NATIONAL HARBOR, Maryland — Written return to work agreements can be an effective tool in managing employees suffering from opioid addiction, including in the construction sector where injuries and opioid overdoses are particularly prevalent.

A return to work agreement lays out the employer’s expectations for the employee’s conduct, including prohibiting drug or alcohol use on the job, and the consequences for violating these terms, including termination.

“When people are on long-term opioid treatment, it’s recommended that they have a written agreement, that there’s random drug monitoring and that there’s a written plan that the patient and the doctor have agreed on” to get the patient off opioids, Dr. Glenn Pransky, scientific adviser for Lincoln National Corp. and associate professor at the University of Massachusetts Medical School in Worchester, Massachusetts, said at the Disability Management Employer Coalition Inc. conference in National Harbor, Maryland, on Tuesday.

“That’s part of this whole idea of active case management, which is really needed to try to keep this from becoming a long-term thing,” he said.

Written return to work agreements, monitoring through random drug testing and observations at work, high-quality treatment, compliance with medical recommendations, support via peer group attendances and counseling, and rapid referrals and evaluation for employees who relapse can all be combined to create an effective approach to managing addicted workers, Dr. Pransky said.

“This isn’t rocket science,” he said. “This formula works. The key thing is that you have an employer who is willing to support it.”

Employers need to take a holistic approach to dealing with their addicted workers — taking into account a range of programs and policies, including the legal implications of drug testing policies and compliance with Family and Medical Leave Act and Americans with Disabilities Act requirements, said Kim Rudeen, assistant vice president of group absence and statutory products for Lincoln National Corp. based in Radnor, Pennsylvania.

“You can’t do it in a silo,” she said. “When you have someone who has one of these issues, you really have to think about your policies much more broadly beyond what’s my policy about drugs in the workplace. That’s only one piece of the puzzle.”

Employer strategies should start with the mindset of preventing their employees from becoming addicted to opioids in the first place through education programs, better care — especially for chronic pain — and drug testing, Dr. Pransky said. If opioids are prescribed, employers need to take steps to minimize the addiction risk, recognize addicted employees and get them into recovery, he said.

In the construction sector, for example, an employee may be dealing with chronic pain in their shoulder, but they are making good money on overtime so they utilize inexpensive opioids rather than rack up hundreds or thousands of dollars in bills for cognitive behavioral therapy, Dr. Pransky said. An employer can counter that cost issue to some extent by partially funding employee health savings accounts and flexible spending accounts and “remind them that that’s what the money is for,” he said.

Massachusetts has “really good data” on deaths by opioids and occupation, and the data shows that the construction industry had the highest rate of opioid-related overdoses from 2011 to 2015 with 124.9 deaths per 100,000 workers, Dr. Pransky said. By comparison, the next highest industry was agriculture, forestry, fishing and hunting at 107.5 deaths per 100,000.

“This has become a big focus for our construction industry in terms of trying to get beyond the stigma and dealing with something which is having a huge effect,” he said.

U.S. Occupational Safety and Health Administration officials recently expressed increasing concern about suicides and opioid-related deaths in the construction sector.

There are several theories about why addiction is so prevalent in the construction sector, Dr. Pransky said.

“One is that there’s a lot of chronic pain in that occupation,” he said. “People are getting hurt all the time. The other is that it’s … unskilled labor. You can walk on and do it, so maybe people who have drug or alcohol or underlying mental health problems that would lead them to take drugs or alcohol, that’s an occupation they might fit into a little bit better. And then there’s maybe a cultural thing. I think all these things combine to create that problem in construction. It’s clearly there, and some of the larger construction companies have the Narcan antidote on site because they have had experiences with people nodding out or passing out.”