opioid heroin abuse, but there are other 

points of suffering as well. And we are earnestly looking for ways 

to deal with that suffering and pain that is so personal. But yesterday’s tragic events in Parkland, Florida force us, I believe, to acknowledge once again that suffering and pain sometimes grip a 

community in the most shocking and unexpected ways. I have 

heard it said this morning and last night that thoughts and prayers are not enough. And they are not enough. I can understand 

why people would say that. But as someone who believes in prayer, 

who has seen its power over and over in my life, I know that any 

petition to the God who created us, the God whose heart is also 

broken, literally broken I am certain, when lives are ended in such 

a tragic and evil way, that these prayers are heard by Him. 

And so I believe this morning we need to pray for those who are 

burdened by grief and loss and pain this morning. We need to pray 

for those who are fighting to stay alive, we need to pray for those 

who are now going to have to find a way to move forward. And we 

need to pray for each other. We need to pray for understanding, for 

wisdom, for grace. We need to pray for guidance on what we can 

do because we have to do something, but not just something, to do 

the right thing for our communities, for our families, for our lives, 

for our future, to stop the heartache before it happens, and, when 

we can, to help rebuild when the need arises. 

So not desiring to offend in any way, and yet believing that we 

have a purpose that causes us to need higher counsel, I would ask 

you to allow me to pray. 

I come to you, Father God, thanking You for wisdom that You 

can give, and I thank You that You care for us and You hurt when 

we hurt. And today I ask that You give wisdom to all in Florida, 

as well as here in this room as we deliberate on things to help and 

not hurt—that You give us wisdom beyond ourselves. To be with 

the families in Florida who are hurting right now, who have lost 

tragically young lives. We pray for the school, that wisdom will be 

given to its administration as they move forward, and ultimately 

we will find answers that will move us forward in this great country, to be a united nation working together. And I pray this in Your 

powerful name. Amen. 

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The tragic opioid epidemic has unfortunately become a major 

part of our national conversation and a problem that we must understand and address. Too many Americans from all walks of 

life—and I am sure everyone at these tables have experienced it in 

their district—with real live families and people that have suffered 

under the crushing impact of this terrifying epidemic and the 

abuse that goes with it. Far too many are dying from opioid misuse 

and overdose every day. According to the Centers for Disease Control and Prevention, opioid use, including prescription opioids, heroin, and fentanyl, was the cause of over 42,000 deaths in 2016, 40 

percent of which involved a prescription. As policymakers, we need 

these statistics to inform what we do, but it is most important to 

remember that every casualty was a person with incredible potential. Not only were they members of our larger social communities, 

they were members of our work communities. Our coworkers see 

more of us during the average day than even our own families. The 

people we see in the workplace have a significant role in each of 

our lives and are part of the community around us. Many Americans work alongside those who suffer from opioid misuse, but may 

not understand what can be done to help their fellow coworker. 

According to the National Council on Alcohol and Drug Dependence, 70 percent of the 14.8 million individuals that are misusing 

drugs, including opioids, are currently employed. While this statistic is alarming, it also shows the workplace can be a resource for 

the community to identify those who are struggling with opioid 

misuse. And we are already seeing some employers assisting employees in their treatment and rehabilitation, and how encouraging 

that is. Already, many employers have deemed it necessary to update or promote existing policies to provide support to employees 

who struggle with opioid abuse. In fact, 70 percent of U.S. companies and 90 percent of Fortune 500 companies have an employee 

assistance program to assist employees struggling with substance 

abuse and other problems. It is reassuring to see these kinds of 

programs and practices implemented by companies who want to 

see their employees healthy and productive. But more needs to be 

done. While much of the current dialogue is about the dangers of 

the opioid epidemic, we also need to hear about the proactive steps 

employers are taking to fight this epidemic within their workplaces 

and broader communities. 

That brings us to today’s discussion of how the opioid epidemic 

is impacting American workers and what some employers are doing 

to address this problem. We must understand that the federal government must not act as a barrier or tie the hands of employers 

when it comes to addressing opioid abuse and the workplace. Rather, we should fortify employers’ efforts to help their employees and 

family members who are affected by this epidemic. 

I look forward to hearing from our witnesses today and I thank 

Chairman Byrne for co-chairing this important joint committee 

hearing. And now recognize Ranking Member, and my good friend, 

Sablan, for his opening remarks. 

[The statement of Chairman Walberg follows:] 

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Prepared Statement of Hon. Tim Walberg, Chairman, Subcommittee on 

Health, Employment, Labor, and Pensions 

Good morning, and welcome to today’s joint subcommittee hearing with the Subcommittee on Workforce Protections. I’d like to thank our witnesses for joining us 

for this important 

discussion on how the opioid epidemic is impacting workplaces, workers, and families cross this country. 

The tragic opioid epidemic has unfortunately become a major part of our national 

conversation, and a problem that we must understand and address. 

Too many Americans – from all walks of life and from all parts of the country 

– are facing the terrifying realities of opioid abuse, and far too many are dying from 

opioid misuse and overdose every day. 

According to the Centers for Disease Control and Prevention, opioid use (including 

prescription opioids, heroin, and fentanyl) was the cause of over 42,000 deaths in 

2016, 40 percent of which involved a prescription. 

As policymakers, we need these statistics to inform what we do. But it’s most important to remember that every casualty was a person with incredible potential. 

Not only were they members of our larger social communities, they were members 

of our work communities. 

Our coworkers see more of us during the average day than even our own families. 

The people we see in the workplace have a significant role in each of our lives, and 

are part of the community around us. 

Many Americans work alongside those who suffer from opioid misuse, but may 

not understand what can be done to help their fellow coworker. 

According to the National Council on Alcohol and Drug Dependence, 70 percent 

of the 14.8 million individuals that are misusing drugs, including opioids, are currently employed. 

While this statistic is alarming, it also shows the workplace can be a resource for 

the community to identify those who are struggling with opioid misuse. And, we are 

already seeing some employers assisting employees in their treatment and rehabilitation. 

Already, many employers have deemed it necessary to update or promote existing 

policies to provide support to employees who struggle with opioid abuse. 

In fact, 70 percent of U.S. companies and 90 percent of Fortune 500 companies 

have an employee assistance program to assist employees struggling with substance 

abuse and other problems. 

It is reassuring to see these kinds of programs and practices implemented by companies who want to see their employees healthy and productive. But more needs to 

be done. 

While much of the current dialog is about the dangers of the opioid epidemic, we 

also need to hear about the proactive steps employers are taking to fight this epidemic within their workplaces and the broader community. 

That brings us to today’s discussion of how the opioid epidemic is impacting 

American workers and what some employers are doing to address this problem. 

We must understand that the federal government must not act as a barrier or 

tie the hands of employers when it comes to addressing opioid abuse and the workplace. Rather, we should fortify employers’ efforts to help their employees and family members, who are affected by this epidemic. 

I look forward to hearing from our witnesses today, and thank Chairman Byrne 

for co-chairing this important joint subcommittee hearing. 

Mr. SABLAN. Thank you very much, Mr. Chairman. Good morning, everyone. I would also like to associate myself with the prayer 

of the Chairman. Our hearts and prayers also go out to the victims, 

seven fatalities. It is tragic. And I couldn’t help asking, so what is 

next, what is next? With all due respect, respectfully not being partisan, I would maybe consider that Congress would reconsider the 

plans and rather than cutting funding for mental health we should 

actually increase it so that those who need the help throughout our 

community, our country, would have access to mental health services and programs. 

The opioid crisis has ravaged communities across the United 

States. It is no surprise that the impacts of the crisis are being felt 

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in the workplace by both workers and businesses. From workplace 

accidents and injuries, employees’ absenteeism, low morale, and increasing lost productivity, our workplaces are experiencing the 

challenges of this epidemic. U.S. companies lose billions of dollars 

a year because of employees’ drug and alcohol use and related 

problems. But it is the human toll that is the most devastating consequence of this epidemic. 

We know that those with substance use disorders come from all 

walks of life. From our factories to our boardrooms, the health 

needs of our workforce should be a top priority. Sadly these needs 

have gone unmet and behavioral healthcare has been out of reach 

for many, particularly lower wage workers, racial and ethnic minorities, and other marginalized populations. The Affordable Care 

Act improved and expanded treatment for people with substance 

use disorders through Medicaid and private insurance, although 

not for the people of my district, the Northern Marianas, and the 

other areas. The law mandated substance use disorder treatment 

as part of essential health benefits and brought in parity requirements to ensure that behavioral health is covered at the same levels as other medical coverage. Further, insurance can no longer 

deny coverage to people with substance use disorders or mental 

health conditions. Maintaining these important gains is paramount 

in the response to this crisis. Attempts to roll back these advances 

by weakening consumer protections or cutting Medicaid will only 

take us backwards. Additional funding at the federal level to combat the crisis will be squandered if we do not provide access to 

health coverage and a safe place to live and work. 

The President’s new budget proposal is another missed opportunity to have a meaningful conversation about improving health 

in this country. Proposing to eliminate coverage and protection for 

millions of Americans is counterproductive, particularly during a 

crisis of this magnitude. Addressing the opioid epidemic requires a 

robust and coordinated approach. Efforts to prevent workplace injuries and illnesses are a critical step toward avoiding the prescription of opioids that initiates abuse. 

We should examine all the impacts that substance use disorder 

has on families and all the tools we have to help, including expanding prevention efforts, focusing on the entire family, increasing access to treatment, and facilitating recovery. We need to support 

those in recovery and provide them with economic opportunity to 

reintegrate into the community. Addressing addiction through 

treatment instead of punishment and incarceration should be applied across the board to all communities. 

It is encouraging that the community is taking time to discuss 

this issue and I am hopeful we can address it through increased 

funding for effective evidence based programs that help increase 

access, health coverage, and treatment. To help the workforce is 

key to help the economy. 

I thank the witnesses for taking the time to testify today and I 

look forward to hearing from them. I thank the two chairmen of 

the two subcommittees, and also my colleague and Ranking Member Mark Takano of the Workforce Protections Subcommittee. 

Thank you very much, Mr. Chairman. I yield back. 

[The statement of Mr. Sablan follows:] 

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Prepared Statement of Hon. Gregorio Kilili Camacho Sablan, Ranking 

Member, Subcommittee on Health, Employment, Labor, and Pensions 

The opioid crisis has ravaged communities across the United States. 

It is no surprise that the impacts of the crisis are being felt in the workplace – 

by both workers and businesses. From workplace accidents and injuries, employee 

absenteeism, low morale, and increased illness and lost productivity, our workplaces 

are experiencing the challenges of this epidemic. U.S. companies lose billions of dollars a year because of employees’ drug and alcohol use and related problems. But 

it is the human toll that is the most devastating consequence of this epidemic. 

We know that those with substance use disorders come from all walks of life. 

From our factories to our board rooms, the health needs of our workforce should be 

a top priority. Sadly, these needs have gone unmet and behavioral health care has 

been out of reach for many, particularly lower wage workers, racial and ethnic minorities and other marginalized populations. 

The Affordable Care Act improved and expanded treatment for people with substance use disorders through Medicaid and private insurance. The law mandated 

substance use disorders treatment as part of ‘‘essential health benefits’’, and broadened parity requirements to ensure that behavioral health is covered at the same 

levels as other medical coverage. Further, insurers can no longer deny coverage to 

people with substance use disorders or mental health conditions. 

Maintaining these important gains is paramount in the response to this crisis. Attempts to roll back these advances by weakening consumer protections or cutting 

Medicaid, will only take us backwards. Additional funding at the federal level to 

combat the crisis will be squandered if we do not provide access to health coverage 

and a safe place to live and work. The President’s new budget proposal is another 

missed opportunity to have a meaningful conversation about improving health in 

this country. Proposing to eliminate coverage and protections for millions of Americans is counterproductive, particularly during a crisis of this magnitude. 

Addressing the opioid epidemic requires a robust and coordinated approach. Efforts to prevent workplace injuries and illnesses are a critical step toward avoiding 

the prescription of opioids that initiates abuse. We should examine all the impacts 

that substance use disorder has on families and all the tools we have to help, including expanding prevention efforts, focusing on the entire family, increasing access to 

treatment, and facilitating recovery. We need to support those in recovery and provide them with economic opportunity to reintegrate into the community. Addressing 

addiction through treatment, instead of punishment and incarceration, should be 

applied across the board to all communities. 

It’s encouraging that the Committee is taking time to discuss this issue and I am 

hopeful that we can address it through increased funding for effective, evidencebased programs that help workers access health coverage and treatment. A healthy 

workforce is key to a healthy economy. 

I thank the witnesses for taking the time to testify today and look forward to 

hearing from them. Thank you. I yield back my time to the chair. 

Chairman WALBERG. I thank the gentleman. Pursuant to Committee Rule 7(c) all subcommittee members will be permitted to 

submit written statements to be included in the permanent hearing 

record. And without objection, the hearing record will remain open 

for 14 days to allow statements, questions for the record, and other 

extraneous material referenced during the hearing to be submitted 

in the official hearing record. 

It is now my pleasure to introduce our distinguished panel of witnesses. Mr. Corwin Rhyan is a senior health care analyst at the 

Altarum Institute’s Sustainable Health Strategies Program, where 

he studies health spending. Welcome. Ms. Lisa Allen is the president and CEO of Ziegenfelder Company, which offers help to employees needing addiction assistance. Welcome. Dr. Christina M. 

Andrews, PhD, is an assistant professor at the University of South 

Carolina where she examines addiction screening and treatment in 

diverse Medicaid health home models. Welcome. Ms. Kathryn J. 

Russo is a principal at Jackson Lewis, where she is the practice 

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leader of the firm’s Drug Testing and Substance Abuse Management Practice Group. Welcome. 

And now I will ask our witnesses to raise your right hand. We 

will swear you in to the record. 

[Witnesses sworn.] 

Chairman WALBERG. Let the record reflect the witnesses answered in the affirmative. 

Before I recognize each of you to provide your testimony let me 

briefly explain our lighting system. It is like the traffic lights. 

When it is green, keep on going. When it turns yellow, you have 

a minute remaining to wrap your comments as quickly as possible. 

When it turns red, finish as quickly as you can. We will have the 

same process for our members of the Committee and they will indeed have opportunity to let you expand on some things maybe 

even you didn’t get to in your testimony. We have the written testimony from each of you as well. 

And so without further ado, I will now recognize Mr. Rhyan for 

your five minutes of testimony. 

TESTIMONY OF CORWIN RHYAN, MPP, SENIOR HEALTH CARE 

ANALYST, ALTARUM INSTITUTE 

Mr. RHYAN. Thank you, and good morning. Subcommittee Chairmen Walberg and Byrne, Subcommittee Ranking Members Sablan 

and Takano, and distinguished members of the Committee, thank 

you for the invitation today to testify on the current state of the 

opioid epidemic and the direct impacts we have observed on employers and the workplace. 

My name is Corwin Ryan; I am a senior health care policy analyst for Altarum, a nonprofit research and consulting institute 

headquartered in Ann Arbor, Michigan. 

In our work, we estimate the total nationwide economic burden 

of the opioid crisis exceeded $95 billion in 2016, including significant costs from losses in productivity and earnings, increased 

health care costs, and increased expenditures on criminal justice, 

child and family assistance, and education. Preliminary data for 

2017 indicate this burden has continued to grow. The number of 

opioid-related overdose deaths in the 12 months prior to June 2017 

were 20 percent higher than they were only a year before. If the 

epidemic continues to grow at its current rate, the total economic 

burden from 2017 through 2020 could exceed $500 billion for the 

entire United States. 

This epidemic impacts all parts of our society, but the combined 

impacts on households and the private sector account for the largest share of the societal burden and exceeded $46 billion in 2016. 

This finding elevates the importance of employers, both as stakeholders directly impacted by the crisis, but also as potential leaders 

in preventing its spread and helping support treatment and recovery. 

Through recent work in Lorain County, Ohio, we heard from 

community stakeholders about the local economic impacts this epidemic can cause. Employers there are acutely aware of the impacts 

of opioids and they expressed repeatedly that they are having difficulty finding qualified candidates who can pass a drug test to fill 

local job openings. They have responded in some cases by changing 

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their hiring and employment practices to increase the pool of potential employees. We have observed employers that are now more 

likely to consider candidates who have recovered or are recovering 

from a substance use disorder. They are also reconsidering zero-tolerance policies for existing employees and are working to help provide treatment and recovery services. In the most extreme cases, 

we have even heard employers express the desire to simply no 

longer drug test their employees. We would also expect that if employers continue to struggle to find qualified applicants that they 

will substitute for greater levels of automation and make larger 

capital investments. 

Many employers are also taking significant steps to improve the 

availability of treatment and recovery services. These businesses 

should be applauded for their efforts, supported in pursuing better 

care for their employees, and empowered to find the best solutions 

for their specific situations. Ensuring access to high quality evidence based treatment and recovery services through an employer 

can prevent overdoses and deaths. Employers should be given the 

flexibility to design and implement interventions that fit their employee population needs and work within available community resources, provided that evidence based practices inform their actions. 

Employers can also embrace their role as a key player in efforts 

to prevent future opioid abuses and addiction. They can offer prescription drug disposal sites and can work with insurers and thirdparty administrators to help cut unnecessary opioid prescriptions. 

When possible, employers should disseminate and share outcomes 

of their efforts to the broader employer community to help inform 

best practices. 

Finally, employers can also support caregivers, co-workers, 

friends, and family members of those suffering from addiction. All 

will need flexibility and resources so they can guide individuals 

through treatment and recovery. 

These Subcommittees should be applauded for their initiative to 

investigate the impacts of the opioid crisis on employers and the 

workforce. We have shown that employers are negatively impacted 

by the crisis, but can and will be at the forefront of implementing 

pivotal solutions to prevent and treat opioid addictions. Public policy should seek to give employers the resources they need to be an 

active and engaged ally in the fight against addiction, and allow 

them flexibility where needed to customize their responses. Including and empowering employers will go a long way toward accelerating the development and implementation of solutions to this 

nationwide epidemic. 

Thank you for the opportunity to present today. I look forward 

to any questions you may have. 

[The statement of Mr. Rhyan follows:] 

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Insert offset folio 1 here 28575.001

Statement of Corwin Rhyan 

on 

"The Opioids Epidemic: Implications for America's Workplaces" 

U.S. House Committee on Education and the Workforce 

Subcommittee on Health, Employment, Labor, and Pensions & Subcommittee on Workforce 

Protections 

February 15,2018 

Subcommittee Chairmen Walberg and Byrne, Subcommittee Ranking Members Sablan and 

Takano, and Distinguished Members of the Committee: 

Thank you for the invitation today to testify on the current state of the opioid epidemic, the direct 

impact it is having on employers and workplaces, the actions we have observed employers taking 

to combat and mitigate its effects, and the further steps needed to address the crisis. My name is 

Corey Rhyan and I am a Senior Health Care Policy Analyst for Altarum, a non-profit research 

and consulting institute headquartered in Ann Arbor, MI. My testimony today is informed by our 

research estimating the economic impacts of the opioid crisis and our on-the-ground work with 

local communities to better understand and combat the far-reaching harms of opioid misuse and 

addiction. 

The total economic burden of the opioid crisis exceeded $95 billion dollars in 2016, including 

significant costs from losses in productivity and earnings, increased health care costs, and 

increased expenditures on crimina! justice, child and family assistance, and education (see Figure 

!)I The burden of this epidemic impacts all parts of our society including households and the 

private sector and federal, state and local governments (see Figure 2). Preliminary data for 2017 

indicate this burden has continued to grow-the number of opioid-related overdose deaths in the 

12 months prior to June 2017 were 20% higher than they were only a year before? If this trend 

continues unchecked, we estimate the total cumulative economic burden from 2017 thru 2020 

could exceed $500 billion dollars for the entire United States (see Figures 3 and 4). 

This burden includes impacts of both the misuse and abuse of prescription opioids and illicit 

drugs such as heroin. The increasing costs of the epidemic have resulted in part due to a rotation 

1 Rhyan, Corwin. (2017). The potential societal bene tit of eliminating opioid overdoses. deaths, and substance use 

disorders exceeds $95 billion per year. Altarum Research Brief. Retrieved from 

and Prevention. Provisional Drug Overdose Counts. Available from: 

Accessed February 2018. 
10 

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Insert offset folio 2 here 28575.002

from prescription opioid abuse to illicit (and far more deadly) drugs-in 2016 deaths from heroin 

overdoses and synthetic opioid overdoses, such as fentanyl and carfentanil, each exceeded the 

number of deaths from natural and semisynthetic opioids such as morphine and oxycodone3 In 

the past natural and semisynthetic opioids resulted in the greatest number of overdose deaths. 

While public policies such as state prescription drug monitoring programs and dispensing limits 

have limited the availability of prescription opioids for misuse, the recent increase in deaths from 

heroin and synthetic variants has more than offset progress made in that area. 

Costs associated with lost productivity (both forgone earnings resulting from overdose fatalities 

and non-fatal productivity losses for those suffering from a substance use disorder) were the 

largest component of the economic burden, exceeding $56 billion in 2016. These were followed 

by increased health care costs ($21.4 billion in 20 16) which include the costs of opioid-rclated 

emergency department visits and hospitalizations and indirect health care costs associated with 

increased risks ofHIV, Hepatitis B, Hepatitis C, Tuberculosis, and Neonatal Abstinence 

Syndrome. Finally, the economic burden of the epidemic includes increased public expenditures 

required to combat opioid misuse and addiction, including criminal justice costs, child and 

family assistance, and K-12 education expenditures. 

Notably, the combined impacts on individuals, households, and the private sector account for the 

largest share of the societal burden. Driven by premature loss oflife due to fatal overdoses, 

decreased productivity and labor force participation for those suffering from opioid substanceuse disorders, and increased health care costs borne by private insurance plans, the cost to 

individuals and the private sector exceeded $46 billion dollars in 2016. While this cost is the 

combined burden on both employers and households, this tlnding elevates the importance of 

employers as key stakeholders who have both been directly impacted by the crisis, but also can 

play a key role in preventing its spread, helping provide treatment and recovery services for 

those who need it, and mitigating the long-term economic and societal harms. 

Thru recent work in Lorain County, Ohio, a medium-sized county just west of Cleveland, we 

heard from community stakeholders in structured interviews and focus groups about the local 

3 Hedegaard, Holly, Warner, Margaret, Mini no. (2017). NCHS Data Brief, No. 294: Drug Overdose Deaths in the 

United States, 1999-2016. Centers tor Disease Control and Prevention. 

!ltJn~:.·:·_~\~\ \·~ ,-;d~L.g_l!_Ln<:·hs:r:m~h!~b- ~l<lt~Jbl:i~Cs_~ill)_l~H)l11_!). Accessed February 2018. 

2 
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economic impacts this epidemic can cause. Lorain County had an opioid overdose fatality rate 

that was 2.5 times the national average in 2016.4 Employers there are acutely aware of the 

impacts of opioids and stakeholders expressed repeatedly that businesses have difficulty finding 

qualified candidates who can pass a drug test to fill local job openings. Furthermore, employers 

in Lorain County are concerned about lost productivity on the job, increased health care costs, 

and workplace accidents caused by employee drug use and substance use disorders. These 

impacts compound into broader economic harms, including perceived effects of decreased 

property values and a reduced tax base for local communitics.5 

Finding and retaining qualified applicants is a top employer concern nationally. The current 

economic recovery and expansion bas created over 16 million jobs since the lowest point of the 

2008 recession and the unemployment rate has fallen to 4.1 %.6 However, the current labor 

market also creates difficulties for employers looking to hire to expand their businesses and meet 

demand for their products. In July 2009 there were 6.6 unemployed individuals for each job 

opening, in December of last year this number fell to 1.1 individuals per job opening. 7 The lack 

of qualified applicants is driven by multiple factors including a retiring baby boom generation, 

but in communities suffering from high rates of drug use and addiction, these factors 

undoubtedly play a role in the shortage of available workers. 

Employers have responded to the opioid and addiction crisis by changing their hiring and 

employment practices to increase the pool of potential employees. Thru our research in Lorain 

County, OH and subsequent collection of national labor market and employment trends, we have 

observed employers that are now more likely to consider candidates who have recovered or are 

recovering ti·om a substance use disorder. Employers are also reconsidering zero-tolerance 

policies for existing employees and rather than immediate dismissal are working to help provide 

treatment and recovery services. In the most extreme cases, we have heard employers express a 

desire to simply no longer drug test candidates for certain positions, knowing that the need for a 

worker outweighs the risks of forgoing previous company policies. We would also expect if 

4 Centers for Disease Control and Prevention. Underlying Cause of Death Mortality Data. Available from: 

Community Assessment of the Opioid Crisis in Lorain County. Ohio. 

Employment Situation Data, Available ti·om: 

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employers continue to struggle to find qualified applicants that they will substitute for greater 

levels of automation when possible and increase investments in capital that obviate the need for 

human labor. 

Many employers are also taking significant steps to improve the treatment and recovery services 

offered to their workers suffering from substance misuse or substance use disorders. These 

businesses should be applauded for their efforts, supported in pursuing better care for their 

employees, and empowered to find the best solutions for their speei fie situations. In most cases 

employers are the primary provider of health insurance for their workers and ensuring that 

individuals have access to high-quality, evidence-based treatment and recovery services within 

their communities can offer a first line of defense against serious adverse outcomes like 

overdoses or death. The sooner substance use problems can be identified and treated, the greater 

the likelihood an individual can achieve recovery. 

Employers should also consider implementing value-based insurance design principles in ways 

that remove financial barriers to treatment and recovery programs for their enrollees. They 

should work to engage and collaborate with experts, health care providers, and local treatment 

and recovery resources. They should be given the flexibility to design and implement 

interventions that fit their employee population needs and the available community resources, 

provided that evidence-based practices inform their actions. 

Employers can also embrace their role as a key player in efforts to prevent future opioid abuses 

and addiction. They can offer prescription drug disposal sites for their employees and can work 

with insurers and third-party administrators to help cut unnecessary opioid prescriptions. They 

can explore higher financial barriers to accessing opioids by adjusting drug tiers with benefit 

managers and work to identify high-frequency providers. Additionally, they can ensure 

alternatives to opioids for managing chronic pain are encouraged through improved insurance 

design and that mental illness and behavioral health services are covered as these untreated 

conditions can be precursors to opioid misuse. Finally, employers can be educators and 

information disseminators for both providers and employees about the risks of opioids and 

alternatives to pain management. Employers should be empowered to find the right mix of 

solutions to tit their worker populations and when possible disseminate and share outcomes of 

their efforts with the broader employer community to help inform best practices. 

4 
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Finally, employers should recognize that it is not only those with or at-risk for substance use 

disorders who need support during this epidemic. Caregivers, coworkers, friends, and family 

members all need flexibility and resources so they can help guide individuals through treatment 

and recovery. ln Lorain County, we heard stories from friends and family members of those 

suffering from addiction including siblings, parents, and grandparents, many of whom put their 

own lives on hold to help guide a loved one through the many stages of the recovery process. 

Where possible, employers should work to support these individuals as they give their own time 

and effort to help others in the community recover from an opioid substance use disorder. 

These subcommittees should be applauded for their initiative to investigate the impacts of the 

opioid crisis on employers and the workforce. Our work has demonstrated that employers, 

households, and the private sector all face a substantial economic burden from the opioid crisis 

and that this burden can be expected to grow if effective, evidence-based approaches are not 

taken immediately to address this crisis. Moreover, our analyses of the economic burden of the 

current crisis can only begin to capture the total societal harms opioid misuse and addiction. In 

fact, the monetized impacts of the crisis like lost wages and increased health care costs are only a 

small part of the story-the emotional burdens of use, the disparate community impacts, and the 

loss of family and community members to overdoses are just as important to consider, although 

not measured in our work to date. 

We have also shown that employers can and will be at the forefront of implementing pivotal 

solutions to prevent future opioid addictions, treat those with substance use disorders, and 

helping individuals achieve recovery. Public policies should seek to give employers the 

resources they need to be an active and engaged ally in the fight against addiction and allow 

them the flexibility where needed to customize approaches to combat this crisis. Solutions to this 

epidemic will come through a combination prevention, treatment, and recovery activities and 

will be supported by a wide variety of stakeholders. Including and empowering employers will 

go a long way towards accelerating the development and implementation of solutions to this 

nationwide epidemic. 

Thank you for the opportunity to present today, I look forward to any questions you may have. 

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7 
16 

Chairman WALBERG. Thank you. I recognize Ms. Allen for your 

five minutes of testimony. Welcome. 

TESTIMONY OF LISA ALLEN, PRESIDENT & CEO, 

ZIEGENFELDER COMPANY 

Ms. ALLEN. Thank you. Chairmen Walberg and Byrne, Ranking 

Members Takano and Sablan, and distinguished members of the 

Subcommittee, thank you for inviting me to testify before you 

today. 

I am here today to talk about our efforts to employ in our commitment as a company to help individuals rebuild their lives. My 

name is Lisa Allen and I am the president and CEO of the 

Ziegenfelder Company, a privately held, family-owned business located in Wheeling, West Virginia. We make people smile with really cool treats and manufacture twin pops and other frozen items. 

I am honored to speak to you today on behalf of the U.S. Chamber 

of Commerce. 

A quick snapshot of our company. In 1860, Ziegenfelder started 

out as a neighborhood candy store located just across the street 

from where we are located today. My grandfather, Abe Lando, 

began working for the company after World War II and in 1960 my 

family fully purchased the company. Although the company struggled financially for years, my father was able to turn the business 

around by developing Budget Saver twin pops. By reducing the expenses associated with the dairy industry and packaging the product in clear bags rather than traditional boxes, we were able to invest more in the company. Now, with three manufacturing facilities 

operating 24 hours a day, seven days a week, we make nearly 2.5 

million twin pops every 24 hours. Today, our products are in grocery stores nationwide in nearly every community across the country. Last year, we proudly placed over 40 million bags of pops in 

homes across America. 

While we are proud of this recent growth, the source of my pride 

comes from our team of employees we call a tribe. We call ourselves a tribe because we are individuals, families, and a community linked by our culture and our bright, vivid vision. And let me 

be clear, our growth has been possible because of our awesome 

tribe, which has grown from 65 to over 300 tribe members across 

the country. 

All members of our Ziggy tribe benefit from committed, compassionate hiring practices, which we expanded several years ago. 

These practices developed out of a realization following a chance 

conversation with a friend of mine from the U.S. District Attorney’s 

Office. Apparently we had hired some of our tribe from a local halfway house, individuals who were in the midst of rebuilding their 

lives. After realizing this, we chose to become more intentional 

with respect to hiring specific populations, such as reentering citizens, veterans, and the homeless; all or none of whom could include 

recovering drug addicts, many of whom are in the throes of the 

opioid addiction. 

As I am sure other witnesses have said before, I have a lot to 

say on this topic at hand. There are many stories of how our tribe 

members have been directly and indirectly impacted by the opioid 

crisis, some of which I have detailed in my written testimony. PerCEWDOCROOM with DISTILLER

17 

haps the best way to tell our story in the five minutes I have is 

to share with you one of the many stories. One of our most valued 

tribe member leaders is Sonny Baxter. The day after he came home 

in August of 2015, he joined our tribe. We didn’t know then about 

his time before joining our trip, nor did we know how much more 

he would achieve afterwards. It turns out he came home after a 10 

year prison sentence after his arrest at age 19 for possession with 

intent to distribute. While he was serving his sentence, he studied 

coding and training to become an addiction counselor in the hopes 

of helping others. In Sonny’s words, ‘‘I was part of the problem,’’ 

and now he is part of the solution. During the two and a half years 

he has worked as a full-time member of our tribe, Sonny earned 

his associate’s degree in software engineering from West Virginia 

Northern Community College just this past December. He recently 

applied to the Organizational Leadership Program at West Liberty 

University and is not only a full-time employee with us and the 

lead operator, he also works as a tech support at Wheeling Jesuit 

University. He has purchased a condo, he has a car, and he is 

using his training to help other members of our tribe who are recovering and reentering the workforce. With his help, our culture 

has become self-perpetuating. We believe that a job is absolutely 

the best antidote. 

Another of our tribe leaders, Tanner Defilbaugh, who also rebuilt 

his life following opioid addiction and incarceration, articulates it 

so well, ‘‘It’s easier to do the right thing when you are working and 

you have a steady job and you have a purpose.’’ It is an honor to 

be part of such a tremendous group of people and humbling to 

think of some of the challenges that they and other members of our 

community and nation have endured and overcome. 

It sounds corny, but I think of the starfish parable. There are 

thousands of people that are in need of help in communities across 

this great nation. It’s hard to help them all. But to each person 

that we’re able to help, we make a difference. I truly believe, one 

by one, we are making a difference. 

Thank you for this opportunity to testify and I look forward to 

your questions. 

[The statement of Ms. Allen follows:] 

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ON: 

TO: 

DATE: 

Statement 

of the 

U.S. Chamber 

of Commerce 

"The Opioids Epidemic: Implications for America's 

Workplaces" 

THE HOUSE COMMITTEE ON EDUCATION AND THE 

WORKFORCE'S SUBCOMMITTEE ON HEALTH, 

EMPLOYMENT, LABOR AND PENSIONS AND 

SUBCOMMITTEE ON WOKRFORCE PROTECTIONS 

February 15, 2018 

The Chamber's mission is to advance human progress through an economic,. 

political and social system based on individual H·eedom. 

incentive, initiative, opportunity and responsibility. 
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The U.S. Chamber of Commerce is the world's largest business federation 

representing the interests of more than 3 million businesses of all sizes, sectors, and 

regions, as well as state and local chambers and industry associations. The Chamber 

is dedicated to promoting, protecting, and defending America's free enterprise 

system. 

More than 96% of Chamber member companies have fewer than 100 

employees, and many of the nation's largest companies are also active members. We 

are therefore cognizant not only of the challenges facing smaller businesses, but also 

those facing the business community at large. 

Besides representing a cross-section of the American business community with 

respect to the number of employees, major classifications of American businesse.g., manufacturing, retailing, services, construction, wholesalers, and finance-are 

represented. The Chamber has membership in all 50 states. 

The Chamber's international reach is substantial as well. We believe that 

global interdependence provides opportunities, not threats. In addition to the 

American Chambers of Commerce abroad, an increasing number of our members 

engage in the export and import of both goods and services and have ongoing 

investment activities. The Chamber favors strengthened international competitiveness 

and opposes artificial U.S. and foreign barriers to international business. 

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Statement on 

"The Opioids Epidemic: Implications for America's Workplaces" 

Submitted to 

THE HOUSE COMMITTEE ON EDUCATION AND THE WORKFORCE'S 

SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR AND PENSIONS 

AND SUBCOMMITTEE ON WORKFORCE PROTECTIONS 

on behalf of the 

U.S. CHAMBER OF COMMERCE 

By 

Lisa Allen 

President & CEO 

Ziegenfelder Company 

Wheeling, West Virginia 

February 15, 2018 

Chairmen Walberg and Byrne, Ranking Members Takano and Sablan and distinguished 

members of the Subcommittees, thank you for inviting me to testify before you today about our 

company and our employees. I hope that my testimony and remarks will help provide a glimpse 

into our compassionate hiring practices and our company's culture of dedication to our employees, 

their families and our communities. More importantly, l hope that by sharing our story l can 

provide a model for others to follow that will help make a dent in this terrible epidemic. 

My name is Lisa Allen. I am the President and CEO of Ziegcnfelder Company, a privatelyheld, family owned business located in Wheeling, West Virginia; we "make people smile with 

really cool treats" manufacturing twin pops and other frozen items. I am honored to speak with you 

today on behalf of the U.S. Chamber of Commerce. The U.S. Chamber of Commerce is the world's 

largest business federation, representing the interests of more than three million businesses and 

organizations of every size. sector, and region. As you might know, more than 96 percent of the 

Chamber's members are small businesses with 100 or fewer employees, and 70 percent of which 

have 10 or fewer employees. For lOO+ years we were one of those businesses until l7 years ago. 

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Our Company's Background 

Originally, the Ziegenfelder Company was a neighborhood candy store dating back to the 

1860s just across the street from where we are today in Wheeling. The Ziegenfelder family 

expanded their business by entering the ice cream manufacturing world in 1922. My roots at 

Ziegenfelder run deep and date back to when my grandfather, Abe Lando, began working for the 

company after World War I. My grandfather, a sweet, kind, hard-working family man, had spent 

his young life in the coal mines and steel mills of our Ohio Valley area, devoted to my grandmother, 

my father and my aunt. Finding work then was ditlicult, yet thankfully the Ziegcnfclder family saw 

potential in him. 

My grandfather found a work-home at Ziegenfelder and began impacting the business with 

his sales and leadership skills, eventually earning the opportunity for ownership in the business. 

Several decades later, in the 1960s, my family fully purchased the company. They were excited 

about the opportunity; they put in long hours and invested all they had in the business, over and 

over, and over again. In those times and frankly sti II today, the dairy manufacturing business was 

very competitive. There were dairies everywhere up and down the Ohio River Valley selling ice 

cream and novelties to mom/pop grocery stores and restaurants throughout West Virginia and 

eastern Ohio. Naturally, (and not unlike today) larger companies with greater resources were better 

equipped to meet market needs faster, including buying machines to automate the work that my 

father and grandfather used to do by hand. My family invested where they could but businesses 

with far more resources and financial assets were able to invest in market share and equipment that 

could boost production. 

Nearing bankruptcy during the struggling economy of the 1980's, Ziegenfelder developed 

the brand Budget $aver twin pops with the intent of servicing consumers in a difficult economy 

4 
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with an affordable, great tasting product. One of the ways we differentiated our product came from 

an idea my mom had. She used to complain because my four brothers and sisters and I would bring 

our entire neighborhood into the house and open numerous boxes of popsicles at the same time 

because we each wanted a different flavor! She told my dad "You should put a whole bunch of 

different flavored popsicles together in the same bag, saving space and craziness in my freezer!" 

Always a trusted advisor to my father, he followed her suggestion and Budget $aver twin pops were 

born! 

My father knew the chances of new brand entry into the grocery market was a long shot, yet 

he also knew that focusing on the consumer might be his competitive advantage. He developed a 

unique sugar blend, excellent flavor profiles and a see-though package; designed to retail at a very 

affordable price. And it did. 

Soon the company sold its dairy lines and focused exclusively on these popsicles. By 

reducing the expenses associated with the dairy ingredients, and packaging the product in clear bags 

rather than traditional boxes, he began turning the financial outlook for the company around. Clear 

plastic bags that featured a rainbow assortment of pops, sold at an affordable price that customers 

and parents, like my mom, loved, 

Since 2001, Ziegenfelder has averaged 12% year-over-year organic growth in a grocery 

category that has been flat to declining, making Budget $aver products a steady market disrupter 

over time. We began supplying Budget $aver brand pops to Walmart in 1992 when they had just 16 

supercenters in Oklahoma, Arkansas, and Texas. 1 Other early retail customers included Giant 

Eagle, Shop'n Save, Dollar General, Food Lion, and HEB in Texas. Demand for our products has 

been supported by operational growth; we added production and storage facilities in Wheeling WV, 

1 https://www.youtube.comiwatch?v=hUmUUyzgkGU 

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and purchased '"similar use" facilities for our operation in Chino, CA and Denver, Colorado. Now 

with three manufacturing facilities operating 24 hours a day, 7 days a week producing water ice 

products for grocery retailers nationwide, we make nearly 2.5 million twin pops every 24 hours. 

Today, Budget $aver products can be found in grocery stores nationwide and in nearly every 

community across the country. Last year, we proudly placed over 40 million bags of pops into 

homes across America. 

While we are proud of this growth operationally and financially, the source of my pride 

really comes from our team- we are a Tribe. We call ourselves a Tribe because we are individuals. 

families, and a community linked by our culture, and our bright, vivid vision. And let me be clear, 

our market and operational growth has been possible because of our awesome Tribe, which has 

grown from 65 to over 300 Tribe members across the country. We know our company success is 

because of our committed, caring, hardworking Tribe. With our Vivid Vision of "growing together, 

revolutionizing our company, and bringing smiles to every home in America" and our mission to 

"make people smile with really cool," we know we are serving our consumers and evolving our 

diverse Tribe and our caring culture in unique ways. Our business continues to expand and our 

Tribe continues to grow as we continue to bring our twin pops to every home in America. 

One of our competitive advantages has always been our low-cost business model, referred to 

as our Zicggy economy. Remembering our original mission of meeting the needs of all consumers 

tor a low-cost frozen treat, we remain true to our mission. Low retail pricing begins with our own 

disciplined business practices and our commitment to the millions of consumers who are unable to 

afford expensive icc cream and other treats. Today, as in the past, Budget $aver products can be 

produced, sold, distributed, and placed on retail shelves for under $2.00. That's important to our 

consumers and to our Tribe. 

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Our Tribe & Our Commitment 

to Workforce Diversity and Compassionate Hiring Practices 

All members of our Zieggy Tribe benefit fi·mn committed, compassionate hiring practices, 

which were expanded several years ago and have facilitated our diverse open-minded tapestry of 

loyal, hardworking people committed to our vision and mission. Perhaps part of how we came to 

focus on these hiring practices developed as an outgrowth of our company's history and culture of 

commitment to our employees and our communities. Perhaps part of it developed as a result of 

where we are located and the impact of the national opioid epidemic on our particular communities. 

The truth is that it most directly developed out of realization following a chance conversation with a 

friend from the U.S. District Attorney's office: apparently, we had hired some of our Tribe from a 

local half-way house- individuals who were in the midst of rebuilding their lives. 

Once we learned the backgrounds of many of our entry level employees, we chose to 

become receptive and intentional with specific populations such as re-entering citizens, veterans, 

and the homeless; all or none of whom could include recovering drug addicts. We have always 

wanted to hire people who are willing to commit to the company and reflect the commitment that 

we arc making to them. People with many different experiences and backgrounds have been 

willing to commit to our company and we remain committed to them. 

Anyone dedicated to living what we call our Zieggy Essentials is welcome to join our 

family. All you have to do is pledge to keep our TWINS principles in mind at all time. THINK 

Tribe first! WIN by always doing the right thing! INSPIRE each other! NURTURE our Zieggy 

Economy! SERVE others putting safety first! Our TWIN principles will produce a future 

brightened by inspiring people, creating smiles, and impacting lives. 

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Our Commitment to Our Tribe: How We Help Those in Trouble 

In addition to our compassionate hiring practices, Ziegenfcldcr and our Tribe work hard to 

foster an emotionally and socially safe environment where our Tribe members have a place to 

recover and prosper. We feel validated by the fact that when our employees arc in trouble, they 

come to many of us including our leaders and ask for help. When our Tribe is hurting, we're 

hurting too. As you know, the complexities of the ·'opioid epidemic" are far-reaching, eventually 

resulting in fiunily and community disintegration, imprisonment, and/or death. 

We've begun to develop loosely structured peer groups in our Tribe who recognize potential 

problems and work together to help each other. We work with local counselors, social service 

agencies, our medical community, law enforcement and Federal and local Parole Officers on a caseby-case basis working to help people get assistance. We've learned from and shared best practices 

with other businesses such as Butterball Farms in Grand Rapids, Ml, who commits to re-entry 

initiatives and returning citizens. Butterball Farms has assisted us in searching for and developing 

wrap-around services for our Tribe. They have created a non-profit organization called THE 

SOURCE, in partnership with DHHR and other businesses in Grand Rapids to assist partner 

companies' employees with needed services and assistance. Navigating the networks of assistancewhether it be health care or health insurance, bill payments, educational needs for children, auto 

repair, counseling services or government assistance needs- can be challenging for just about 

anyone. These confidential services have proven to reduce absenteeism and turnover and increased 

trust and commitment to Butterball Farms and to Ziegenfelder in our early stages of success. These 

issues are complex, and much bigger than our little company, we know this. That is why we are 

open and continuously in search of ideas, resources, and best practices to improve our processes. 

8 
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While we are compassionate and have open hearts, we are not foolish- we have employees 

and a business to run. We are grateful that the majority of our employees are also committed to 

protecting the business and each other. We are part of a close knit community where people look 

out for each other and many have known one another for a long time. 

Roughly one-third of our workforce has been with us for 10 years or more. This portion of 

our Tribe is hard working and has never "been in trouble." They are well trained and committed. 

Another third of our Tribe comes to us following what some would call a "checkered past." Some 

of the Tribe members have made bad decisions in the past, but they come to work with us as they 

rebuild their lives and they succeed in staying on a positive, self-aware, and well-lived life. Then 

we have those people that seem to be in everybody's workforce: people that may be in the middle of 

something not good, spiraling downward, but they haven't gotten caught. We are committed to 

creating and maintaining a safe environment, one that is socially and emotionally safe and 

trusting, where people feel safe being vulnerable and can grow. We hope that this environment and 

culture can help support and reward those of our Zieggy population who truly are in it to win it. 

Stories from Our Tribe 

One of our most valued Tribe members is Sonny Baxter. We have an amazing video about 

his story that we are honored to highlight on our website. As he says in this video, he has been 

home since August of 2015.2 The day after he came home, he joined our Tribe. We didn't know 

then what he has since shared with us. nor did we know then what more he would go on to achieve. 

Turns out when he came home. it was following a ten year prison sentence that he served by 

spending seven years in federal prison and three years in state prison. When he was 16 years old he 

started to get into "different things" as he puts it and skipping school more and more. When he was 

2 https:/1\\ nw.hudgctsa\·Cr.com/employment/s.onnys~story/1 06 

9 
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19 years old, he was arrested for possession of drugs with intent to distribute and sent to prison in 

the state ofNew Jersey. While he was serving his sentence, he trained to become an addiction 

counselor in the hopes of helping others. In his words, "I was part of the problem." Now he is part 

of the solution. He said, "I was told a long time ago the things you learn are not yours to keep and I 

place that responsibility on myself." What we know now is that he is headed to West Liberty 

University after earning his associate's degree in software engineering from West Virginia Northern 

Community College. He is a full-time leader at our company and works as a Tech Support at 

Wheeling Jesuit University. lie has a condo and a car and he uses his training to help other 

members of the Tribe who are in recovery and re-entering the workforce. He has been a huge asset 

to our culture, our Tribe, and our community. His story is one of success and there are many others. 

Another story that not only exemplifies our workplace culture but also touches on the many 

elements of addiction is one involving theft and restitution. Opioid addiction becomes expensive; 

drug use often leads to criminal behavior. We know from the stories our Tribe members share that 

a lot of drug addicts, including those with a history of opioid misuse, end up in jail because of the 

criminal behavior that they engage in to support their addiction. 

One early morning I came into the plant and saw three employees huddled around a video 

monitor. I asked them what was up. These three guys, who had a prior history of drug addiction 

and criminal activity, were talking and watching the video footage from the night-turn shift. They 

told me that an employee in our factory had her wallet stolen. I asked them how they thought we 

should handle the situation. It was their idea to go and speak with the individual on the monitor 

who took the wallet- employee to employee- as people who had walked that path in the past. When 

confronted by peers, the individual first denied and then admitted his actions. He apologized to the 

owner (a suggestion by the peers) gave the wallet back and remains a valued member of our tribe to 

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this day. However, had supervisors or managers confronted him, 1 truly believe the outcome would 

have been different- he would have been nervous, frightened, and defensive. I am not sure 

whether he would have been able to change his path. By creating a trusting environment- we were 

able to keep him employed, which is really the first step in cleaning up a life. 

The story of another one of our Tribe members speaks to the value of employment and 

culture too. One of our Tribe members Tanner's past started out a Jot like many people but 

devolved quickly with addiction. Tanner played varsity baseball in high school and graduated with 

good grades. He went to college on a baseball scholarship but, like many kids, he partied a little too 

much. He ended up quitting school. and got caught up in the spiral of addiction. He was sent to 

prison for two years for breaking and entering. While Tanner was in prison, his mother developed 

cancer and passed away- never seeing her son's abilities to put addiction in his past, to work hard, 

and to develop a meaningful live. After release and while in drug court, he met his Hance- who had 

a difficult background as well. Tanner struggled to find a full time job. He was delivering pizzas 

and happened to deliver a pizza to our plant. The folks at the plant told him what a great steady job 

they had and told him to come work with us. Now, he is the highest level hourly employee that we 

have, and he and his fiance have three children; he has developed leadership skills and has a bright 

future. Our Tribe saw in him someone who was looking to make a better future for himself and he 

has since helped many of our employees. One such Tribe member whom Tanner has helped is 

Charles. 

Charles had an addiction problem in the past as well prior to working for us. Much like 

others, he got clean and he found us through friends of Tanner's. He began working for us while on 

parole. As a father with full-custody of his two-year-old daughter, he tried to steer clear of other 

addicts that might pull him back to that life. One of his parole stipulations was that he cannot see 

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his ex-girlfriend who was the mother of his child. Despite his every effort to steer clear and fulfill 

the terms of his parole, the mother of his child called him incessantly and hammered on him. He 

went and met her and was caught and sent back to jail for violating the terms of his parole. When 

Charles was sent back to prison, Tanner and his fiance took Charles's son into their home with their 

three children. For Charles, two weeks turned into 30 days. We tried to stay in touch with Charles 

because he was our employee and he really had no one else. When he finally got a court appointed 

attorney, we contacted the attorney and offered to stand up at his hearing as a character 

witness. Our plant manager stood up for him at this hearing; he was released that day and continues 

to work for us now. Charles reunited with his two-year-old as a parent and a full-time employed 

caregiver. 

There arc so many stories of peer-to-peer support that I am not even aware of- hut these are 

two that I am honored to share. In addition, we have conversations within our community and 

leverage these relationships to help our Tribe. 

For example. Reynolds Memorial Hospital is a local regional hospital and the CEO Dr. 

David Hess is a friend of mine. He has people coming and going in and out of his hospital and 

Emergency Room due to drug use. He went to his board and implored that someone take the 

lead. What is step one? Getting people off of drugs. However, many places won't take people if 

they have drugs, including opioids, in their system. He has developed the "Break Through" 

program. He has a small staff of three employees, two nurses and an administrator who treat 

anywhere from two to ten patients per week inpatient for between two and four days. He and his 

small team monitor these patients very closely on an inpatient basis and help them manage the 

symptoms of withdrawal with medical protocol. They work with a medical management company 

who helps them stay current with medical trends. They help them through the physical trauma of 

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detoxing and withdrawal. Dr. Hess has told me that if any of our Tribe needs help, he will get the 

assistance they need- this is an example of our community partnership. 

UnJortunately, we know this is a crisis and not all outcomes arc successes. In fact, successes 

are often fleeting. Nearly one year ago, 25-year-old Trevor came to us clean from the Federal 

Prison system. Through our community relationships, Trevor's Parole Officer recommended him to 

us. Trevor was a great asset to our company, working hard both at work and to stay clean ... for 

about 10 months. We noticed changes in Trevor's behaviors and confronted him multiple times. At 

one point Trevor, along with his beautifu14-ycar-old son, sat in our plant manager's oflice as they 

discussed his slippery slope or addiction and all that was at stake for Trevor. Efforts to assist Trevor 

through working with his PO, professional counseling services, and ongoing peer assistance were 

not enough to combat the evil draw of addiction and its overpowering effects. Trevor returned to 

the streets and quickly found himself locked up again. 

Bottom line, we arc not experts in this arena. We make popsicles. We do, however 

recognize our responsibility as a steward of our tribe and our community to do what we can to 

change the trajectory of this epidemic. It is a messy process, wrought with failures and 

heartbreak. Our efforts are likely not as process oriented or results driven as they could be. I wish 

we could devote more resources to defined solutions, and continue inching forward. Connecting the 

dots of care tor these marginalized millions of people addicted to opioids is not easy, and there arc 

more starfish on the shore than we could ever manage. In our little world, we are doing what we 

can with the hopes of making a difference in a life, one person at a time. 

Our Culture Has Become Self-Perpetuating 

Diversity is our strength and our competitive advantage. With open minds and open hearts, 

we recognize many people have capabilities and a need to be part of success and something bigger 

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than themselves. These could be our children, our friends, our neighbors, our co-workers; all the 

fabric of our community. People who have so much to contribute yet may have made decisions, 

changing the course of their lives. 

Standing idle, often in judgement of others, and doing little but measuring statistics does not 

erase mistakes people have made. Even worse, it may perpetuate crime and other debilitating 

problems. We believe and have found that for many of our Tribe members, a job is the best 

antidote. And this belief has been aftirmed over and over again by our Tribe members. Tanner 

Defilbaugh articulated it so well: ''When you work somewhere like this it makes it easier to do the 

right things when you are working and you have a steady job and you have a purpose. If you're just 

waning in the wind and you can"t get a job, you're just gonna say to heck with it -I might as well 

do what I was doing and that's how a lot of people end up doing the same thing all over again."3 

We recognize that there's a huge opioid epidemic so what we have done is come together 

and figure out a solution to it versus continue to be or foster the problem. We have opened our 

doors to a certain extent to give people the opportunity to become better. [t takes courage to stand 

up and make change. It takes courage to believe in the resiliency of the human spirit, and it 

requires courage to take the tlrst step. We have and will continue to embrace the opportunity to 

demonstrate and reward this courage. Our results are not without failures. However, we learn from 

our failures and believe that the next person deserves our open minds and open hearts as much as 

the last individual. 

Conclusion 

1 https:/1" ww.faccbook.com/1 OODayslnAppalachia!videos/17271960206851991 

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I am proud of the company that my grandfather and dad invested in years ago and I am 

proud of the Tribe that continues to build our company today. It is an honor to be a part of such a 

tremendous group of people and humbling to think of some of the challenges they and other 

members of our community and nation have endured and overcome. 

Their successes and our intentional and compassionate hiring practices have enabled us to 

share our story in many open forums, including this experience today. Ziegcnfelder's Tribe's 

efforts have stretched into our community, generating renewed energy in our slowly recovering 

local economy. Working with leaders in education, business, medicine, local government, the U.S. 

Department of Justice, and the Board of Prisons, we are partnering to reach our community in 

unique ways. Drug addiction, including opioid addiction, and associated social problems have been 

smoldering for generations and it may take as long to win this battle. In our communities in 

Wheeling, Chino CA and Denver, CO and at the Ziegenfelder Company, we are working together to 

combat this enemy; one person, one family and one community at a time. Just like starfish on the 

beach, there are thousands of people that need help in our communities across this great nation, but 

to each person we are able to help, we make a difference. One by one we are making a difference. 

Thank you for this opportunity to testify, and I look forward to your questions. 

15 
33 

Chairman WALBERG. Thank you for your testimony. And I guess 

I should say I thank you for addicting my grandkids to twin pops. 

(Laughter) 

Ms. ALLEN. And I thank you for purchasing them, sir. 

Chairman WALBERG. It is a better addiction than anything else. 

Ms. ALLEN. Absolutely. Have at it. 

Chairman WALBERG. Okay. 

Ms. ALLEN. Thank you. 

Chairman WALBERG. And I will recognize Dr. Andrews for your 

five minutes of testimony. 

TESTIMONY OF CHRISTINA M. ANDREWS, PHD, ASSISTANT 

PROFESSOR, UNIVERSITY OF SOUTH CAROLINA 

Dr. ANDREWS. Subcommittee Chairmen Walberg and Byrne, 

Ranking Members Sablan and Takano, and distinguished members 

of the Committee, thank you for the opportunity to speak with you. 

I am a professor at the University of South Carolina and have 

spent the past decade researching how we can improve access to 

opioid use disorder treatment in the United States. Without question, the opioid epidemic is having a profound impact on our nation. We are now losing more people to opioid overdose than to 

AIDS in the height of that epidemic. And we will have lost 10 

Americans to a fatal opioid overdose by the conclusion of this hearing today. 

The human cost of addiction and overdose is accompanied by a 

substantial financial price. In 2013 alone, expenses related to 

opioid use were estimated to be $79 billion. The epidemic presents 

new challenges for our economy. Reports from employers across the 

country tell a similar tale, opioid misuse is impairing their ability 

to hire and retain qualified workers. The Fed recently identified 

the epidemic as an emerging threat to economic growth. In its 

‘‘Beige Book: A Summary of Regional Economic Conditions,’’ officials point to a concerning number of employers who are reporting 

difficulty finding qualified employees who are drug free. 

The research indicates a strong link between opioids and labor 

force participation. More prescriptions, more unemployment. The 

proportion of prime age men in the workforce has reached a historic low. Among those age 25–54 who are unemployed, a staggering 50 percent report taking pain medication on a regular basis, 

in most cases prescription drugs. About 70 percent of employers report negative consequences of opioid use, including absenteeism 

and drug use on the job. 

The most effective strategy to address these challenges is expansion of treatments. Decades of research have established that 

opioid addiction is a chronic disease and it can be treated effectively with a combination of medication and psychosocial intervention. Workers struggling with addiction must be connected to treatment so that they can achieve recovery and remain employed. 

Those who have dropped out of the workforce due to addiction must 

also receive treatment so that they can get back to work. This is 

the only realistic way to increase the supply of qualified workers. 

Drug testing is not an effective deterrent for people who have the 

disease of addiction. Treatment is the most evidence based approach to reduce opioid misuse in the workplace. 

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34 

How can we increase treatment? Let me share with you several 

recommendations, many of which come from the Opioid Commission appointed by President Trump. First, protect the Medicaid expansion and the health insurance exchanges. The Affordable Care 

Act has extended health insurance coverage to nearly 1 million people with opioid use disorders. Many are in the workforce. If the law 

were repealed, nearly one-third of all Americans with an opioid use 

disorder would suddenly lose access to lifesaving treatments. Medicaid waivers that impose work requirements could force beneficiaries to quit treatment in order to maintain coverage. Second, 

actively enforce parity regulations established under the Mental 

Health Parity and Addiction Equity Act of 2008. For employers to 

help their workers get the treatment they need we must ensure 

that their health plans provide equitable access to opioid use disorder treatment. Third, we need to uphold regulations on association health plans. The proposed rule issued by the Department of 

Labor last month would allow for the proliferation of poorly regulated health plans that are subject to few consumer protections. We 

must not allow Americans to spend their money on health plans 

that may not provide coverage for opioid use disorder treatment 

should they or a family member need it. Fourth, rapidly expand the 

distribution of naloxone, a lifesaving overdose reversal drug. We 

must get naloxone into every hospital, school, and local police station in the country. Thousands of lives can be saved by taking this 

step alone. Finally, increase prevention efforts. This includes better 

regulation of opioid prescribing, expanded options for safe disposal, 

support for effective non-opioid approaches to pain management, 

and expansion of injury prevention programs to reduce the need for 

pain medications. I applaud Congress for including an additional $6 billion over 

two years in the recent budget agreement for treatment of opioid 

use disorder. However, given the magnitude of the crisis, more 

funding is needed. It is crucial that these funds be directed specifically towards the purchase of naloxone, as well as evidence based 

treatment, such as buprenorphine and extended release naltrexone. 

Greater resources are going to be absolutely crucial to enable our 

states and our local communities to mount an effective response to 

this deadly epidemic. 

Thank you for your time. I look forward to your comments and 

questions. 

[The statement of Dr. Andrews follows:] 

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DATE: 

TO: 

FROM: 

RE: 

February 15, 20 I 8 

Committee on Education and the Workforce: Joint Subcommittees on Health, 

Employment, Labor and Pensions and Workforce Protections 

Dr. Christina M. Andrews, University of South Carolina 

Testimony: "Opioids Epidemic: Implications for America's Workplaces" 

Chairwoman Foxx, Ranking Member Scott, Subcommittee Chairmen Walberg and Byrne, 

Ranking Members Sablan and Takano, and Distinguished Members of the Committee: 

Thank you for the opportunity to speak with you today. I am a professor of social policy 

at the University of South Carolina and have spent the past decade researching how we can 

improve access to substance use disorder treatment in the United States, with a particularly focus 

on opioid addiction. 

Without question, the opioid epidemic is having a profound impact on our nation. We are 

now losing more people to opioid overdose than to AIDS at the height of that epidemic, and will 

have lost 10 Americans to a fatal opioid overdose by the conclusion of this hearing today. The 

human cost of addiction and overdose is accompanied by a substantial financial price: In 2013 

alone, expenses related to opioid use, overdose, death were estimated to be $79 billion. More 

recent estimates from 2016 put these expenses at over $95 billion. 

The epidemic presents new challenges for our economy. Reports from employers across 

the country tell a similar tale: Opioid misuse is impairing their ability to hire and retain qualified 

workers. The Fed recently identified the epidemic as an emerging threat to economic growth. In 

its Beige Book, a summary of regional economic conditions, officials point to a concerning 

number of employers who arc reporting diftlculty finding qualified employees who are drug free. 

The research indicates a strong link between opioids and labor force participation. More 

prescriptions, more unemployment. The proportion of prime-age men in the workforce has 

reached a historic low. Among those 25-54 who arc unemployed, a staggering 50% report taking 

pain medication on a regular basis- in most cases, prescription drugs. The National Safety 

Council reports that 70% of employers report witnessing negative consequences of opioid use in 

Christina M. Andrews. I 
36 

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the workplace, including absenteeism and drug use on the job. The total cost to employers 

annually: An estimated $26 billion resulting from no shows, turnover, and reduced productivity. 

The most effective strategy to address these challenges is expansion of opioid use 

disorder treatment. Decades of research have established that opioid addiction is a chronic 

disease that can be treated effectively with a combination of medication and psychosocial 

intervention. Recovery is possible. 

Employees struggling with addiction must be connected to treatment so that they can 

achieve recovery and remain employed. Those who have dropped out of the workforce due to 

addiction must also receive treatment so that that can get back to work. This is the only realistic 

way to increase the supply of qualified workers. Drug testing is not an effective deterrent for 

people who have the disease of addiction. Treatment is the most sensible and evidence-based 

approach to reduce opioid misuse in the workplace. 

How can we increase access to treatment? Let me share with you several excellent 

recommendations, many of which come from the Surgeon General's Report on Alcohol, Drugs. 

and Health, and the Final Report of the Opioid Commission appointed by President Trump: 

First, protect the Medicaid expansion and the health insurance exchanges. The Affordable 

Care Act (ACA) has extended health insurance coverage to nearly one million people with 

opioid use disorders. Many are in the workforce. If the law were repealed, nearly one-third of all 

Americans with an opioid use disorder would suddenly lose access to treatment. Lifesaving 

drugs, such as buprenorphine and extended-release naltrexonc, are costly and financially out of 

reach for many uninsured people. The uninsured must seek care from overburdened safety-net 

providers, which often have long waiting lists to enter treatment. People with opioid use disorder 

risk a fatal overdose each day that they must wait for treatment to begin. With an increase in the 

use of deadly drugs as fentanyl in the heroin purchased in the United States, the stakes of not 

receiving treatment on demand are high. 

Moreover, Medicaid waivers that impose work requirements could force beneficiaries to 

quit treatment in order to maintain their coverage, with negative effects for the workplace and the 

epidemic. This poses a particular hardship for Medicaid beneficiaries who have severe substance 

Christina M. Andrews, 2 
37 

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use disorder that requires medically-managed inpatient or residential treatment in order to 

achieve detoxification and stabilization. 

Second, actively enforce parity regulations established under the Mental Health Parity 

and Addiction Equity Act (MHAEA) of2008 and extended under the ACA. These regulations, 

which have benefited approximately 60 million Americans, have been critically important in 

reducing utilization controls have historically limited patients' ability to access to opioid use 

disorder treatment. Research findings from the National Drug Abuse Treatment System Survey 

have revealed substantial decreases in use ofpreauthorization and annual service limits for lifesaving treatment for opioid use disorder after implementation ofMHPAEA parity regulations. 

For employers to help their workers get the treatment they need, we must ensure that their health 

plans provide equitable access to opioid use disorder treatment benefits. 

Third, uphold existing regulations on Association Health Plans. The Trump 

Administration recently directed the federal government to expand access to association health 

plans and other types of insurance products, such as short-term limited duration insurance. The 

proposed rule issued by the Department of Labor last month would allow for a proliferation of 

poorly-regulated health plans subject to few consumer protections. We must not allow 

Americans to spend their money on health plans that may not provide coverage for opioid use 

disorder treatment should they need it. 

Fourth, rapidly expand distribution of naloxone, the opioid-agonist designed to counteract 

the effects opioid overdose. We must get naloxone into every hospital, school, and local police 

station in the country. While the price of naloxone has increased substantially in recent years, the 

Federal government is in a strong position to purchase naloxone in bulk at a reduced rate. 

According to the Centers on Disease Control, naloxone has saved over 27,000 lives between 

1996 and 2014. Thousands of additional lives can be saved by taking this step alone. 

Finally, increase prevention efforts. This includes better regulation and monitoring of 

opioid prescribing. expanded options for safe disposal, greater support for effective non-opioid 

approaches to pain management, and expansion of injury prevention programs to reduce the need 

for pain medications. 

Christina M. Andrews, 3 
38 

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I applaud Congress for including an additional $6 billion over two years for opioid use 

disorder treatment in the recent budget agreement. However, given the magnitude of this crisis, 

more funding is needed to meet the need. It is critical that these funds be directed towards 

purchase of naloxone and evidence-based treatments such as buprenorphine and extended-release 

naltrcxone. Greater resources are absolutely crucial to enable our states and local communities to 

mount an effective response to this deadly epidemic. 

I express my sincere gratitude for the opportunity to share my thoughts with the 

Committee. I look forward to your comments and questions. 

Christina M. Andrews, Ph.D. 

Assistant Professor 

College of Social Work 

University of South Carolina 

1512 Pendleton Street 

Columbia, SC 29208 

candrews@mailbox.sc.edu 

Christina M. Andrews, 4 
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Testimony of Christina M. Andrews to the House Committee on Education and the Workforce 

Subcommittees on Health, Employment, Labor and Pensions and Workforce Protections 

Hearing on the Opioids Epidemic: Implications for America's Workplaces 

REFERENCES 

I. Beronio, K., Po, R., Skopec, L., & Glied, S. (2013, February 20). Affordable Care Act 

expands mental health and substance usc disorder benefits and federal parity protections for 

62 million Americans. U.S. Department of Health and Human Services Office for the 

Assistant Secretary for Planning and Evaluation: https://aspe.hhs.gov/report/affordable-careact-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parityprotections-62-m iII ion-americans 

2. Birnbaum, H. G., White, A. G., Schiller, M., Waldman, T., Cleveland, J. M., & Roland, C. L. 

(20 11 ). Societal costs of prescription opioid abuse, dependence, and misuse in the United 

States. Pain Medicine, 12(4), 657-667. 

3. Christie, C.. Baker, C., Cooper, R .. Kennedy, P. J., Madras, B., & Bondi, P. (2017, 

November l ). The President's commission on combatting drug addiction and the opioid 

crisis. https:/ /www. wh itehouse.gov /sites/wh itehouse.gov /files/images/Final_ Report_ Draft_ 

11-l-20 17.pdf 

4. Federal Reserve Bank of St. Louis. (20 17, July 12). The beige book: Summary of 

commentary on current economic conditions. U.S. Federal Reserve: 

https://www. fcderalreserve.gov/monetarypolicy/files/BeigeBook _ 20 170712.pdf 

5. Friedmann, P. D., Andrews, C. M., & Humphreys, K. (2017). How ACA repeal would 

worsen the opioid epidemic. New England Journal of Medicine, 376( I 0), e 16. 

6. Hersman, D. A. P. (2017, March 9). Prescription drug misuse impacts more than 70% of U.S. 

workplaces. National Safety Council: https://aspe.hhs.gov/report/aftordable-care-actexpands-mental-health-and-substance-use-disordcr-bencfits-and-federal-parity-protcctions62-million-americans 

7. Humphreys, K., Malenka, R. C., Knutson, B., MacCoun, R. J. (2017). Brains, environments, 

and policy responses to addiction. Science. 2017, 356(6344),1237-8. 

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8. Keith, K. (2018, January 5). The association health plan proposed rule: What is says and 

what it would do. Health Affairs Blog: https://w\vw.hcalthaffairs.org/do/10.1377/hblog2 

01801 04.347494/full/ 

9. Krueger. A. B. (20 19, September 7-8). Where have all the workers gone? An inquiry into the 

decline of the U.S. labor force participation rate. Brookings Papers on Economic Activity: 

https://www.brookings.edu/wp-content/uploads/20 17/09/1_ krueger.pdf 

10. Pidd, K., & Roche, A.M. (2014). How effective is drug testing as a workplace safety 

strategy? A systematic review of the evidence. Accident Analysis & Prevenlion, 71, 154-165. 

11. Pidd, K., Kostadinov, V., & Roche, A. (2016). Do workplace policies work? An examination 

of the relationship between alcohol and other drug policies and workers' substance use. 

International Journal of Drug Policy. 28, 48-54. 

12. Rhyan, C. N. (2017, November 16). The potential societal benefit of eliminating opioid 

overdoses, deaths, and substance use disorders exceeds $95 billion per year. Altarum: 

https://altarum.org/sites/default/files/uploaded-publication-files/Rescarch-Brief_ OpioidEpidemic-Economic-Burden.pdf 

13. Strang, J., Babor, T., Caulkins, .1., Fischer, B., Foxcroft, D., Humphreys, K. (2012). Drug 

policy and the public good: evidence for effective interventions. Lancet, 379, 71-83. 

14. U.S. Department of Health and Human Services, Office of the Surgeon General. (2016). 

Facing addiction in America: The Surgeon General's report on alcohol, drugs, and health. 

https://addiction.surgeongeneral.gov/surgcon-generals-rcport.pdf 

15. Volkow, N.D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the 

brain disease model of addiction. New England Journal of Medicine, 374, 363-71. 

16. Waehrer, G. M., Miller, T. R., Hendrie, D., & Galvin, D. M. (2016). Employee assistance 

programs, drug testing, and workplace injury. Journal of Safety Research, 57, 53-60. 

17. Wheeler, E., Jones, S., Gilbert, M. K., & Davidson. P. J. (20 15, June 19). Opioid overdose 

prevention programs providing naloxone to laypersons. Centers for Disease Control and 

Prevention !vforbidity and Mortalizv Weekly Report: https://www.cdc.gov/mmwr/preview/ 

mmwrhtml/mm6423a2.htm 

18. Zhou, C., Luo. F., Xu, L. (20 16). The Economic Burden of Prescription Opioid Overdose, 

Abuse, and Dependence in the United States, 2013. Medical Care, 54(10): 901-906. 

Christina M. Andrews, 2 
41 

Chairman WALBERG. We thank you. I recognize Ms. Russo for 

your five minutes of testimony. 

TESTIMONY OF KATHRYN J. RUSSO, PRINCIPAL, JACKSON 

LEWIS P.C. 

Ms. RUSSO. Chairmen Walberg and Byrne, Ranking Members 

Sablan and Takano, and distinguished members of the Subcommittees, thank you for inviting me to testify here today. 

My name is Kathryn Russo and I’m an attorney at Jackson 

Lewis where I manage the Drug Testing and Substance Abuse 

Management Practice Group. My practice consists of advising employers on drug and alcohol issues that arise in the workplace, including drug testing and disability management issues. Many employers I work with are struggling with the workplace impacts of 

opioid addiction, including issues such as increased work-related 

accidents and injuries, increased employee turnover, and increased 

workers compensation costs. An employer may learn that an employee is using opioids when an employee voluntarily discloses that 

he is using prescription painkillers or that he is addicted to opioids. 

Alternatively, the employee may test positive for opioids on a workplace drug test. The way that an employer responds to each of 

these situations depends on whether the employee can be characterized as disabled for purposes of federal and state discrimination 

laws. Current users of illegal drugs, including those who use prescription drugs without a valid prescription, are not protected as 

disabled under federal and state laws. This is why an employer can 

take disciplinary action against an employee who uses illegal drugs 

or tests positive for illegal drugs on a workplace drug test. But 

when an employee is using prescription medication to treat an illness or is recovering or recovered from a substance abuse problem, 

the employee is disabled under the Americans with Disabilities Act 

and comparable state laws. These laws require employers to offer 

disabled employees accommodations in certain circumstances. For 

example, when an employee voluntarily discloses that she has an 

opioid addiction and needs help, employers typically offer accommodations that might consist of a medical leave of absence to obtain evaluation and treatment or a change in the employee’s work 

hours so that she can go to treatment sessions. Many employers 

have employee assistance programs that allow employees to seek 

confidential assistance with substance abuse problems. 

While employers are willing to help employees who disclose 

opioid addiction, they also must manage employee misconduct arising from illegal opioid use. Drug testing is an important tool used 

by employers to detect illegal drug use. I am seeing an increase in 

the number of employers who conduct drug testing, an increase in 

the number of drugs that employers test for, as well as an increase 

in the types of tests that are being conducted. Employers who conduct drug testing commonly use a ‘‘five-panel’’ drug test, indicating 

that five categories of drugs will be tested. In a typical five-panel 

drug test, however, the only opioids tested for are heroin, morphine, and codeine. Because of the prescription painkiller epidemic, 

many employers have concluded that a five-panel test is insufficient. And so employers increasingly are utilizing larger drug testing panels that include synthetic and semi-synthetic opioids. 

CEWDOCROOM with DISTILLER

42 

Employers increasingly are using post-accident testing and random testing to promote drug free workplaces. Random testing is a 

particularly useful tool for employers because it is unannounced 

and unexpected. Post-accident testing is also a very useful tool for 

employers to help rule out whether an employee had drugs in his 

system at the time of the accident. However, the U.S. Department 

of Labor’s Occupational Safety and Health Administration’s recent 

statements concerning post-accident drug testing have been a 

source of confusion and frustration for employers. In May 2016, 

OSHA stated in the preamble to its final rule on electronic record 

keeping that employers are prohibited from using drug testing as 

a form of adverse action against employees who report injuries or 

illnesses. In a subsequent memorandum, OSHA explained that 

post-accident drug testing may be permissible where there is a reasonable basis that drugs or alcohol could have contributed to the 

injury or illness. This standard is confusing to most employers. 

Many employers believe that OSHA now requires reasonable suspicion in order to test, while other employers have stated that they 

don’t know what the rule means. 

Employers have complained that this post-accident standard first 

appeared in the preamble to an electronic record keeping rule and 

that there is no formal OSHA regulation addressing drug testing 

that employers were permitted to comment on before the rule took 

effect. Many employers believe that drug testing is an issue that 

is already regulated by many other federal, state, and local laws 

and that OSHA’s position on this topic unnecessarily complicates 

the already complicated arena of workplace drug testing. 

I appreciate the opportunity to share my thoughts with the Committee. 

[The statement of Ms. Russo follows:] 

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COMMITTEE ON EDUCATION AND THE WORKFORCE 

SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR AND PENSIONS 

SUBCOMMITTEE ON WORKFORCE PROTECTIONS 

THE OPIOIDS EPIDEMIC: IMPLICATIONS FOR AMERICA'S WORKPLACES 

February 15, 2018 

Kathryn J. Russo 

Good morning, my name is Kathryn Russo and I am an attorney at Jackson Lewis, where 

l manage the Drug Testing and Substance Abuse Management Practice Group. Jackson Lewis is 

one of the largest law firms dedicated to representing employers in workplace law. My practice 

consists of providing advice to employers on drug and alcohol issues that arise in the workplace, 

including drug testing and disability management issues. I am privileged to work with 

employers in many different industries and in all fifty states. 

I am pleased to offer my perspective on how the opioid crisis impacts employers. Many 

employers I work with are struggling with the workplace impacts of opioid addiction, including 

issues such as increased work-related accidents and injuries, increased employee turnover, 

decreased productivity and increased workers' compensation costs and health insurance costs. 

For employers who operate dangerous workplaces, ensuring the safety of employees and others 

is critical. 

The opioid crisis affects employers in many different ways. Consider the following 

examples of situations that employers are faced with routinely: 

• An employee is out of work for some time on a medical leave of absence. In 

conjunction with medical treatment, he begins taking a prescription painkiller. 

After returning to work, the employee admits to his employer that he has become 

addicted to painkillers and requests another leave of absence to treat the addiction. 

• An employee is involved in a work-related accident and is required to submit to a 

post-accident drug test. The employee tests positive for prescription painkillers. 

An employer learns that one of its employees is selling OxyContin to his coworkers. 

• An employee reports for work appearing drowsy, incoherent, and apparently 

unable to perform his job duties. The employer has a "reasonable suspicion" 

testing policy and decides to send the employee for a drug test. When the 

employer meets with the employee to escort him for testing, he admits that he 

took too many painkillers. 

• An employee who previously completed drug rehabilitation for painkiller 

addiction becomes addicted to heroin and overdoses at work. 
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These scenarios are just a few of the situations that employers are grappling with. The 

way that an employer responds to each of these situations depends on whether the employee can 

be characterized as "disabled'' for purposes of federal and state discrimination laws. 

Employees who use opioid medications pursuant to lawful prescriptions, as well as 

recovering and recovered substance abusers are considered "disabled" for purposes of the federal 

Americans with Disabilities Act of 1990, 42 U.S.C. §12101 et seq., ("ADA"), and comparable 

state laws. However. "current users" of illegal drugs (including those who usc prescription drugs 

without a lawful prescription) are not protected under federal and state discrimination laws. 

This is why an employer can take disciplinary action against an employee who uses 

illegal drugs at work or tests positive for illegal drugs on a workplace drug test. But when an 

employee is using prescription medication, or is recovering or recovered from a substance abuse 

problem, the employer must analyze its legal obligations under applicable laws including the 

ADA, the Family and Medical Leave Act, and comparable state and local laws. 

A. Who Is Protected Under The Americans With Disabilities Act? 

The ADA provides that no employer "shall discriminate against a qualified individual on 

the basis of disability in regard to job application procedures, the hiring, advancement, or 

discharge of employees, employee compensation, job training, and other terms, conditions and 

privileges of employment." 42 U.S.C. § 12112(a). A ·'qualified individual with a disability" is 

defined as an "individual with a disability who, with or without reasonable accommodation, can 

perform the essential f\mctions of the employment position that such individual holds or desires." 

42 U.S.C. § 12111(8). The ADA defines a "disability" as: (1) a physical or mental impairment 

that substantially limits one or more of the major life activities of such individual; (2) a record of 

such an impairment; or (3) being regarded as having such an impairment. 42 U.S.C. § 12102(1). 

1. Current Illegal Drug Users Are Not Protected by the ADA 

An individual who is currently engaged in the illegal use of drugs is not considered a 

"qualified individual with a disability" for purposes of the ADA. 42 U.S.C. § l2114(a). This 

includes any individual who tests positive for illegal drug usc, which is defined to mean the use, 

possession or distribution of any drugs considered unlawful under the federal Controlled 

Substances Act (21 U.S.C. § 801 et seq.). The "illegal use of drugs" does not include the use of 

any drugs taken under the supervision of a licensed healthcare professional or other lawful uses 

authorized by the Controlled Substances Act or other provisions of federal law. 42 U.S.C. § 

12111(6)(a). 

2. Recovering and Recovered Drug Abusers Are Protected Under the 

ADA. 

The ADA provides that a "qualified individual with a disability" may include the 

following: 

• An individual who has successfully completed a supervised drug 

rehabilitation program and is no longer engaging in the illegal use of 

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drugs, or has otherwise been rehabilitated successfully and is no longer 

engaged in such use; 

• An individual who is participating in a supervised rehabilitation program 

and is no longer engaging in such use; or, 

• An individual who is erroneously regarded as engaging in such use, but is 

not engaging in such use. 

42 U.S.C. § 12114(b)(!), (2) and (3). 

B. Permissible Employer Actions Under the ADA. 

The ADA expressly permits employers to: 

• Prohibit the use of alcohol and the use of illegal drugs in the workplace; 

• Prohibit employees from being under the influence of alcohol or illegal 

drugs in the workplace; 

• Comply with the Drug-Free Workplace Act of 1988 (which requires 

certain federal contractors and grantees to create policies prohibiting 

illegal drug use at work, among other things); 

• Require employees to comply with any applicable drug and alcohol testing 

regulations of the U.S. Department of Transportation, Department of 

Defense or Nuclear Regulatory Commission; 

• Hold employees who engage in illegal drug use to the same qualification, 

performance and behavior standards to which it holds all other employees, 

even if the unsatisfactory performance or behavior is related to the drug 

use. 

42 U.S.C. § 12114(c). 

In addition, the ADA expressly provides that drug tests to determine current illegal drug 

use are not medical examinations. 42 U.S.C. § 121!4(d)(l). 

C. What Must Employers Oo If An Employee Volunteers a Substance Abuse 

Problem and Requests Help? 

The ADA prohibits employers from "not making reasonable accommodations to the 

known physical or mental limitations of an otherwise qualified individual with a disability who is 

an applicant or employee, unless [the employer) can demonstrate that the accommodation would 

impose an undue hardship on the operation of the business of [the employer.] 42 U.S.C. § 

l2ll2(b)(5)(A). When an employee volunteers that he or she has a substance abuse problem and 

wishes to seck help for that problem, or is already seeking help for that problem, an employer 

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must consider whether it can make a "reasonable accommodation" for the employee. Such 

"reasonable accommodation" could include a leave of absence, or a modit!ed work schedule, 

among other things. The employer must make an "individualized assessment" of the situation 

through an "interactive dialogue" with the employee. 

In addition, under the Family and Medical Leave Aet, 29 U.S.C. § 2601 et seq., substance 

dependence is considered a "serious health condition" and there tore, if the employee is FMLAeligible. he or she may take FMLA leave for substance abuse treatment. See 29 C.F.R. § 

825.119. 

However, if the employee discloses a substance abuse problem and requests help merely 

to avoid disciplinary action for misconduct that he/she already has engaged in, the employer is 

not required to offer an accommodation and may instead enforce its disciplinary policy. See 

U.S. Equal Employment Opportunity Commission's The Americans with Disabilities Act: 

Applying Performance and Conduct Standards to Employees With Disabilities No. 28 (Dec. 20, 

201 7). 

D. Must An Employer Permit Employees To Use Opioids At Work If They Are 

Taken Pursuant To A Lawful Prescription? 

In general, employers should avoid making medical inquiries about employees' use of 

prescription medications. Under the ADA, medical inquiries are required to be '~job-related and 

consistent with business necessity," which means, as a practical matter, that the employer must 

have a safety reason for the inquiry. An employer with employees in dangerous or "safetysensitive" jobs, however, should consider a policy provision requiring those "safety-sensitive" 

employees to disclose the use of medications that may impact the employee's ability to do the 

job safely. The employer then must consider whether the employee's use of the medication 

poses a "direct threat" of harm to himself or others. 29 C.F.R. § 1630.2(r). These issues must be 

addressed on an individualized, case-by-case basis. 

Employers should not assume that an employee using prescription opioids cannot do the 

job, and more importantly, employers should not have policies containing blanket prohibitions 

on the usc of certain drugs - such as opioids at work. Such blanket policies, without any 

individualized analysis, may result in legal claims under the ADA and comparable state laws. 

E. May Emplovers Drug Test Employees For Opioids, Including Prescription 

Opioids, And Take Disciplinary Action For Positive Test Results? 

Many employers conduct drug testing to ensure that workers are not impaired by drugs 

while performing their jobs. There are many laws that regulate workplace drug testing, including 

tederal regulations (such as the drug and alcohol testing regulations of the U.S. Department of 

Transportation's operating agencies, and other federal agencies); state laws (including mandatory 

laws that apply to all employers and voluntary Jaws permitting employers to obtain workers' 

compensation premium discounts); and, local laws (some cities have their own drug testing 

laws). 

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Employers who conduct drug testing commonly use a "live-panel" drug test, indicating 

that live categories of drugs will be tested, i.e., amphetamines, cocaine, marijuana, opioids and 

phencyclidine (PCP). In a typical live-panel drug test, however, the only ''opioids" tested for are 

heroin, morphine and codeine. Because of the prescription painkiller epidemic, many employers 

have concluded that a five-panel test is insufficient, and so employers increasingly are utilizing 

larger drug testing panels that include synthetic and semi-synthetic opioids. 

Semi-synthetic opioids include oxycodone, oxymorphone, hydrocodone, hydromorphone, 

and buprenorphine. Synthetic opioids include fentanyl, methadone, and tramadol. 

Last October, the U.S. Department of Health and Human Services' Mandatory Guidelines 

for Federal Workplace Drug Testing Programs Using Urine (which affect all federal employees 

in testing designated positions) were revised to add four semi-synthetic opioids to the drug 

testing panel. The U.S. Department of Transportation followed suit and revised its drug and 

alcohol testing regulations for certain transportation workers to add the same four semi-synthetic 

opioids to its drug testing panel. Those semi-synthetic opioids are oxycodonc, oxymorphone, 

hydrocodone and hydromorphone, more commonly known as Vicodin, OxyContin, Opana, 

Percocet and Dilaudid, among others. DOT's revised regulations took effect on January I, 2018, 

and now all DOT-regulated employers are required to test for those four additional opioids. 49 

C.F.R. § 40.87. DOT-regulated employers include those in the trucking, aviation, railroad, 

transit, pipeline and marine industries. 

If an employer is not regulated by federal drug testing regulations, may it lawfully test for 

semi-synthetic opioids? The answer is yes, as long as it is permitted by applicable state law 

(there are a few states that limit the drugs that employers may test for), and, there is a mechanism 

to distinguish between unlawful use of drugs and lawful use of drugs. It is critical that 

employers who conduct drug testing utilize a Medical Review Officer ("MRO") to make this 

distinction for them. A MRO is a licensed physician with expertise in analyzing drug test results. 

The MRO contacts an applicant or employee who has tested positive to discuss whether there is 

any legitimate medical reason that could have caused the positive test result, such as the use of 

prescription medications. If the MRO accepts the tested individual's explanation. the test result 

is reported to the employer as negative. If the MRO does not accept the tested individual's 

explanation, the test result is reported to the employer as positive. This process ensures that 

employers do not take adverse employment actions against individuals who are using lawful 

medications as opposed to illegal drugs. 

With regard to disciplinary consequences for pos1t1Ve drug test results, employers 

generally may choose whether they wish to terminate employees who test positive for illegal 

drugs or whether they will offer the employee an opportunity for evaluation and rehabilitation, if 

necessary. (There are some exceptions: a few states do not permit employers to terminate 

employees for a first-time positive drug or alcohol test result). If. however, the employee is 

using prescription opioids lawfully, no disciplinary action should be taken, although the 

employer may need to assess the safety risk, if applicable, as mentioned above. 

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F. Are Employers Conducting More Drug Testing to Combat the Opioid 

Epidemic, Such as Post-Accident Testing and Random Testing? 

Employers increasingly are using post-accident drug testing and random drug testing to 

promote drug-free workplaces, assuming that these types of tests are permitted under applicable 

federal, state and local laws. 

Random drug testing is a particularly useful tool for employers because it is unannounced 

and unexpected. Post-accident testing also is a very useful tool for employers to help rule out 

whether an employee had drugs or alcohol in his system at the time of the accident. However, 

the U.S. Department of Labor's Occupational Safety and Health Administration's recent 

statements concerning post-accident drug testing have been a source of confusion and frustration 

for employers. In May 2016, OSHA published a final rule on electronic recordkeeping that 

contained a prohibition on retaliating against employees for reporting work-related injuries or 

illnesses. 29 C.F.R. § 1904.35. In the preamble to that rule, OSHA stated that "blanket postinjury drug testing policies deter proper reporting" and that the final rule prohibits employers 

from using drug testing (or the threat of drug testing) as a form of adverse action against 

employers who report injuries or illnesses. These statements raised many questions from 

employers, particularly because there are no OSHA regulations addressing post-accident drug 

testing. 

OSHA published a memorandum in October 20!6 that explained its preamble comments 

further. It stated that post-accident drug testing may be permissible where there is a "reasonable 

basis" or "reasonable possibility" that drugs or alcohol could have contributed to the injury or 

illness. This standard has created much confusion. Many employers believe that it means that 

individualized "reasonable suspicion" is required in order to conduct post-accident drug testing. 

Other employers have stated that they don't know what it means, and, because of that 

uncertainty, they will not conduct any post-accident drug testing at all, out of concern that they 

risk a potential OSHA citation. 

OSHA also clarified that it will not issue citations to employers who conduct postaccident drug testing under federal or state laws. While this sounds reasonable, it will adversely 

impact employers in states with no drug testing laws (and who arc not subject to any federal 

regulations). For example, the state of Minnesota has a drug testing law that applies to all 

employers which permits broad post-accident drug testing. It is therefore reasonable to expect 

that citations will not be issued to Minnesota employers for post-accident drug tests. However, 

in many other states, post-accident drug testing is not regulated at all, which means that 

employers in those states must comply with OSHA's rule or face a potential OSHA citation. 

Employers also have complained that this post-accident testing standard first appeared in 

the preamble to an electronic recordkeeping rule, and that there is no formal OSHA regulation 

addressing drug testing that employers were permitted to comment on prior to the rule taking 

effect. Many employers believe that drug testing is an issue that already is regulated by many 

other federal, state and local laws, and that OSHA's position on this topic unnecessarily 

complicates the already-complicated arena of workplace drug testing. 

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G. What Are Employers Doing To Address the Opioid Epidemic? 

There are a number of steps that employers can take to address the effects of the opioid 

epidemic in the workplace, such as: 

1. Enact strong company drug policies. Consider implementing a drug testing 

program if the Company does not already have one; 

2. Expand the drug testing panel to include semi-synthetic opioids; 

3. Consider whether the Company will terminate employees for positive drug test 

results, or whether the Company will offer an opportunity for evaluation and 

treatment; 

4. Train supervisors how to spot the signs of drug misuse, and to take appropriate 

steps under the employer's policy; 

5. Train all employees on the dangers posed by prescription painkillers (because 

many people do not fully understand how addictive they are), including: 

a. The risks of opioid pain medication use, especially for workers with sleep 

apnea, COPD and other respiratory problems; 

b. The dangers of using alcohol and sleep aids with opioid pain medications; 

c. The risks of addiction and drug overdose. 

6. Do not stigmatize those who arc struggling to recover from substance abuse 

problems; and, 

7. Make employee assistance programs available to assist employees when they 

need help but may be afraid to tell anyone at work. 

I appreciate the opportunity to share my thoughts with the Committee. 

4824-6983-5357, V. 1 

7 
50 

Chairman WALBERG. Thank you. And thank you to each of the 

witnesses and trust that my colleagues and myself will note how 

well you all kept to the time limits, and may we do the same. 

I recognize myself now for my five minutes of questions. 

Mr. Rhyan, I noted earlier that today in our modern world we 

often spend more time with our co-workers than we do with anyone 

else, including our families. What role can you suggest that employers could play in supporting substance abuse recovery in the 

workplaces and in their communities? 

Mr. RHYAN. Absolutely. It’s very important to consider the role 

of the employers. As you mentioned, there’s a significant amount 

of time that individuals spend there and also the key role that employers play for the majority—in cases of providing insurance. And 

as a result, making sure that they are aware of the services that 

they can provide and they make them available to their employees. 

So, through that role, it is very important for employers to both 

make their employees aware of what services are available and 

also make sure that they get access to them when needed and in 

the best case possible. 

Chairman WALBERG. On the other side of the ledger, what can 

employees do as part of this process as well in the workplace and 

in their communities? 

Mr. RHYAN. Yeah. I think employees can take an active role to 

work with their colleagues and certainly be aware of issues that become available. We know that having a good support system is 

really important for those trying to recover from an opioid addiction and so certainly employees being aware of, and being there for 

other individuals is very important. 

Chairman WALBERG. Ms. Russo, you noted in your testimony 

there could be a situation in which an employee has a legal prescription for opioids and then tests positive during a drug test. In 

that case, would the employer be notified by the drug testing facility of the employee’s opioid use? 

Ms. RUSSO. Typically no. So what happens is when the drug testing facility gets a positive test result, they send it to a medical review officer, who is a licensed physician, to analyze whether this 

is lawful or illegal drug use. If the medical review officer is satisfied that the person had a valid prescription, it will usually get reported to the employer as a negative. However, sometimes in very 

dangerous industries, I’ve seen arrangements where the medical 

review officer will flag it for the employer, just to note there may 

be a safety issue without disclosing what the issue is. And then the 

employer then has the obligation to talk to the employee to find 

out, you know, what’s the situation, we think there may be a safety 

issue, and to work it out, just to make sure that the employee can 

use their medication and work safely in the workplace. 

Chairman WALBERG. And there isn’t a legal problem with doing 

that for the employer if they follow certain prescribed? 

Ms. RUSSO. No, that’s correct; they can do that. 

Chairman WALBERG. With prescription drugs? 

Ms. RUSSO. Yes. 

Chairman WALBERG. Okay. Because, you know, as you mentioned, that five-points test, that does cause a bit of a problem 

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51 

when you are dealing with such an expansive problem that goes 

from opioids to heroin and back and forth at times. 

Ms. RUSSO. That’s correct. Because, if an employee tests positive 

for opioids, the employer isn’t going to know. Is it because of heroin 

or because they’re using a prescription drug? So that’s why there’s 

this mechanism to have a medical review officer to review it to determine whether this is pursuant to a valid prescription or whether 

it’s an illegal drug. 

Chairman WALBERG. Okay. Mr. Rhyan, you stated that health 

care costs related to opioid crisis from 2001–2017 were almost $216 

billion, stemming largely from emergency room visits to treat and 

stabilize patients after an overdose and associated costs. In your 

opinion, would earlier interventions to address opioid abuse help to 

decrease these associated health care costs and keep employees 

participating in the workforce? 

Mr. RHYAN. Yes, absolutely. There’s two components to that. Certainly the first is preventing an opioid substance use disorder before it occurs. Because obviously any steps that can be taken to 

limit the excessive amounts of opioids that might be prescribed initially or any other steps that can be taken to decrease the likelihood that somebody develops a substance use disorder will prevent 

those adverse outcomes, such as emergency department visits, hospitalizations, or any downstream increased healthcare costs associated with diseases such as HIV, hepatitis B, hepatitis C, all of 

which we know are related to opioid substance use disorders and 

illegal drug use. 

The other component, that is of course providing treatment once 

we can identify those that have a substance use disorder. So, if we 

can provide better treatment and recovery services early on, we can 

prevent individuals from falling into those most severe outcomes. 

And that absolutely will cut healthcare costs on the front end if we 

can do that. 

Chairman WALBERG. Thank you. My time has expired. I now represent my friend and ranking member, Mr. Sablan. 

Mr. SABLAN. Yeah, thank you. Thank you very much again, Mr. 

Chairman, for today’s hearing. 

I have a question—actually two questions, Dr. Andrews, if I may. 

Thank you again for taking the time to testify today to all the witnesses. 

So, Dr. Andrews, can you discuss any gaps in access to substance 

use disorder treatment, especially in workplace health care coverage? For example, how does treatment access differ for blue collar workers as opposed to white collar workers? Does it differ 

across racial groups or socioeconomic groups? 

Dr. ANDREWS. Absolutely. Currently in the United States only 

about 10 percent of people with a substance use disorder ever receive any treatment for their condition. So that means we have 

about 90 percent of Americans who have an active substance use 

disorder and are not receiving treatment for their condition. The 

reasons for that are multifaceted and complex. Insurance access to 

treatment is an incredibly important aspect of it, as patients who 

report that they sought treatment but were unable to receive it indicate time and time again that financial barriers were key to their 

inability to access treatment. People in white-collar professions 

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52 

typically have greater likelihood of having a private insurance plan 

that offers higher reimbursement rates, that opens doors to entry 

into a greater number of addiction treatment programs. So, more 

choices means more likelihood of being able to enter treatment. 

People in blue-collar professions, maybe working in fields where 

whether it’s in the restaurant service industry or different areas of 

manufacturing or construction, where insurance benefits may not 

exist or they may be less generous and— 

Mr. SABLAN. I mean what about does it differ across racial 

groups or socioeconomic groups? You have alluded to the socioeconomic group, but the racial groups? 

Dr. ANDREWS. Right, right. While racial and ethnic minority 

groups do not use substances any more than whites—similar rates 

of use—they tend to access treatment less frequently. And there 

are a number of reasons for that, but again, insurance access, geographic access to treatment, barriers related to other challenges 

they may be facing related to employment, childcare, transportation, and the ability to access culturally and linguistically competent care are also key. 

Mr. SABLAN. So you also testified, Dr. Andrews, that increased 

prevention efforts could stem the opioid crisis. The need for pain 

medication after a workplace-related injury or illness is often the 

gateway to addiction. Can you comment—we have a minute and a 

half—on what some of those workplace prevention programs might 

include and whether there are ways we can address the prescription of opioids in the workman’s compensation system? 

Dr. ANDREWS. Right, absolutely. The research suggests that 

there is a really strong connection between working in industries 

that have high levels of injury. When people have an injury they’re 

much more likely to receive opioid prescriptions, and when they receive opioid prescriptions they are at greater likelihood of developing an opioid use disorder as a result. So one of the upstream 

prevention strategies that we can use to try to break this sort of 

domino effect before it begins is illness and injury prevention programs, particularly those offered by OSHA, that can try to minimize the likelihood of those injuries from happening and the need 

for pain medication moving forward. 

Mr. SABLAN. Ms. Russo, let me just ask you because you sort of 

mentioned and I am trying to understand. I have very little time, 

but when a person in the workplace is tested and it comes back 

positive, does the result show it, whether it is prescription drugs 

or heroin, for example? Or does it just show as positive? 

Ms. RUSSO. The result that the employer gets will usually just 

say positive and then it will show the category, cocaine, opioids, 

whatever it is. If the person is using a valid prescription it will already have been screened by the medical review officer who will 

then make it into a negative, so the employer won’t know. 

Mr. SABLAN. All right. Thank you, Ms. Russo. Thank you, Mr. 

Chairman. 

Chairman WALBERG. I now recognize the chairman of the Workforce Protections Subcommittee and co-chairman of this hearing, 

Mr. Byrne from Alabama. 

Mr. BYRNE. Thank you, Mr. Chairman. Thank you, ladies and 

gentlemen, for being here today. Very important topic. 

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53 

Ms. Russo, in my prior life I was an attorney who represented 

management, so this would come up not infrequently in conversations I would have with my clients. And I would inevitably have 

to talk with them about the Americans with Disabilities Act. So if 

you would please expand on—I know you have touched on this a 

little bit—expand on, first of all, what protections the employee has 

under the Americans with Disabilities Act in this particular environment, but also, most importantly, what the employer is permitted to do. 

Ms. RUSSO. Okay. So there’s really two ways I think in the context of drug use that an employee would be protected under the 

Americans with Disabilities Act. So some employers will ask employees to disclose the use of prescription medication if they’re in 

a very dangerous job. Generally, an employer would not ask that 

question, but to promote workplace safety they may ask people in 

very dangerous jobs to report it so that the employer can have a 

discussion with them about how can we accommodate it and make 

sure that you can do your job safely. That’s one potential context 

that it may come up. 

The other one is that recovering and recovered substance abusers 

are protected as disabled. So if an employee comes forward and 

says, ‘‘I have a problem. I need help,’’ then they are now protected 

as disabled. The employer then would consider a reasonable accommodation, which in this instance typically means a leave of absence. So we would give them a leave of absence to go for evaluation and treatment. They might be eligible for a leave under the 

Family and Medical Leave Act. Even if they’re not eligible, there 

may be other policies that the employer has that they can take advantage of. But in that instance, they would be—you know their 

substance dependence would be the illness that’s protected. So the 

employer would not take adverse action against them. 

Mr. BYRNE. Ms. Allen, I wanted to talk to you too about your testimony. I think you mentioned that when your employees are in 

trouble, many of them come to the company’s leadership and ask 

for help. This is not the case in all workplaces. I am sure you know 

that. And not all employees feel comfortable talking about these 

issues with their bosses, the people that they work under. How did 

you first begin to reduce that stigma that surrounds opioid abuse 

within your workplace to create a community of acceptance and 

support? 

Ms. ALLEN. Well, thank you for the question. I would have to say 

that in our organization we all interact together. The folks that 

have worked with us, we have people who have been with us for 

30 years and somebody new walked in the door today, I’m sure, in 

all three of our facilities. And we believe in close communication. 

We believe in observing each other, being friends, being family. 

When somebody—I think I said in my testimony—when somebody 

in our company hurts, we all hurt. So we grow. It’s a small community. Wheeling, West Virginia is a small community. We grow up 

together. A lot of people have grown up together. We attend weddings. We attend funerals. So we know each other. And if we don’t, 

then others do. And we communicate and we share. Just about 

every one of our shift changes in our facilities we try to have somebody on the floor saying, ‘‘Hi, how are you doing? What’s new?’’ 

CEWDOCROOM with DISTILLER

54 

And, when somebody walks in the door, and goes straight to the 

telephone, and picks up the telephone, and makes a call, and puts 

it down, that used to tell us that person came from the halfway 

house, because they had to report in. And then, after their shift, 

they’d pick up the phone, make a call, and head out the door. And 

so it’s just what we begin to observe. It’s the culture that we create 

inside our company, and we talk about it. We communicate. 

Mr. BYRNE. And talk also about the leadership, because everything starts at the top. So how does the leadership of an organization, whether it is a private sector company or anywhere else, how 

does the leadership communicate that to create that sort of culture? 

Ms. ALLEN. By leading. And I don’t mean to be disrespectful with 

that comment, but leadership is about taking care of people in your 

fold. It’s about inspiring people to grow and to develop and to do 

the right thing. It’s about having influential behavior so that others 

can model that behavior and feel comfortable modeling that behavior. In our culture, we communicate together. We work together. 

And as I stand in front of our company, I encourage other leaders 

in our company to stand in front of all of our folks and recognize 

that we’re just like the rest of the people inside our company, it 

makes it a safe environment. It makes it a non-threatening environment. It makes it an environment where people can feel a little 

vulnerable to say, ‘‘Can I talk to you for a minute?’’ 

My door is always open. Our leadership, the rest of our leadership team, our doors are always open and we’re there to help. What 

that also does for us, quite frankly, is it builds a strong community 

inside of our company and it makes us hopefully a model for other 

businesses to recognize the same. 

Mr. BYRNE. Thank you. My time is up. I yield back. 

[The statement of Chairman Byrne follows:] 

Prepared Statement of Hon. Bradley Byrne, Chairman, Subcommittee on 

Workforce Protections 

Good morning, and thank you Chairman Walberg for beginning today’s joint subcommittee hearing. 

I’m pleased to be joining our witnesses and members of both subcommittees as 

we continue the discussion on the impact the opioid epidemic is having on American 

communities and workplaces. 

The alarming increase in the abuse and misuse of opioids is a matter of great national concern, and I am pleased that Congress and the private sector are having 

these discussions and actively looking for ways to reverse the damage of opioids in 

our communities. 

One of the most alarming aspects of this epidemic is that misuse and abuse of 

opioids can happen so quickly, and often begins with prescription medication. 

My home state of Alabama is not immune from this troubling development. Alabama ranks first in the nation in the number of painkiller prescriptions per capita, 

with more than 5.8 million opioid prescriptions written in 2015. That’s more than 

1.2 prescriptions per person. 

An unfortunate reality is that this epidemic is happening to our coworkers, and 

in business communities large and small. Employers and employees alike are seeing 

the personal and economic toll this epidemic is having. 

Only now are we grasping the tragic statistics that illustrate the impact this problem is having on the American workforce. According to one recent estimate, opioid 

abuse costs employers $18 billion per year in sick days and medical expenses. 

It is troubling to hear that workplaces around the country have been affected by 

opioid misuse and addiction. But increased costs are not the most troubling way this 

epidemic has impacted the workplace. According to the Bureau of Labor Statistics, 

CEWDOCROOM with DISTILLER

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the number of overdose fatalities on the job has increased by at least 25 percent 

annually since 2012. 

These facts are alarming because they show that employees who abuse drugs, like 

opioids, are creating unintended consequences for their fellow coworkers. 

Those who misuse any illicit substance while at work are creating a risky environment, and that can also lead to workplace incidents where other employees could 

be hurt on the job. 

Employers are recognizing the risks that opioid abuse has on the workplace, and 

it is reassuring to hear that businesses large and small are taking steps to address 

this problem in their organizations. 

It is encouraging to hear that more employers are looking for ways to identify, 

educate, and assist employees who struggle with opioid abuse and addiction. Employee Assistance Programs are a great tool to help employees get the resources 

they need to start on the road to recovery. I do believe more can and should be done 

to make employees more aware of these resources before it is too late. 

Employers and fellow coworkers play a pivotal role in keeping workplaces safe 

across the country. I join my colleagues in cautioning the federal government from 

taking broad and sweeping action to create unnecessary bureaucratic mandates that 

would inhibit employers who know what programs work best for their individual 

employees. 

Our witnesses today have proven that they are uniquely positioned to tell us more 

about how companies are adopting and executing new best practices to combat this 

tragic epidemic in our communities. I would like to thank the witnesses for sharing 

their stories about how the opioid epidemic affects the workplace, as well as what 

they are doing to help solve this problem. 

Working together with government, businesses, nonprofits, and local communities, 

I am hopeful we can bring an end to the opioid epidemic. 

Chairman WALBERG. I thank the gentleman. I recognize now the 

ranking member on the Workforce Protections Subcommittee, Mr. 

Takano. 

Mr. TAKANO. Thank you, Mr. Chairman. I appreciate this opportunity to question our witnesses. 

My first questions are for Dr. Christina Andrews. Dr. Andrews, 

we know that access to health insurance coverage often makes the 

difference between whether someone seeks healthcare or foregoes 

it. Can you discuss the impact of the Affordable Care Act on the 

ability of patients to access substance use disorder treatment? 

Dr. ANDREWS. Certainly. The Medicaid expansion has been an 

absolutely critical tool used by states in order to improve access to 

opioid use disorder treatment. As I mentioned in my statement, 

roughly one-third of people who are living in the United States who 

have an opioid use disorder have access to insurance, either 

through Medicaid or through the newly established health insurance exchanges. And that enables them to access lifesaving treatment for their condition, most notably medications like 

buprenorphine and extended release naltrexone, which have been 

shown to dramatically reduce risk of overdose and death. 

In our research that we’ve done with stakeholders in 10 states 

throughout the United States these leaders have indicated time 

and time again that a big part of their decision to expand Medicaid 

was related to the opioid epidemic and that they wanted to use 

every policy tool they had available to them in order to address this 

disorder because they were seeing the devastation that it was causing in their communities. 

Mr. TAKANO. So Medicaid has been an extremely, extremely important tool in addressing opioid addictions? 

Dr. ANDREWS. Absolutely. 

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Mr. TAKANO. Well, the budget proposal released earlier this week 

calls for huge cuts to Medicaid funding, what will these cuts do to 

coverage? 

Dr. ANDREWS. Cuts to Medicaid in the midst of an escalating 

opioid epidemic could result in lost lives. I think that Medicaid 

being such an important tool for responding to this epidemic and 

getting treatment for people who need it make it really key. And 

the research that we’ve been doing, as well as a lot of evidence 

that’s been coming out over the past few years, suggests that Medicaid has played an extraordinarily important role in increasing access to opioid use disorders. 

Mr. TAKANO. I just want it to be clear to people out there that 

when the administration talks about cutting back or repealing and 

replacing the ACA, that Medicaid expansion was a huge part of the 

Affordable Care Act. So, you know, I could be using the word Affordable Care Act, but one big chunk of the Affordable Care Act 

was the expanded Medicaid, which allows for just a tremendous 

number of people, millions of people, gaining access to it, gaining 

access to this insurance, therefore also being able to address their 

opioid addictions. 

There seems to be the notion that those on Medicaid are not 

working. However, a majority of Medicaid recipients are working. 

And that is what the head of the Inland Empire—IEHP, which is 

the Medicaid plan in my area, my county, in Riverside County— 

he tells me that, you know, up to 60 percent of the people are 

working. Those that are not are either disabled or they are 

caregiving for somebody. But many of these folks are on low-wage 

jobs where coverage is not available otherwise and so Medicaid fills 

in that gap. 

How does Medicaid impact the health of a workplace? 

Dr. ANDREWS. Mm-hmm, absolutely. Yes, I read that report. Excellent work by the Kaiser Family Foundation looking at non-elderly adults’ participation in the workforce, and seeing upwards of 60 

percent are already in the workforce. Those who are not able to be 

in the workforce, many of whom have substantial barriers to work. 

And one of the major ones is behavioral health disorders, including 

opioid use disorder treatment. So if we were to impose work requirements on this group of individuals it may force them to either 

quit treatment that they need to get well or it would force them 

to forgo treatment in order to maintain their health benefits. 

Mr. TAKANO. Very quickly, my time is running out. So really giving them access to the medical care, the Medicaid, actually will enable them to work. 

Dr. ANDREWS. Absolutely. 

Mr. TAKANO. And supporting the work requirement paradoxically 

would hamper their ability to get into the workforce? 

Dr. ANDREWS. Yes. 

Mr. TAKANO. Anyway, my time is up, Mr. Chairman, and thank 

you for the opportunity. 

Chairman WALBERG. I thank the gentleman. Now I recognize our 

resident professor, Mr. Brat, from Virginia. 

Mr. BRAT. Thank you, Chairman. Your words are prescient. I am 

going to—everyone is going off on the technical side and the policy 

side and the employer/employee side, so I am going to switch my 

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comments a little. I really liked your comment on leadership. I 

think that is absolutely key. Back home I have a few leaders. 

Shinholser runs a foundation. My sheriff, Karl Leonard, in Chesterfield has a program that is so successful, when the inmates get out 

they come back in. They voluntarily come back in for treatment 

and recovery because the team and the spiritual bonds they formed 

are so powerful in helping them recover. And they realize this and 

they speak in those terms. And so that language, the inmates 

themselves use, ‘‘I have a hole in my soul.’’ That is their words. 

That is their language, right. 

And so today in the scientific world, and I taught economics and 

got a PhD, and et cetera. It is hard to quantify the soul, right. Not 

good stuff on that. So I will not bore you with going back to Plato 

and Aristotle. But a lot of ethics, for example, there is not data 

points on ethics. So terms like ‘‘the good,’’ you can’t measure it. It 

is important, I think. Science, right. You can’t prove science exists 

because it is an idea. And yet, I think all of you on this panel agree 

that science exists. And so this has a long pedigree in the history 

of philosophy. And so have we overdone it on the drugs and the 

treatments and the professionalism and missed the boat a little bit 

in terms of ‘‘Hey, I got a hole in my soul. These people are helping 

me deal with that,’’ is there anything going on in the literature? 

And if you all just want to take a quick crack at it, you get 45 seconds each according to the clock. 

Let us start with Mr. Rhyan. 

Mr. RHYAN. I think we very much need to look at solving this 

problem with a holistic approach. And so it’s really both/and because you need both evidence-based treatment services, which have 

been established to work very well, and you also need to look at 

the individual. And certainly taking the approach of doing the care 

one individual at a time is really the best way to solve this problem. But that can be informed by the research as well. It’s really 

both. 

Mr. BRAT. Ms. Allen? 

Ms. ALLEN. Well, thank you, Congressman, for your question. I 

don’t know the research. I don’t do the research; we make 

popsicles. But we believe in people and we believe in the resiliency 

of the human spirit. And we have peer groups, informal peer 

groups inside our company that are friends with each other and 

they recognize problems and they work together. And I don’t know, 

thankfully, because—I’m thankful because that’s the way an organization should operate. I don’t know all of the things that happen, 

but I know that they happen because people care about each other. 

And when you create that kind of an environment, I personally believe a lot of the statistics would take care of themselves. 

Mr. BRAT. Thank you. Professor? 

Dr. ANDREWS. Well, the importance of human connection cannot 

be argued. And I really appreciate that comment. I think it’s central to what we’re doing. It must be a multifaceted approach. We 

need resources to buy naloxone because naloxone can save somebody who has experienced an overdose from dying. We need resources for medications like buprenorphine and extended release 

naltrexone. A recent evaluation coming out of Vermont, where 

they’ve been doing some excellent work around addressing the 

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opioid epidemic, showed that providing that drug along with the 

kind of psychosocial support reduced use of opioids from 86 out of 

90 days when people were coming down to only three days on average; the vast majority of people making huge improvements. And 

as the evidence suggests, we have the tools to solve these problems. 

We need to put the resources to getting them out to everyone who 

needs them. 

Mr. BRAT. Super. Ms. Russo? 

Ms. RUSSO. I’m seeing more employers offering that kind of support to their employees, putting employee assistance plans in place, 

making sure they know about it, making sure that they know 

where in their geographical area they can go for help, you know, 

having strong policies, letting people know that you can take a 

medical leave of absence if you need it. And the other thing that 

many employers do, is they don’t always terminate somebody when 

they test positive on a drug test. They very often will give them 

an opportunity, get evaluated, you know, get help, and then come 

back to work. That’s a very common thing. 

Mr. BRAT. That is great. Thank you very much. Chairman, I 

yield back. 

Chairman WALBERG. I thank the gentleman. I recognize the 

gentlelady from Ohio, Ms. Fudge. 

Ms. FUDGE. Thank you very much, Mr. Chairman. And I am 

really happy that we are having this kumbaya moment right now, 

that we have such a religious group. I too am very religious and 

I thank you for praying the victims of the 18th school shooting this 

year. You know, the Bible tells us to watch as well as pray. So we 

should be knowing and talking about what is going on around us. 

The Bible tells us that we are our brother’s keeper. The Bible tells 

us that we should take care of our children and what Jesus thinks 

about those who don’t. You know, we talk about praying is enough, 

it is not enough. We talk about the mentally ill. There are mentally 

ill people in every industrialized nation in the world and there is 

no other country that has these kinds of shootings. You know why? 

Because they do not have access to weapons of mass destruction by 

way of assault rifles, AR–15s, AK–47s. They don’t have them. That 

is the difference. Yet, we talk about mental health is the problem, 

but we defund mental health treatment, we defund counselors in 

schools. So you can’t have it both ways. Either you care about these 

kids or you do not. Praying doesn’t make it any different. 

Dr. Andrews, we know that it is not always what happens in the 

world, we know sometimes it is about who it happens to. So I remember very clearly when we had a war on drugs and a just say 

no, just because it was crack cocaine and it was affecting people in 

poor and minority and urban communities. Now we are all worried 

about opioids, which I am as well because it is ravaging my community, but because it is happening in rural communities, in 

wealthier communities. We talk about it but we don’t put any 

money behind. We say we want people to get better but we won’t 

pay to treat them. So please help me understand what is it that 

we can do as a Congress to make this situation better? 

Dr. ANDREWS. Absolutely. Thank you for the question. I think 

that one of the things that we learned from the crack cocaine epidemic and the war on drugs was that a strong law enforcement apCEWDOCROOM with DISTILLER

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proach that does not also take seriously the importance of a public 

health perspective and the need for treatment is not successful. 

And it resulted in a mass incarceration of many individuals in 

urban and largely African-American communities. And that resulted in devastating impacts for their children, their families, and 

their communities. And those are mistakes that we must not repeat. And I think that one of the things that is going to be most 

important moving forward is to reduce the stigma around opioid 

use and to connect people to treatment and to provide the resources 

that we need in order to do that successfully. And while I am very 

grateful for the funding that Congress has allocated through both 

the Cures Act as well as the recent budget agreement, addiction is 

a disease that is chronic in nature and that once somebody has the 

disease of addiction they will have to receive services to maintain 

their wellbeing for the rest of their lives. And so short-term funding initiatives that last one or two or three years will not address 

the problem in the long-term. Insurance coverage to enable people 

to stay well is going to be really key. 

Ms. FUDGE. Okay. Just quickly, is it going to help us at all if we 

say to these drug companies, stop marketing opioids to doctors’ offices and paying them to distribute them? A lot of our doctors’ offices have become drug dealers. Am I right? 

Dr. ANDREWS. While this is somewhat out of my area of expertise, I have certainly kept up with the reports and I think it has 

been a very problematic trend that these drugs have been marketed to physicians over a long period of time indicating that they 

are a safe— 

Ms. FUDGE. Dr. Andrews, I am sorry to interrupt you, my time 

is really going. 

Dr. ANDREWS. That’s all right. 

Ms. FUDGE. So I think that we are going in the right direction. 

And I would just say to you that the next time somebody reports 

to you with an opioid problem tell them that our prayers and our 

thoughts are with them. See if it heals them. 

I yield back. 

Chairman WALBERG. I thank the gentlelady and I recognize the 

distinguished chairperson of our full Education Workforce Committee, Mrs. Foxx. 

Mrs. FOXX. Thank you very much, Mr. Chairman, and thanks to 

you and Mr. Byrne for organizing this hearing, and also to all of 

the members of the panel. I think you can see this is a topic that 

unfortunately we have a great deal of interest in because we know 

it is impacting so many people. And we very much appreciate you 

all coming here today. 

Ms. Allen, thank you very much for talking about your personal 

experiences with the Committee today and thank you for taking 

steps in your business to decrease the stigma around prior drug 

use and give individuals a second chance. According to several 

studies, individuals who previously used opioids have the highest 

relapse rates of all substances, excluding alcohol. This suggests 

there is still much work to be done even after rehabilitation. At 

your company, what programs do you have in place that will help 

to decrease the likelihood of relapse? 

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Ms. ALLEN. Thank you, Dr. Foxx, for your question. Specific programs in place, unfortunately, we don’t at this time, but we have 

individual instances. Unfortunately, also, the failure rate is high, 

as you suggested. Once again, it’s not formal, but we watch each 

other, we pay attention to each other. One example I can think of, 

and I believe is in my written testimony, is about an individual 

who we noticed slipping. We tried our best to have conversations. 

We connected him with an outside counselor. We have insurance 

services that will cover those things. But it’s a slippery slope and 

it’s a painful slope. And as Dr. Andrews suggested, it’s a lifelong 

illness. It’s an illness. And we were unable to help him and I believe he’s incarcerated again. 

So we’re working on it. It’s a journey for us. And I have to thank 

the Committee, the Subcommittee for inviting me because out of 

this will come a lot more programs inside our company and inside 

our community as we learn as well. 

Mrs. FOXX. Thank you very much. Mr. Rhyan, many proactive responses to the opioid epidemic came out of necessity, starting at 

the local level. You mentioned the engagement of community stakeholders to discuss the local impact of the opioid epidemic in Lorain 

County, Ohio. Can you talk more about specific ways employers are 

getting involved in their local communities and how local leaders 

are playing an important role by coordinating with employers and 

others to address the opioid epidemic? 

Mr. RHYAN. Thank you. That’s a very important question. And 

being aware of the local circumstances, not only of the problems 

that are going on within the community, but also what the resources available there are. Part of our project in Lorain County 

was to go and do an availability and services analysis and go out 

and actually look and say, ‘‘What are the services that are available right now and where are they within the county?’’ Because the 

services that are available don’t always line up with where the 

needs are of the population. And so certainly employers that can 

be aware and make those connections ahead of time and be aware 

of where the needs are and then also where the solutions are and 

where the services are available is really important. And to be able 

to draw those connections for their employees as soon as possible 

helps expedite individuals into treatment and helps make that 

treatment more likely that it’s going to stick and that they’re going 

to actually continue through to recovery. 

Mrs. FOXX. So being prepared in case something happens you are 

saying? 

Mr. RHYAN. Yes, right, absolutely. This is certainly something 

that we need to—employers need to be ready for ahead of time. 

They can’t be reactive to this problem anymore. 

Mrs. FOXX. All right. Ms. Russo, we heard Ms. Allen talk about 

how her company is providing resources and assistance to employees who are struggling with opioid abuse. What are some of the 

steps that you think that small businesses in particular can take, 

regardless of their size, to begin to address opioid abuse in their 

workplace? Are you familiar with other programs that you can 

share with us? 

Ms. RUSSO. I think training is a very important thing for employers to do, both of their supervisors and the employees. I think, you 

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know, many employees don’t really understand how addictive painkillers are, how dangerous it is if they are interacted with alcohol 

or other types of drugs. I think, you know, providing training to 

employees is helpful. Training supervisors on drug policies and how 

to address drug problems in the workplace, I think, is extraordinarily helpful because very often supervisors don’t know what to 

do. Having clear medical leave policies is very important. Having 

employee assistance plans is very important. Consider changing 

your drug testing policy from terminating everyone, to offering 

them an opportunity to get treatment. Those are some of the things 

that I’m seeing employers do. 

Mrs. FOXX. Thank you very much. My time is up. 

Chairman WALBERG. I thank the Chairwoman and I recognize 

the ranking member of the full Committee and gentleman from 

Virginia, Mr. Scott. 

Mr. SCOTT. Thank you, Mr. Chairman. Mr. Chairman, you 

opened the hearing by talking about the tragedy in Florida and the 

need to do something about school shootings. So, Mr. Chairman, it 

is obvious that the Judiciary Committee is unable to hold hearings. 

They didn’t hold hearings even after Sandy Hook. And I was wondering if this committee could hold hearings, particularly in light 

of the quote this morning in Politico where Secretary DeVos has 

encouraged Congress to hold hearings on school shootings. I was 

wondering if you could make a commitment to hold some hearings 

in this committee. 

Chairman WALBERG. Well, I appreciate the question and I certainly will talk with the chairman of the full Committee, Ms. Foxx, 

about that and where we have authority and opportunity to assist 

and move forward in whatever area that comes under our jurisdiction. We are certainly open to that. 

Mr. SCOTT. Thank you, Mr. Chairman. 

Dr. Andrews, you indicated that drug testing is not an effective 

deterrent. Other testimony has suggested that it is a good strategy. 

Could you comment further on why drug testing is not an effective 

strategy to deal with the problem? 

Dr. ANDREWS. I’d be happy to. As I’ve mentioned previously, addiction is a disease. It is a chronic disease. And one of the symptoms of the disease is uncontrollable cravings for a substance. And 

as a result of that, the threat of a drug test or random drug testing 

would not necessarily be successful in keeping somebody from 

using because they have a physiological dependence on that substance. The best way to stop people from using opioids is to provide 

treatment, especially medication assisted treatment. 

Mr. SCOTT. Is that reality the reason why the criminal justice 

system as a response is a totally ineffective strategy from a cost effective basis? 

Dr. ANDREWS. Yes, I believe very strongly that a public health 

approach is needed to respond effectively to the opioid epidemic. 

Decades of research document that addiction is a disease and it requires treatment in order to help people to move into recovery and 

to maintain recovery. 

Over the past couple of decades science has made incredible advances in treatment and we now have medications, such as 

buprenorphine and naltrexone that are very effective in helping 

CEWDOCROOM with DISTILLER

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people to get well. And that has incredible benefits for employers 

who are able to retain people who’ve made valuable contributions 

to their company. 

Mr. SCOTT. As you have suggested, that treatment is not free and 

you said one-third of the people pay through the Affordable Care 

Act, either Medicaid expansion or the exchanges. One of the Affordable Care Act visions is a list of essential benefits where behavioral 

healthcare, including substance abuse treatment, is part of it. You 

mentioned the associated health plans that will allow plans to be 

written without the essential health benefits, how do other initiatives that eliminate or reduce the importance of essential health 

benefits, how do they affect the ability to afford substance abuse 

treatment? 

Dr. ANDREWS. Right. When people purchase a plan that doesn’t 

include the consumer protection to cover substance use disorder 

treatment they can find themselves in a position where one of their 

or their family members needs lifesaving treatment for opioid use 

disorder and cannot afford to receive it. In those cases their only 

option is attempt to receive treatment from a safety net provider 

that is funded by federal and state block grants. But unfortunately 

those programs often have very long wait lists and people are required to wait weeks and months to receive treatment. And we 

simply do not have that kind of margin of error with this particular 

illness and the high risk of overdose and death that is associated 

with it. 

Mr. SCOTT. Thank you. And the Affordable Care Act also has a 

prohibition against considering preexisting conditions. If someone 

has had a long period of addiction and buys a policy, under present 

law they can get treatment. If the Affordable Care Act and all its 

protection are repealed, can you say what effect the loss of preexisting conditions protection would have? 

Dr. ANDREWS. When people who have an opioid use disorder are 

unable to access treatment due to financial barriers they will suffer, their children will suffer, their families will suffer. They will 

have risk of overdose and death as a result. 

Mr. SCOTT. Thank you, Mr. Chairman. 

Chairman WALBERG. I thank the gentleman. Now I recognize the 

gentleman from Wisconsin, Mr. Grothman. 

Mr. GROTHMAN. Thank you. I was just looking a little bit about 

the tragedy yesterday in Florida and, at least if you can believe 

what they say on the internet, the shooter was receiving mental 

health treatment, which reminds us that mental health treatment 

is not all panacea. Sometimes it makes things better, sometimes it 

makes thing worse. You never know, but it is something we have 

got to remember. 

One of my senior staff had a relative who recently had a major 

surgery, was prescribed opiates and, per usual, more opiates than 

they would ever need. It is really a problem with the medical establishment, that they have overprescribed these things. But when his 

fellow co-workers found out that they had extra opiates they harassed him all the time for them, which is kind of amazing. And I 

wonder is this a common experience that you find, that employees 

who maybe were injured at one time or another get harassed by 

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other employees looking for more opiates? Anybody heard of that 

being a problem? No, nobody has. 

Ms. RUSSO. I have. 

Mr. GROTHMAN. Okay. 

Ms. RUSSO. I often counsel employers who are dealing with employee misconduct issues because they have got employees who are 

selling their oxycontin to co-workers at work. It is a very big problem for employers. 

Mr. GROTHMAN. Okay. Yeah, it is a real problem with the medical community that they have over prescribed these things. And 

it shows no matter how long you go to school, it doesn’t give you 

common sense. 

Next question I have, obviously there is a lot of treatment going 

on already and again and again you hear of people who have been 

in treatment lots of times and it doesn’t succeed. So it would indicate to me that the last thing we want to do is throw money at 

treatment because, again, bad treatment is almost sometimes better than no treatment. Could anybody comment on the percentage 

of times people go in for treatment that they stop using opiates? 

Anybody have a comment on that in their experience, in their businesses? Does it work half the time, a tenth of the time, 90 percent 

of the time? Any comments? 

Dr. ANDREWS. I can speak to that. Before we had access to evidence-based medications for treatment of opioid use disorder, rates 

of recurrence of use were very high, upwards of 80 percent. But 

with the introduction of buprenorphine and extended release 

naltrexone we are seeing much, much higher success rates in terms 

of people being able to maintain—to get into recovery and to maintain recovery. 

Mr. GROTHMAN. I am going to cut you off because I have such 

a limited period of time. How many times do you have to use say 

an opiate, say heroin, to become addicted to heroin? Do you want 

to go right down the aisle and you can all give me a number? 

Mr. RHYAN. I’m not a medical professional so I don’t think I 

should— 

Mr. GROTHMAN. Nobody knows? Anybody have an opinion on 

that? 

Ms. ALLEN. I have no idea. I’ve never used opioids. 

Mr. GROTHMAN. Okay, nobody knows. 

Ms. ALLEN. But I have heard that it doesn’t take more than once. 

I’ve heard people say that the only difference between them and me 

or you is one decision. 

Mr. GROTHMAN. Well, I am not sure that is true. Okay, go ahead, 

Ms. Allen—or Ms.—I am sorry. 

Dr. ANDREWS. The research suggests that the proportion of people who engage in what is called casual opioid use or heroin use, 

about 20 percent of those will proceed on to sort of a full-fledged 

dependence and addiction. So that’s what we know at present. 

Mr. GROTHMAN. Okay. Okay. Okay, we will leave it at that. I 

give the rest of my time back to the Chair. 

Chairman WALBERG. I thank the gentleman. Votes, have they 

been called? 10 minutes left to vote? Well, we will—the members 

have this series of votes. We need to get to the floor. But to allow 

members the opportunity to question the witnesses, we will return 

CEWDOCROOM with DISTILLER

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to the hearing as quickly as possible. I urge all members to return 

here and as soon as we have a sufficient number of members we 

will begin. And so forgive us for having to leave you at your seat 

right now. We will do our best to get the votes and then be back. 

We stand in recess. 

[Recess] 

Chairman WALBERG. The Subcommittee will come to order. I appreciate the witnesses cooling your heels for that period of time, including our demonstrations. So we are glad to be back. 

I now recognize the gentlelady from Delaware, Ms. Blunt Rochester. 

Ms. BLUNT ROCHESTER. Thank you, Mr. Chairman. First, I want 

to thank the panel so much for your testimony and just on so many 

different levels. And I have a few different questions that aren’t 

necessarily connected. 

So the first is going to be Ms. Russo. You all talked about the— 

my real question is whether—you know, I assume if it is a physically demanding or a dangerous job that it would be 

disproportionally impacted in terms of who is prescribed and who 

might be a part of this epidemic. But I was wondering if there are 

particular industries that you are seeing higher incidents of addiction? And also for Dr. Andrews as well. 

Ms. RUSSO. For me I can only give you anecdotal evidence. What 

I’m seeing is—the highest rate of addiction I’m seeing is in the 

health care industry, mainly because people who work in hospitals 

and clinics have access to drugs. So I deal with a lot of health care 

employers who have employees who are addicted. That’s just my 

personal reaction. 

Ms. BLUNT ROCHESTER. Great, thank you. Dr. Andrews? 

Dr. ANDREWS. The available research we have suggests that the 

highest incidence that rates we are seeing are in the fields of construction, manufacturing, and mining. And I do not think it is coincidental that those are all fields that are physically demanding and 

sometimes dangerous. 

Ms. BLUNT ROCHESTER. Thank you. My next question shifts to 

Ms. Allen. I want to really thank you so much for the leadership 

that your company provides, both for the products that you produce 

but also your person centered approach to management. And I was 

wondering if you could talk a little bit about the supports that you 

provide. As you talked about Sonny, you know, I wondered about 

what kind of infrastructure you have, whether it is an HR team, 

a really good HR team. You talked about the peer to peer and also 

just the culture, a family culture. But I was more interested also 

in are there specific supports that you provide. If you want to give 

it in writing later, that is fine too. 

Ms. ALLEN. No, I will be happy to answer that. Thank you. One 

of the things that we have done is we work with some local social 

service agencies. We’ve worked with other businesses around the 

country to share best practices. And what we’ve done is we work 

with the social service agencies for the wraparound services for our 

employees. So if they have an issue we can refer them. We can help 

them find the help that they need hopefully. 

We were talking at the break, one of the problems in our area 

is that the services are busting at the seams with the need and not 

CEWDOCROOM with DISTILLER

65 

enough opportunity to provide the services. We work with counseling services in our community, we work with the healthcare industry, and we work with other businesses just to see what, you 

know, other avenues are out there to help our folks. 

Ms. BLUNT ROCHESTER. Great. Thank you. 

Ms. ALLEN. We also—one other thing, if I may, is we work closely with the Board of Prisons, both in West Virginia, in our area— 

and we’re in Wheeling, which is the northern panhandle, so we 

work closely with the Board of Prisons in the Ohio system as well. 

And so we interact with them and hopefully can find reentering 

citizens that way. 

Ms. BLUNT ROCHESTER. Thank you. And then my last question 

is really centered around the whole issue that Mr. Sablan and Ms. 

Fudge touched on in terms of the incidence in terms of people of 

color. I read recently a New York Times article that actually said 

that the opioid crisis is getting worse, particularly for black America. That was the title of this New York Times article. And in the 

beginning I think there was an under representation because many 

people of color were not being prescribed pain medicine. And now 

with fentanyl it seems to be on the rise. And so I was hoping that, 

whether it is Dr. Andrews, and then, Mr. Rhyan, if you would like 

to touch on that. And we have 30 seconds. 

Dr. ANDREWS. I’ll try to make this quick. Overdose and death 

among African-Americans is on the rise. It is now growing faster 

than it is for white Americans. This problem is exacerbated by the 

fact that African-Americans were under represented in Medicaid 

expansion states. What I mean by that is that those states that 

chose not to expand Medicaid have a higher proportion of AfricanAmericans. So at a time when this rate is increasing rapidly they 

are more likely to be in places where they will not have access to 

care if they are low income. 

Ms. BLUNT ROCHESTER. Thank you. My time is expired, but I 

would appreciate anything in writing as a follow up. 

Thank you. Thank you, Mr. Chairman. 

Chairman WALBERG. I thank the gentlelady. Now I recognize the 

gentleman from Georgia, Mr. Allen. 

Mr. ALLEN. Thank you, Mr. Chairman. And thank you so much 

for being with us and enduring some of these questions that you 

are getting. I feel like I have got to comment as far as the terrible 

tragedy yesterday. And I just pray that prayers continue to flow 

there because it is the only way that I know that we can try to— 

I mean it is the only way that I can deal with things like this. It 

is just horrible. It is evil at its worst and it is just terrible. And 

my strength comes from Mark 11:24, ‘‘Therefore I tell you, whatever you ask in prayer, believe that you have received it, and it will 

be yours.’’ And of course that takes a tremendous amount of faith 

to do that. And there are hundreds of other verses. God promises 

that if we would just believe those that we could correct a lot of 

these issues that we are dealing and talking with here today. And 

that is just my belief and my value system. I cannot change you, 

I cannot change myself. I cannot change anybody. But- and as far 

as the ironic part of this is that we are talking about something 

that is an epidemic here that is highly illegal in this country. I 

mean, we cannot seem to obey the laws we have, whether it is imCEWDOCROOM with DISTILLER

66 

migration or drugs or whatever. So I don’t know. You know, I think 

the answer is, you know, what makes up your DNA and what you 

believe. 

To that extent, Ms. Allen—I hope we are related somewhere because, I will tell you, I was really impressed with—I am a small 

business owner and had to deal with a lot of these issues and had 

to deal with the drug situation. And, again, did it not from my— 

did it in a compassionate way and tried to help folks get well and 

get back to work. But as far as the percentage of your employees 

that have a drug problem, is it—I mean what—in your past, and 

you have got 300 employees now, what percent are really have an 

issue with this would you say? 

Ms. ALLEN. Well, Congressman Allen, we believe—we don’t ask 

the question necessarily. There is conversation, but we don’t necessarily ask it. It is our estimation that between 20–25 percent of 

our total workforce has some kind of a checkered past. 

Mr. ALLEN. Right, okay. So they have had to deal with this issue 

in the past? 

Ms. ALLEN. Themselves. Their families I can’t even speak to. 

Mr. ALLEN. Is there any evidence that—obviously you are a great 

company—And like I said, I have 12 grandchildren and we do, I 

use a lot of your products. 

Ms. ALLEN. Thank you so much. 

Mr. ALLEN. Yeah, I mean it is the best babysitter in the world, 

let me tell you. But you have got a great company and obviously 

you care deeply for your employees and they care deeply for you 

and that company. And you have had an amazing track record in 

rehabilitation. And I don’t know what, you know, those that you 

have lost that you haven’t been able to save from this problem, but 

would the fact that you are able to give somebody a good job making a great product and the opportunity for them to give themselves the dignity and the empowerment that they deserve as a 

human being on this earth, would that have something to do with 

them recovering from this horrible addiction? 

Ms. ALLEN. 100 percent, absolutely. 

Mr. ALLEN. 100 percent? Yeah. 

Ms. ALLEN. Absolutely it would. The ability to have a job and feel 

secure in having the ability to take care of yourself, let alone your 

family, to get out of homelessness, all those things require money 

and you get money from having a job. And so to provide somebody 

the opportunity to have the sense of pride and the sense of selfworth and the sense of dignity, to be able to walk home with a paycheck, that feels good, that feels really good to them. And for us 

to be able to provide that, we’re proud of that. We’re very proud 

of that. Are there failures? Absolutely. Does that stop us? No. We 

look for people who can fit inside our value system. And just because some people made a bad decision or a bad choice, doesn’t 

mean they still aren’t great people and have the opportunity to reprove themselves. 

Mr. ALLEN. We all fall short, we all fall short. 

Ms. ALLEN. Absolutely. Because we’ve all made bad decision. 

Mr. ALLEN. Mr. Rhyan, do you have any research that—I got 20 

seconds—any research that might help us with, okay, how do we 

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67 

actually fix this? You know, what is the best way to deal with these 

things? 

Mr. RHYAN. Yeah, I think, as I said in my oral and written testimony, looking at this both from a treatment and a prevention perspective is really important. And I think employers that can play 

a role in providing treatment and recovery services is important, 

but also thinking about how they can act on the prevention side, 

and really limiting the opioids that are going into their environment and also helping their employees not get an addiction before 

it starts. 

Mr. ALLEN. Thank you all so much. And I yield back. 

Chairman WALBERG. I thank the gentleman. Now I recognize the 

gentlelady from Oregon who has spent a lot of time recently listening to these concerns, Ms. Bonamici. 

Ms. BONAMICI. I have. And thank you, Mr. Chairman. And I 

wanted to start also by making a comment, and with following up 

to Mr. Allen’s comment, you know we have all been praying in our 

ways. We prayed after Sandy Hook, we prayed after Pulse, we 

prayed after Tamaqua Community College, we prayed after Las 

Vegas, after the church in Texas, and of course the nation is all 

praying, everybody in his or her own way after yesterday. But kids 

are still being murdered in schools. Prayers are not enough. And 

I want to align myself with Mr. Scott’s call. And I don’t always 

agree with Secretary DeVos, but I agree with her this morning. We 

have to have hearings to find out how we can keep our kids safe 

in school. I am a mom, my kids are grown, but I cannot imagine 

what those parents are going through. 

So, thank you, Mr. Walberg. Yes, I have just had five listening 

sessions around northwest Oregon with health care providers, people in recovery, law enforcement, and of course employers. I appreciate so much of the testimony here today and understand that 

work and our personal lives are so intertwined. Ms. Allen, thank 

you so much for setting that example. We have a business in my 

district, Beaverton Bakery, that has a second chance program. 

They work with our drug treatment court. And when we acknowledged them recently I prepared for an onslaught of criticism, but 

the response was overwhelmingly positive. So I think we will see 

that as more and more businesses do what you are doing. 

Mr. Rhyan and Dr. Andrews, you both mentioned drug disposal 

as important tools, and that is something that has come up in my 

listening sessions. There just are not enough options for people. It 

is one important step. There are not enough options for people to 

get rid of their unused prescription pills. So can you please elaborate about the role that employers could play in providing a solution? And briefly because I do have another question. Mr. Rhyan? 

Mr. RHYAN. Sure. I think you can look at Walmart as a great example. And they have proposed offering these sites both for their 

employees and for customers as well. And so I think employers absolutely can step up to do that, because you’re right, not all local 

police stations have this. I know many do, but certainly many 

don’t. 

Ms. BONAMICI. And not to interrupt, but a lot of my constituents 

don’t feel comfortable walking in to a police station saying I want 

to get rid of my unused drugs. I have a significant Latino popuCEWDOCROOM with DISTILLER

68 

lation, minority populations. They are just not comfortable walking 

into a police station with drugs. So we have to have alternatives 

for people to get rid of those pills. 

Dr. Andrews, do you have anything to add? 

Dr. ANDREWS. I think that this is an incredibly important issue. 

Safe drug disposal must be an important component of prevention 

efforts around the opioid epidemic. I think that, you know, integrating safe disposal into places like pharmacies, primary care, 

places that are not either stigmatized or present criminal threats, 

and allow people to feel comfortable getting rid of those unwanted 

drugs is really key. 

Ms. BONAMICI. Thank you. Those are logical. I want to move on— 

as the clock goes down. Mr. Rhyan, you mentioned parity for coverage of behavioral health. And one of the issues that has come up 

frequently is alternative treatments. We have at our Oregon 

Health Sciences University a great pain management clinic, but 

often times alternative treatments, whether it be physical therapy, 

massage therapy, acupuncture, they are not covered. And so they 

are not prescribed and instead opioids are prescribed. So are there 

good reasons for employers to make sure these alternative treatments are covered in the plans they offer? And how could we expand the number of employers who are doing that? 

Mr. RHYAN. Yes, absolutely. Employers should be involved and 

engaged in the insurance that they’re offering to their employees 

and making sure that these alternatives are available. I think 

we’ve realized the risk of prescribing an opioid for chronic pain and 

the risk of addiction that occurs from that is very costly to that employer. And so making these alternatives available has the potential to save that employer money and is a better option for the employee themselves. 

Ms. BONAMICI. Dr. Andrews, anything to add? 

Dr. ANDREWS. Yes. I would add to that there’s research that suggests that opioids are not effective for chronic pain management 

and that we have to start funding both services as well as medications that are going to be more effective. 

Ms. BONAMICI. Alternatives. And, Mr. Rhyan, you know, I have 

heard about sometimes fear of job loss or income loss. Somebody 

with a substance abuse disorder might delay or forego getting 

treatment. So how could comprehensive job protected paid leave 

allow workers to seek treatment and support those in their family 

who many need treatment? 

Mr. RHYAN. I think both of those options are very important. The 

evidence that we’ve seen from Lorain County and the other work 

that we’ve done is that employers that offer those programs tend 

to see very positive results from those cases. And certainly I think 

you can give examples as well, that shows a strong benefit and is 

good for all parties. 

Ms. BONAMICI. Thank you. And, again, Mr. Chairman, thank you 

so much, and Ranking Member, for holding this hearing. It has 

been very informative and I yield back. 

Chairman WALBERG. I thank the gentlelady. And now without 

objection I would like to recognize for questioning, five minutes of 

questioning, the gentleman from Pennsylvania who does not serve 

on the Subcommittee but who is in the full Education Workforce 

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69 

Committee and has a background in medical profession and has 

great interest in this issue, Mr. Thompson. 

Mr. THOMPSON. Well, thank you, Chairman. First of all, I appreciate not being objected to. 

Chairman WALBERG. I didn’t hear objection. 

Mr. THOMPSON. Okay. I am not going to raise one, so. And thank 

you to the panelists who are here. I mean this is the public health 

crisis of our generation. I have also conducted opioid roundtable listening sessions throughout my congressional district and continue 

to do that. I represent about a quarter of geographically the state 

of Pennsylvania, a lot of rural communities. The CDC, in October 

of 2017, published a report showing how disproportionately this is 

hitting rural America. This is hitting all populations, all households, all zip codes, all socioeconomic levels of living. 

I would caution against a narrow focus on opioids, because what 

we need to be looking at is addictive behaviors. I have communities, and I heard these stories where it was opioids and then because of what happened with heroine and opioids and some of the 

things that were put into it, the number of deaths, the number of 

focus on it, that the users shifted, they actually went to the treatment, suboxone, and utilized that illegally. They have gone back to 

meth because of all the factors. Whatever we do, we cannot do a 

narrow focus, Mr. Chairman. We need to do this so it applies to all 

behaviors. 

Most recently I met with folks from—some wonderful people that 

work in the prison system. They talked about this frightening thing 

called—and I am not going to go into it—but K2, which is—could 

not believe the stories they told with that. But some of the things 

I heard about though, was a lack of treatment. We have since the 

Great Society—there was a push back then to deinstitutionalize the 

Great Society. I think their push, the outlawing in 1965 of any 

kind of use of Medicaid in facilities larger than 16 people. That was 

a huge mistake. As opposed to improving those facilities so that 

they actually met needs, they just arbitrarily said you just can’t go 

there. And I believe, as I talked with family members and people 

in the community, we have very limited options. We have drivethrough treatment today, which doesn’t work. And we need longterm treatment. 

And I was very pleased, the Trump administration’s actually was 

the first one since the Great Society of 1965 who encouraged the 

states to exercise their waivers for Medicaid to be able to, you 

know, to be able to use those in facilities that have more than 16 

beds. That is what we need. In a rural part of America, which is 

where I am from, you know, it is small facilities. And we have very 

limited options. 

And also, I am pleased with the support. Under President 

Obama we put $1 billion into this battle through the Cures Act, 

and under President Trump, just last week, we put $6 billion into 

this battle. You know, we need to continue to be attentive. 

So workforce, like many national crises the opioid epidemic is 

multifaceted. We have taken steps to respond and I am really appreciative of your comments. 

The President’s Commission on Combating Drug Addiction and 

the Opioid Crisis released recommendations in November. And 

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70 

while the Commission’s recommendations were vast, the only notable recommendation related to workforce addressed the shortage 

and the lack of training for substance abuse and medical training 

professional. 

So, very quick, in the time I have left, do you agree with the 

workforce recommendation by the Commission? And what further 

workforce recommendations were you anticipating? That is jump 

ball. Go for it, whoever would like to take that on. 

Dr. ANDREWS. I think that training is absolutely key, particularly 

around safe prescribing of opioids, and particularly for physicians 

and other prescribers of drugs. We have a series of excellent guidelines that have been established by the CDC to help physicians 

make good choices about safe prescribing, but we need to do more 

in terms— 

Mr. THOMPSON. But how about on the treatment side? 

Dr. ANDREWS. Mm-hmm. Right. 

Mr. THOMPSON. Because, you know, I understand responding to 

the crisis and preventing the problem. 

Dr. ANDREWS. Oh, absolutely. 

Mr. THOMPSON. But I am finding the key now really is—the key 

thing that we are not doing that we need to do is making sure that 

we have the long-term effective treatment to help people get, you 

know, get—once you are an addict I understand you always carry 

part of that, but how do we deal with that and help people live 

healthy lives post addiction? 

Dr. ANDREWS. Well, I think every state in the country should 

apply for a waiver for the IMD exclusion. 

Mr. THOMPSON. Agreed. 

Dr. ANDREWS. And I think that we need to, you know, train licensed professionals to provide these services. We’ve been making 

strides towards that end, but there is more to be done. 

Mr. THOMPSON. Thank you. Thank you, Chairman. 

Chairman WALBERG. I thank the gentleman. And I would like to 

thank Mr. Rhyan, Ms. Allen, Dr. Andrews, Ms. Russo. Thank you 

for providing your insights to our panel today. A number of them 

talked to me on the way back to votes that they were so disappointed we just couldn’t have carried it on, and schedules get in 

the way. One even said she is going to get the tape of it and see 

the ending. So you have been a great help to us and this is all a 

process that we go through. 

Seeing no other members that have questions I now turn to 

Ranking Member Takano for his closing comments. 

Mr. TAKANO. Thank you, Mr. Chairman. And I want to thank 

you again for hosting this important hearing, and the witnesses for 

providing their testimony. 

The opioid epidemic, and substance abuse more broadly, has 

been felt in every corner of this country. The impact is never limited to just one individual, it affects families, friends, and even employers. More than half of adults struggling with substance abuse 

were employed full-time in 2012. In a recent survey from the National Safety Council found that 70 percent of employers have felt 

the negative effects of prescription drug usage, including absenteeism, impaired or decreased job performance, and near misses or injuries. If we are going to make any progress in addressing the 

CEWDOCROOM with DISTILLER

71 

opioid epidemic and addressing substance abuse disorders in general, our workplaces must have policies that support affected workers. 

Now as Ranking Member Sablan said, access to comprehensive 

health coverage is imperative for workers with substance abuse 

disorders. Efforts to rollback protections or reduce the quality of 

health coverage denies them the help they need to move towards 

recovery. Workers affected by substance abuse also benefit from 

strong workplace policies that prevent addiction, allow them to 

take time to seek recovery, and help them reenter the workforce. 

As with many of the problems this committee seeks to tackle, 

preventative efforts will save lives. Employees who sustain workrelated injuries and are treated within the workers’ compensation 

system are often prescribed opioid pain medications. In 2011 more 

than 25 percent of cost from worker’s compensation prescription 

drug claims were for opioid pain medications. Employers can take 

active steps to reduce the risk of workplace injuries that lead to 

opioid use. Injury and illness prevention programs require employers to work with their employees to proactively find and fix hazards. These programs required or encouraged by 34 states, including my home state of California, are proven to reduce injuries on 

the job. 

At work, when employees do suffer from a substance abuse disorder they often need to take extended periods of time to seek 

treatment. But workers who fear losing their jobs or missing a paycheck may delay or forego needed treatment. Currently, eligible 

workers who take leave under the Family and Medical Leave Act 

for substance abuse treatment are protected from retaliation. Unfortunately, 60 percent of workers are not eligible for leave under 

the FMLA. What is more, workers who are actually eligible often 

cannot afford a missed paycheck. According to a 2012 survey, 46 

percent of FMLA eligible workers did not take leave because they 

could not afford to take unpaid time off. Paid family leave, as provided under the Family Act can provide crucial support for workers 

seeking treatment. 

Now, as we have recently seen, Republican proposals for paid 

leave, and we have actually seen Republican proposals for paid 

leave, and this is very encouraging. As we consider them, I think 

we should ask if these proposals would guarantee workers the ability to take leave for substance abuse treatment. 

We also know that the opioid crisis and the substance abuse disorders in general can lead to people leaving the workforce. An estimated 20 percent of men’s and 25 percent of women’s decreased 

labor force participation between 1999 and 2015 can be attributed 

to the increase in opioid prescriptions. When we hear these statistics it becomes clear how important it is for our employers to implement policies that break down barriers for impacted workers trying 

to reenter the workforce. For instance, while there is wide use of 

workplace drug testing policies there is little evidence that they actually are effective. Likewise, employers should reconsider hiring 

practices and policies for those with a criminal record. Ban the box 

policies can ensure employers first consider a worker’s ability to do 

the job. 

CEWDOCROOM with DISTILLER

72 

To put it mildly, our country has had inconsistent responses to 

drug epidemics affecting our communities. But if we have learned 

anything, it is that we should try to rely on evidence base approaches to support those who are impacted. Strong sentiment and 

feelings of support are not enough. America’s employers must step 

up to the plate and implement strong policies that support national 

efforts to address substance abuse. 

Thank you again, Mr. Chairman, for this hearing. Thank you to 

the witnesses. And I yield back my time. 

[The statement of Mr. Takano follows:] 

Prepared Statement of Hon. Mark Takano, Ranking Member, Subcommittee 

on Workforce Protections 

I want to thank the Chair for hosting this important hearing. The opioid epidemic 

- and substance abuse more broadly – has been felt in every corner of this country. 

The impact of addition is never limited to just one individual. It is affect families, 

friends, and even employers. 

More than half of adults struggling with substance abuse were employed full-time 

in 2012. And a recent survey from the National Safety Council found that 70 percent of employers have felt the negative effects of prescription drug usage, including 

absenteeism, impaired or decreased job performance, and near misses or injuries. 

If we are going to make any progress in addressing the opioid epidemic and addressing substance abuse disorders in general, our workplaces must have policies 

that support affected workers. 

As Ranking Member Sablan has said, access to comprehensive health coverage is 

imperative for workers with substance abuse disorders. Efforts to roll back protections, or reduce the quality of health coverage, denies them the help they need to 

move towards recovery. 

Workers affected by substance abuse also benefit from strong workplace policies 

that prevent addiction, allow them take time to seek recovery, or help them re-enter 

the workplace. 

As with many of the problems this committee seeks to tackle, preventative efforts 

will save lives. 

Employees who sustain work-related injuries, and are treated within the workers’ 

compensation system, are often prescribed opioid pain medications. In 2011, more 

than 25 percent of cost from workers’ compensation prescription drug claims were 

for opioid pain medications. 

Employers can take active steps to reduce the risk of the workplace injuries that 

lead to opioid use. Injury and Illness Prevention Programs require employers to 

work with their employees to proactively find and fix hazards. These programs, required or encouraged by 34 states, including my home state of California, are a 

proven way to reduce injuries on the job. 

At work, when employees do suffer from a substance abuse disorder, they often 

need to take extended periods of time to seek treatment. But workers who fear losing their jobs or missing a paycheck may delay or forgo needed treatment. 

Currently, eligible workers who take leave under the Family and Medical Leave 

Act for substance abuse treatment are protected from retaliation. Unfortunately, 

sixty percent of workers are not eligible for leave under the FMLA. What’s more, 

workers who are actually eligible often cannot afford a missed paycheck. According 

to a 2012 survey, 46 percent of FMLA-eligible workers did not take leave because 

they could not afford to take unpaid time off. Paid family leave, as provided under 

the FAMILY Act, can prove crucial for workers seeking treatment. 

We have recently seen Republican proposals for paid leave, and this is encouraging. As we consider them, I think we should ask if these proposals would guarantee workers the ability to take leave for substance abuse treatment. 

We also know that the opioid crisis, and substance abuse disorders in general, can 

lead to people leaving the workforce. An estimated 20 percent of men’s and 25 percent of women’s decreased labor force participation between 1999 and 2015 can be 

attributed to the increase in opioid prescriptions. When we hear these statistics, it 

becomes clear how important it is for our employers to implement policies that 

break down barriers for impacted workers trying to re-enter the workforce. 

For instance, while there is wide use of workplace drug testing policies, there’s 

little evidence that they are actually effective. Likewise, employers should reconsider hiring practices and policies for those with a criminal record. Ban the box policies can ensure employers first consider a worker’s ability to do the job. 

CEWDOCROOM with DISTILLER

73 

To put it mildly, our country has had inconsistent responses to drug epidemics 

affecting our communities. But if we’ve learned anything, it is that we should rely 

on evidence-based approaches to support those impacted. Strong sentiment and feelings of support are not enough. America’s employers must step up to the plate and 

implement strong policies that support national efforts to address substance abuse. 

I thank the witnesses for taking the time to testify today. Thank you. I yield back 

my time. 

Chairman WALBERG. I thank the gentleman, appreciate his 

words. This was an important hearing. This hopefully will lead to 

further considerations, hopefully will lead to compassionate responses, sensitivity to the issue of concerns on both sides, on the 

issue of employee with a need for something to deal with chronic 

pain, for the employee who has become addicted to a substance, an 

ability to look at their needs and find cooperative solutions. On the 

other side, to look to the employer, to make sure that we applaud 

the employers who are trying their best to find a way to work with 

the problem and see it as an opportunity to grow a family, or a 

tribe, as you mentioned, Ms. Allen, in your experience. That we encourage employers by allowing a great amount of latitude and flexibility, to work with their own employee group and not have a onesize-fits-all that sometimes becomes extremely costly and unproductive, but also have some framework in place that does the encouragement that is necessary to find solutions that at least go as 

far as possible in making things work. 

I think as well, my colleagues would agree, that while we look 

at opioid heroine abuse, as was mentioned by Mr. Thompson, it is 

broader than that. Because if it goes from there, it will go to something else, and we need to be prepared for that as well. 

And also in the process, I might also suggest that we develop a 

recommitment to a society that shares some common values that 

impact in a positive way our nation, our thought processes, and encourage decency and order, compassion and caring, and commitment to responsibility as well as accountability also. 

It is a big challenge, but this country has met challenges before. 

I remember reading in history, over and over again, of times when 

our framers and founders ultimately locked horns and just could 

not come to a solution, knelt in prayer, ultimately got up and did 

things. Faith and works together make an impact. 

So thank you for being with us today. Thanks to the Committee. 

And having no other thing to come before us, I declare it adjourned. 

[Whereupon, at 12:41 p.m., the subcommittees were adjourned.] 

Æ 

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