"Opioids are not the only prescription drugs that may be misused," the report says. "Ensuring proper use is also clinically challenging for anti-anxiety medications and drug treatments for attention deficit disorder, for instance."

Among 33,000 specimens tested for opioids, benzodiazepines and alcohol, more than 20 percent were positive for both opioids and benzodiazepines, more than 10 percent were positive for both alcohol and opioids, and 3 percent were positive for all three. 

Among all specimens positive for heroin, 19 percent were also positive for non-prescribed fentanyl. Moreover, 12 percent of all specimens positive for prescribed opioids were also positive for prescribed benzodiazepines, "suggesting one or more health care providers had prescribed these drugs for the patient." 

"Combining a prescribed drug with non-prescribed or illicit drugs can lead to dangerous drug combinations, and suggests the possibility that the patient is using a drug or drugs without the benefit of oversight from a health care provider," the authors write. "Not taking a prescribed drug may contribute to health care waste and failed treatment, and the potential for unintentional or criminal diversion."

Sarah R. Skubas, an attorney in the Hartford, Connecticut office of Jackson Lewis PC, writes in Lexology that employers should consider "whether they are equipped to respond to this epidemic," by conducting these following measures: 

• Review workplace policies and practices to address the use of prescription medications that may cause a safety risk in the workplace. Employees in "safety-sensitive" jobs should report the use of prescription medications that may impact the ability to perform the job safely, so that the company can address the matter with the employee.

• Review substance abuse policies to prohibit the use of prescription medications for which the employee does not have a valid prescription.

• Where permitted by applicable law, consider expanding drug-testing panels to cover prescription medications, as well as illegal drugs. All positive drug tests should be reviewed by a medical review officer, who will determine whether the drug use was lawful or unlawful.

• Educate employees on the dangers of using opioid pain medications, and publish options for employees to seek help for substance abuse problems, such as an employee assistance program.

• Train supervisors on addressing suspected misuse of drugs and alcohol in the workplace. Distinguish between employees who violate company policies by using drugs at work, and employees who volunteer that they have a substance abuse problem before a policy violation has occurred.

• Train supervisors on the legal issues involved when discussing an employee's medical condition, disability status and related use of prescription medications, which can lead to disability discrimination claims if handled improperly.