Even before the opioid crisis, Clyde McClellan used to require a drug test before people could work at his Ohio pottery company, which produces 2,500 hand-cast coffee mugs a day for Starbucks and others.

Now, he skips the tests and finds it more efficient to flat-out ask applicants: “What are you on?”

At Homer Laughlin China, a company that makes a colorful line of dishware known as Fiesta and employs 850 at a sprawling complex in Newell, W.V., up to half of applicants either fail or refuse to take mandatory pre-employment drug screens, said company president Liz McIlvain.

“The drugs are so cheap and they’re so easily accessible,” McIlvain, a fourth-generation owner of the company, said. “We have a horrible problem here.”

The misuse of prescription painkillers, heroin and synthetic opioids like fentanyl is, by now, painfully well known. The U.S. tops the world in drug deaths; in 2015, more people died from overdoses — with two thirds involving an opioid — than from car accidents or gun violence.

The epidemic is also having a devastating effect on companies — large and small — and their ability to stay competitive. Managers and owners across the country are at a loss in how to deal with addicted workers and potential workers, calling the issue one of the biggest problems they face. Applicants are increasingly unwilling or unable to pass drug tests; then there are those who pass only to show signs of addiction once employed. Even more confounding: how to respond to employees who have a legitimate prescription for opioids but whose performance slips. “That is really the battlefield for us right now,” said Markus Dietrich, global manager of employee assistance and worklife services at chemical giant DuPont, which employs 46,000 worldwide.

The issue is amplifying labor shortages in industries like trucking, which has had difficulty for the last six years finding qualified workers. It’s also pushing employers to broaden their job searches, recruiting people from greater distances when roles can’t be filled with local workers. At stake is not only safety and productivity within companies — but the need for humans altogether, with some manufacturers claiming opioids force them to automate work faster.

One nonprofit called the misuse of prescription drugs a hidden workplace epidemic. McClellan, who runs the American Mug & Stein pottery, puts it more plainly: “It’s a freaking nightmare.”

‘The biggest threat in manufacturing, period’

To understand the scope of the problem, it’s helpful to consider the recent experience of one company in America’s heartland.

Balco is a Wichita, Kan.-based producer of building materials, part of the larger publicly traded CSW Industrials. With construction booming, the company’s products — like expansion joint covers that help buildings to safely sway in the wind — are in demand; it needs more people to make them.

So earlier this year, Balco went on a hiring binge, tripling the size of its production staff at its Kansas facility by adding 35 workers. Within weeks, though, problems emerged. Some new employees abruptly stopped showing up. Others got sloppy, missing details and making mistakes that required co-workers to re-do their work down the production line. After three months, two thirds of the freshly hired employees — 24 of the 35 — had been fired or quit.

The company’s senior manager of manufacturing operations, Tom L. Shupe, blames substance abuse — and, specifically, opioids for the majority of the problems.

“It’s all addiction issues,” Shupe, a 37-year veteran of the company, said in a recent interview at a coffee shop near his home outside of Oklahoma City. He called the opioid epidemic “probably the biggest threat in manufacturing, period.”

Balco drug tests new hires and conducts random follow-up screenings for employees, but that can’t snuff out those who get sober specifically for the test or who relapse after a bout in recovery. Shupe said the company’s found synthetic urine on property and now requires drug screens to be observed — meaning a lab representative monitors in the restroom — to prevent cheating. “We’ve actually had quite a few folks turned away at that stage. Once they realized it’s going to be witnessed, they’ll just say, ‘Screw it, I’m done,’ and walk away from it,” he said.

The drug epidemic has changed how the company operates, too. It used to put job ads up and quickly take them down, finding itself overrun with applicants. Now, Shupe keeps the ads up, knowing he may need to continuously replace workers. The difficulties in spotting possible addiction issues have made it far tougher to spot a future higher performer in an interview.

“You’re like, ‘Wow, I never saw that coming, you know?’” he said. “Nowadays, it’s so masked, it’s very difficult to pick up on some of that until you get right into it and you employ them.”

So, Shupe’s turning to an alternative: machines. He’s now working with engineering students at a local college to mechanize some of Balco’s work done by humans — automating part of a metal fabrication process that currently requires six people but, aided by technology, could be done with one. He said the hiring and retention challenge associated with opioids and other substances “forces my hand to look at automation.”

“You’re going to see manufacturing jobs slowly going away for, if nothing else, that reason alone,” he said of the drug crisis. “It’s getting worse, not better.”

Economists have noticed. In Congressional testimony earlier this month, Federal Reserve chair Janet Yellen related opioid use to a decline in the labor participation rate. The past three Fed surveys on the economy, known as the Beige Book, explicitly mentioned employers’ struggles in finding applicants to pass drug tests as a barrier to hiring. The surveys, snapshots of economic conditions in the Fed’s 12 districts, don’t mention the type of drugs used.

Lab giant Quest Diagnostics reported in May that positive drug test results had reached a 12-year high, driven largely by an increase in marijuana and cocaine use, based on its analysis of 10 million workplace drug screenings. Heroin rates were steady among the general workforce, while opioid use actually declined slightly in its results.

Dr. Todd Simo, the chief medical officer of background check firm HireRight, notes that a positive test for an opioid will be thrown out if an applicant can produce a prescription, regardless of whether the person is taking the drug as prescribed.

“It doesn’t matter if the donor is using one OxyContin a day or 12,” Simo said. “Once they have a legitimate and verifiable medical explanation for the result, the medical review officer is bound to report that as a negative drug screen.”

While he’s gotten more questions from employers about testing for opioids, Simo said it would be “a bit of hyperbole” to suggest employers can’t fill jobs because of drug tests.

Still, at Congressional hearing last month focused on opioids and their economic consequences, Ohio attorney general Mike DeWine estimated that 40 percent of applicants in the state either failed or refused a drug test. This prevents people from operating machinery, driving a truck or getting a job managing a McDonald’s, he said.

The problem is hardly limited to blue-collar professions, though. Among attorneys and those in the legal field, abuse of prescription drugs ranks as the most common issue behind only alcoholism, a report by the American Bar Association’s Commission on Lawyer Assistance Programs found.

“The gateway into opioid addiction oftentimes comes through what somebody in a white-collar profession such as a lawyer feels is totally legitimate. They don’t feel like they’re doing anything wrong; they’re getting the prescription from another white-collar peer,” said Patrick Krill, an attorney and licensed alcohol and drug counselor who runs a consulting firm focused on addiction issues. “It’s a valid use of a narcotic in their mind. But that narcotic can really begin to take hold of them.”

Yet, there’s often a stark difference in how those with addictions are treated in office settings. Professionals may be more adept at concealing their difficulties, and their colleagues may be more deferential, making them less likely to suspect peers of a problem, Krill said. What’s more, it’s often “culturally abnormal” to confront someone about an issue in their life.

At his firm, he’s now seeing a higher rate of requests for trainings and education materials from mid- and large-size law practices, with many companies unsure of how to respond to opioid issues. “Addiction does not discriminate,” he said. “It occurs across the entire spectrum of humanity.”

‘I’m going to send you for a drug test. What are you on?’

In East Liverpool, Ohio, a city once known as the pottery capital of the U.S. for its four dozen local potteries — and whose high school mascot, Potter Pete, remains to this day a particularly terrifying-looking kiln head — the opioid problem is especially raw.

The city in September released a photo on Facebook of two adults passed out in a car from an overdose while a 4-year-old sat in the back. Almost immediately, the image went viral, bringing widespread attention to a city that’s already lost half of its population since the 1950s as all but two potteries closed and thousands of jobs vanished. In May, the national headlines returned: this time, after an officer accidentally overdosed by coming into contact with fentanyl during an arrest. Once again, East Liverpool found itself in an unwanted spotlight.

McClellan, the owner of American Mug & Stein, provides one of the town’s last remaining links to its ceramic heritage. His factory, housed in a 1930’s brick building, is filled with plaster molds, clay shavings and rows and rows of mugs. (Even the office cat is named Mugsy.) Starbucks makes up about 40 percent of his business and sells his mugs at its flagship location near Pike’s Place Market in Seattle.

He said he finds the opioid crisis tragic and challenging as a business owner. He’s found people shooting heroin into their arms behind American Mug and come across needles in his parking lot after the grass is mowed. About three years ago, he gave up on drug tests for applicants altogether, finding it more effective to ask them questions instead.

“I say, ‘I’m going to send you for a drug test. What are you on? What are they going to find?’ Before I waste $65 or $100, whatever the thing is now. And they go, ‘Well, I drink and I smoke marijuana on the weekend.’ ‘Okay. Nothing else?’ ‘Nope.’ I say, ‘So I’m going to send you up now and they’re not going to tell me you have crack or heroin or anything like that?’ ‘No.’ So then we’ll try them out for a while, then you can usually tell if they’re getting a little [high].”

He’s employed people with opioid addictions — including one who relapsed on the job — and says it’s often difficult to tell if someone is under the influence. “Alcohol is a little bit easier, he said. “You can smell it on people, they get a little jerky.”

Read more: Can technology play a role in solving the opioid overdose epidemic?

Indeed, the reason employers find themselves grasping at how to approach opioid addiction is because it is so different than other substances, like alcohol. Managers and co-workers can’t afford to wait months or years before intervening, watching for gradual signs of a shift in performance, said Greg DeLapp, CEO of the Employee Assistance Professionals Association.

“The opioid push is weeks to months,” DeLapp said. “By year end, the employee may be dead.”

He now advises companies to check on staffers who miss more than a week of work due to an injury; a recent study by the Workers Compensation Research Institute found that more than half of workers in 26 states who missed at least seven days of work and received at least one prescription for a pain medication had an opioid prescribed.

Even large companies with vast HR teams are at odds with how to respond because established corporate procedures, like a zero-tolerance drug-free workplace policy, no longer apply when employees can produce a prescription for their medications. At DuPont, the company’s encountered multiple examples of employees who begin appearing groggy, forgetful or whose behavior shifts. The company can send the employees for a “fit for duty” evaluation by a medical professional, but must tread cautiously.

The situation is “a whole lot more complicated with so many more people on opioid medication,” said DuPont’s Dietrich. “We do not have the right to ask anybody about their medical condition or what prescription they’re on, of course not.”

Some business owners say they’re fed up. In Virginia Beach, Va., where William W. Warwick IV owns a roofing company in his name, “it’s impossible to find qualified applicants who are sober, have their life together,” Warwick said, citing alcoholism as his company’s particular challenge.

He says he typically must go through about 100 applicants to hire for one position. The job market is so tight — a factor he attributed, in part, to the opioid epidemic taking qualified workers out of the labor pool — that “it’s almost like trying to find a star athlete,” he said. “For roofers. We’re talking about roofers!”

In response to the crisis, some companies are being forced to get creative. Dianne Porter, the president and CEO of metal fabricator Zeyon in Erie, Pa., turns to international agencies that work with refugees. Others are going out of their way to hire those with addictions.

Brian Howard, a licensed drug and alcohol counselor and the founder of OneLife Treatment in Edmond, Okla. said local landscaping firms and retailers in his area will typically employ those in recovery. He stresses that former addicts make excellent employees. “Willpower is never the issue for an addict. Watch an addict work when they don’t have something they need. Tell me it’s willpower. That’s not the issue,” he said. “And when that’s turned the right direction, it’s amazing.”

‘Like free money’

In Ohio, East Liverpool mayor Ryan Stovall is clear, too: No one sets out to become addicted to opioids or heroin. But, he believes it’s a question of alternatives. Do enough jobs exist in a region? Are treatment options sufficient?

After years of economic decline and drug use in his city, he said the region is now paying the price. “As businesses are starting to come back, it’s harder to find employable people.”

Some, though, have found an opportunity in the turmoil. Jim Mixter, a 72-year-old who made a career in the timber industry, got hired on the spot in December to drive a 26-foot box truck, delivering holiday packages for extra money.

He made about $80 a night, and said the company, Diamond Cargo Express LLC, hired him so quickly, in part, because he readily submitted to its urine screening.

“It was like free money,” he said. “A lot of guys can’t pass drug tests.”

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