You can smell marijuana use. And you can see methamphetamine abuse — in the teeth, the hollow eyes, the pale skin.

But prescription drugs? Abuse of those can go undetected, an invisible threat to the well-being of Hoosier workers and the businesses relying on them.

Recent studies indicate prescription drug abuse is on the rise in Indiana and 80 percent of Hoosier employers have experienced an issue with employees abusing opiates or other prescription medicines.

Still, a survey conducted for the Indiana Attorney General's Prescription Drug Abuse Task Force found just half of employers test for synthetic opioids — a prescription painkiller — during their drug testing and more than 60 percent weren't confident their staff could recognize the signs if employees were abusing prescription drugs.

UNSEEN ASSAILANT

"Once they've gotten their tolerance, and people see them at their tolerance level, you wouldn't know they're using anything — especially the opioids," Kathy Coffing said. She's an addictions counselor at Four County Counseling in Logansport.

"But when they can't get it, they drop."

Opioid painkillers like oxycodone, known by the brand name Oxycontin, and hydrocodone — sold as Vicodin or under other brand names — are among the most commonly abused prescription drugs, according to the Mayo Clinic. Others include anti-anxiety medications like Valium and stimulants such as Ritalin and Adderall.

Indiana Attorney General Greg Zoeller has called prescription drug abuse an epidemic in Indiana, pointing to the fivefold increase in drug poisonings in the state since 1999. It's now the biggest cause of injury deaths among Hoosier adults.

About 5 percent of Indiana residents abuse painkillers and other prescription drugs in a year's time, according to a study conducted by the Center for Health Policy at Indiana University-Purdue University Indianapolis.

Young adults are more than twice as likely, on average, to take medications that weren't prescribed to them, the study indicates.

"They'll steal it out of grandma's medicine cabinet. Or mom's or somebody else's," Coffing said, especially with narcotics — opiates and synthetics that mimic them.

Eventually, those who continue taking prescription drugs become dependent on them.

"If they run out and they haven't got that prescription refilled, they do a withdrawal," Coffing said.

That takes its toll throughout a person's life, particularly during work hours.

"They're going to miss more work, they're not going to be as accurate on their job," Coffing said. "While they're at their job they're not going to be as productive."

The Indiana Prescription Drug Abuse Prevention Task Force says people dependent on narcotics, in particular, are 10 times more likely to miss work and a third less productive. They're also responsible for 40 percent of all industrial fatalities.

LOCAL EFFECTS

The Cass County Prosecutor's office reported filing 46 cases involving dealing or possession of narcotics or controlled substances in 2015 — a category which includes both misused prescription drugs and substances like street heroin that aren't prescription drugs at all.

Coffing notes that most of the clients she works with who have been dependent on an opioid were addicted to heroin, not prescription painkillers, since prescription medications have become harder to obtain for illegal purposes.

And some local employers have said they haven't noticed prescription drug abuse interfering with their businesses.

Deb Spencer, with Numbers & Words staffing company in Logansport, said she hasn't seen much of an issue with prescription painkillers, if any at all.

Locally, meth is probably the biggest issue, according to Spencer. Two applicants through that firm tested positive for methamphetamine abuse over the last six months, but the companies that Numbers & Words works with haven't mentioned painkillers being an issue.

The firm has applicants undergo a seven-panel pre-employment screening. Some other local businesses, like Security Federal Savings Bank, have employees undergo five-panel screens in certain cases, like when an injury happens on the job. Five-panel tests focus on illegal substances and include testing for basic opiates, like heroin. A seven-panel screen also tests for oxycodone abuse.

Todd Miller of Myers Spring Co. in Logansport said his company has pre-employment and incident screenings conducted through Logansport Memorial Hospital's workforce clinic, but has never had anyone test positive for prescription drugs.

"But I don't know if that's something they test for," he added.

Healthy Companies is the occupational health clinic at Logansport Memorial which serves more than 400 local companies. It conducts drug testing after job offers and for Workers Compensation and randomized screenings, and results get sent straight to the employer.

Hospital employees themselves must at times undergo a 10-panel drug screening which includes testing for synthetic opiates, according to Lynda Shrock, vice president of human resources.

The hospital doesn't conduct random drug screenings — "yet," Shrock said — but will mandate a screening if an employee is suspected of substance abuse or if an accident happens.

Positive results are rare among the 670 employees at the hospital. In her 17 years there, Shrock has seen five confirmed cases of any kind of substance abuse among employees, and just two of them involving prescription painkillers.

She said hospital staff don't have as easy access to prescription medications as some people believe. But she's confident that hospital staff could identify prescription drug abuse when they see it — at least, that clinical staff could.

Like 60 percent of Indiana's employers, Shrock isn't entirely confident that other staffers — like employees in maintenance or the cafeteria — would know what to look for. So she's offered training to managers who felt they needed it on the signs and symptoms of prescription drug abuse.

The training is available as part of the hospital's employee assistance program, she said, which also provides counseling and other services that she believes would be helpful should an employee be battling substance abuse, or even in cases where the situation isn't yet that dire.

Stress can be dealt with before it spurs someone to turn to self-medication, she offered.

"If we could teach people how to cope, we could head off a lot of things," Shrock said.

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