Treating deadly opioid epidemic is a top concern for UAW

People are dying.

They're dying across the country — an average of more than 130 people a day amid the deadliest U.S. drug epidemic in the modern era. But the fast-spreading opioid crisis has taken an especially large toll in Kentucky, where Ford Motor Co. has nearly 14,000 workers at two of its biggest assembly plants.

It's just a matter of statistics, UAW Local 862 President Todd Dunn says, that the casualties include some of those workers and their families.

"When you look at the Kentucky Truck Plant, you basically have two aircraft carriers' worth of people," Dunn told Automotive News. "There's not one person that's not touched in some way or another from opioid use, opioid death, suicide or overdose."

More help preventing and treating opioid misuse is high on the UAW's agenda for this year's contract negotiations with the Detroit 3.

"The issue demands that we get involved, and it demands that we set an example of combating it in a positive way — the union and the company," UAW Vice President Rory Gamble, whose granddaughter died of an opioid overdose in January, told Automotive News. "We have to grab this thing and address it now."

Dunn is certainly trying. An Army veteran, he started brainstorming with a consortium of former military members across the country about the opioid epidemic in early 2017. He learned of a medical device under development that could help ease withdrawal symptoms and flew to Michigan to convince Gamble and Bill Dirksen, Ford's vice president of labor affairs, that his members going through recovery should have access to it.They agreed. This summer, the UAW is working with the University of Louisville on a pilot program with the device to help more than 200 Ford workers and family members quit their addictions.

It's a step.

Auto plants are fertile ground for addiction, as the repetitive, physically demanding labor leads to frequent injuries and chronic pain. Generous medical plans then provide low-cost access to powerful drugs.

"I don't believe that the UAW and the automakers should have necessarily seen this coming, because I don't think a lot of other people did," said Jeremy Milloy, a postdoctoral fellow at Mount Allison University in New Brunswick, Canada, who has studied drug and alcohol use in North American workplaces over the last 50 years.

"But now that they are dealing with this situation, it's a really obvious time for them to say that policies based on surveillance and stigmatization have failed," Milloy said. "They can't work in a system where the No. 1 most-abused drug is a licit one being prescribed through company health plans."

The union is seeking an expansion of employer-funded, union-administered assistance programs aimed at preventing the use of prescription painkillers from turning into harmful, long-term dependence. It also wants to ensure that workers can seek help without fear of retribution by their employer so they would be less likely to hide an addiction to maintain their paycheck.

The UAW's goals include formalizing efforts started by the automakers since the current contract was signed in 2015. General Motors implemented a pharmacy program in the fall of 2017 to curb the quantity of short-acting opioids employees can receive after simple surgeries. The company also promotes safe opioid use and disposal through annual seminars and communications. Ford and Fiat Chrysler Automobiles say they have initiated similar programs.

GM, in a statement, said it "recognizes this is an issue that impacts communities and families nationwide" and that it is "dedicated to ensuring a culture of safety, both at home and in the workplace."

The UAW and Ford in 2017 teamed to launch the Campaign of Hope, an education and awareness initiative to combat drug misuse among hourly and salaried workers.

The campaign, which now reaches all of Ford's U.S. plants, began in a state where the opioid epidemic has been particularly devastating: Ohio. In 2017, the most recent year with government data available, 5,111 people died of drug overdoses in Ohio, where Ford has four plants and more than 6,500 employees.

"Some of our rural cities don't have 3,000 people. Imagine losing a whole city," Jerry Carson, a UAW employee support representative at Ford, said on a community podcast. "That's what's happening throughout our country."

Ohio had the nation's second-highest rate of overdose deaths in 2017, with 46 per 100,000 people, according to the Centers for Disease Control and Prevention, coming in after neighboring West Virginia, which had 58 deaths per 100,000. Kentucky ranked fifth, with 37, vs. a national average of 22.

GM, FCA and Honda of America Manufacturing also have plants in Ohio. Toyota Motor Corp. operates plants in Kentucky and West Virginia.

"Whatever's happening to our communities filters into our work locations," Carson said. "This epidemic didn't happen overnight; we're not going to get out of it overnight, but the key is educate, provide treatment resources and show them they can make it through it."

Through the Campaign of Hope, Ford paved connections with local recovery centers, which began providing education and drug deactivation kits to plant employees. Dunn said that at one in-plant session, nearly all of the 60 people in attendance said they either had personal experience with opioids or knew someone who did.

The campaign warns of the dangers of opioid use through plant newsletters, magazines published through Ford and the UAW, and TV screens in plants.

"We're basically using all the communication channels we have to reach as many people as we can," said Dirksen, the Ford vice president.

Part of what makes the opioid epidemic so deadly is the depth of the addiction. Pain from withdrawal is so severe, Dunn said, that workers will often leave recovery treatment after just a few days.

The medical device Ford is supporting with pilot testing is called a point-stimulation therapy device, known commercially as Lenus Freedom. It delivers pain relief by sending low-level electric pulses to the brain through the ear via three acupuncture needles. The device, cleared by the U.S. Food and Drug Administration for commercial distribution in November, can also be used to treat the symptoms of addiction.

Dunn, who has seen the device used on someone experiencing extreme heroin withdrawal, says it can dampen the majority of symptoms in as little as half an hour.

"This device is not a miracle, but it is the next best thing," he said. "It's a positive, disruptive solution to opioid treatment. I think you're going to see GM, Chrysler, a lot of companies and organizations look at this device as a game changer."

There were 70,237 drug overdose deaths in the U.S. in 2017, according to the most recent data from the CDC. Deaths were driven mainly by synthetic opioids, which were involved in 47,600 fatalities that year — or 68 percent of all drug overdose deaths.

"It's not a UAW problem; it's not a Ford problem," Dunn said. "It's a nationwide community problem."

In June 2009, Mike Warchuck was in a car accident and severely hurt. Over the last 10 years, he's lived with two major consequences of the crash: pain and an opioid prescription meant to treat it.

But Warchuck, who is president of UAW Local 653 in Pontiac, Mich., said he has kept his use of the painkillers in check.

"I had morphine patches attached to my body," he said. "I'm down to tramadol, if it's needed. It's the lowest form of an opioid you can get. For the most part, I've been fortunate. I've had plenty of opportunities to get addicted. I never did."Warchuck has had nine operations on his back, hips and knees resulting from the accident. For five years, he said, "I walked around in a glazed-over stupor because that was the only way I could function." For two of those years, he spent more time off than on the job as an electrician at GM's Global Propulsion Systems lab.

"In my opinion, I was safe and capable of working," Warchuck said. "I never abused anything."

Warchuck said he supports GM's policies that allow workers to seek help for substance use. The company makes education about the dangers of substance use available, he said, but management is less tolerant of recreational substance use on the line. Because of the confidential nature of GM's employee assistance program, however, Warchuck said he wouldn't know if workers were struggling with an addiction unless they came into his office and told him.

"There's probably people that have an opioid problem that are on sick leave," he said. "There's probably people in the plant working every day that could probably have a problem with it. But am I personally aware of it being a crisis in our local? The answer would have to be no."

The nonpunitive approach the UAW is seeking is an integral component of a functional workplace system for recovery, said Jodi Debbrecht Switalski, a former district court judge and prosecutor in Michigan who is now a consultant to employers on substance use.

For most companies, Switalski said, managing the list of legal and illicit drugs that enter workplaces would require a complete process overhaul. Outside of opioids, workers can struggle with benzodiazepines, antidepressants and anti-anxiety drugs, amphetamines and stimulants. Even drugs purported to act as alternatives to opioids can be powerfully addictive.

"We cannot limit it to the opioid epidemic," she said. "We would not be broadening the system far enough. What the UAW is starting to recognize is that outdated workplace policies and protocols could never possibly have anticipated the impact of legally prescribed substances."

People often seek treatment only after getting in trouble on the job, said Scott Masi, president of the nonprofit Unite to Face Addiction Michigan. Masi, who has worked with the UAW for 10 years providing addiction recovery services and education, said employees who are protected by their employer are more likely to seek help.

Masi is in long-term recovery himself from an addiction to crack cocaine he developed while working at the auto supplier Roush Industries. After eight years with the company, Masi was fired when he was caught sleeping on the job.

"If I was struggling with diabetes and I wasn't getting my medication, and I was sleeping because of that, do you think they would have fired me? No," Masi said. "I had no recourse to save my job, get the help that I needed or utilize the insurance that I had worked for."

Large-employer health plans spent $2.6 billion on treatment for opioid addiction and overdoses in 2016, nearly nine times as much as in 2004, according to a joint study by the Kaiser Family Foundation and the U.S. Bureau of Economic Analysis.

Inpatient and outpatient treatment for opioid addiction and overdoses added an average of $26 per person to the annual cost of health benefits coverage in 2016, the study said, up from $3 in 2004.

Given those increases, automakers might balk at spending even more to handle the problem. But experts say costly initiatives such as creating sober homes near plants could make all the difference in those workers' lives and help get the epidemic more under control.

After treatment, union employees may struggle to return to the environment where opioids came into their lives. Masi said reintegrating employees is one of the most difficult challenges, and those who lack a recovery-oriented system of care will continue to struggle.

Pamela Feinberg-Rivkin, CEO of Feinberg Consulting in West Bloomfield, Mich., says creating sober homes isn't that far-fetched of an idea.

"If one or all three of [the automakers] would invest — not only in recovery; they need to have treatment first — but invest in the detox treatment and then a recovery community where they can live and work and receive that long-term care — that's a model that should be created in the state," Feinberg-Rivkin said. "Many workers that we have could benefit from having that whole continuum of care."Automakers and the UAW may be open to experimental recovery efforts such as the Lenus Freedom device but will have to weigh the costs of further investments. In the give-and-take of negotiations, getting more funding to treat opioid misuse can mean the UAW would have to give up something in return.

"I am not against any type of solution that makes sense. But when you sit down with a company, you have to craft that where it makes economic sense," Gamble said. "We have members who live from time to time in halfway-house situations, and that seems to work."

Ford has a variety of opportunities to help prevent and recover from addiction, Dirksen said, but "we have limits of what we can do."

Labor experts say both sides have a vested interest in battling opioid misuse, which should ease negotiations on the topic even as health care expenses surge.

"I'm thinking they can get quite a bit accomplished," said Arthur Wheaton, director of the Worker Institute at Cornell University. The UAW is "looking for anything they can do to try to help save costs and keep plants in the United States. If this is a barrier for them to have more workers, they'll want to work together."

Gamble said he's confident Ford and the union will work toward meaningful solutions at the negotiating table.

"We look at it as having the ability to address an issue that is affecting our members, and from the company's perspective, their employees, and how that problem is affecting the end product," he said. "All of these things add to the cost of the vehicle — when you have high absenteeism; when employees just can't function. At the end of the day, it affects the quality of the vehicles we produce."

Dirksen pointed to efforts underway in collaboration with the UAW as proof that Ford is committed to addressing the opioid problem.

"All this work we've done has been between contracts," Dirksen said. "We didn't have to collectively bargain it and write it down; we just recognized it together and got to work on it."