Hussein Nasser spent hours every day working on his knees. The Dearborn native and carpet installer for Belleville-based Empire Flooring went home every day in pain. His knees ached, but the paycheck was worth the discomfort. Until over-the-counter remedies no longer worked.

For relief, Nasser, 28, turned to prescription opioids — first Percocet, then OxyContin — that he bought from street-level dealers. Addiction took hold. Nasser's habit peaked to 300 milligrams of OxyContin per day, far higher than the average prescription of 20 mg a day. As you might expect, Nasser lost his job and Empire lost customers.

The use and misuse of opioid prescriptions and street-level heroin is rising throughout the U.S. While the figures remain low enough to barely impact the overall national labor force picture, overdose deaths and dependency linked to opioids is toxic and spreading among the ranks of labor at a rate that should alarm the health care industry and employers as a whole.

Last year roughly 11 million opioid prescriptions were written in Michigan — a state with only 9.9 million residents, according to Michigan Health and Human Services data. The prevalence of these highly-addictive drugs — such as oxycodone (OxyContin), hydrocodone (Vicodin), methadone and fentanyl — has left a large population of the workforce strung out and created a costly epidemic for employers.

New policy measures in Michigan are targeting the over-prescribing of opioids, such as the Michigan Automated Prescription System, which allows prescribers access to patient records for certain drug classes and Medicaid coverage expansion for treatment programs. But experts are urging employers to help abate the crisis, too.

Opioid abuse cost employers nationally $16.3 billion in 2013 due to reduced productivity and increased disability. Another $14 billion is absorbed by private health insurers, according to a 2016 Centers for Disease Control and Prevention study.

In Michigan, health care costs associated with opioid abuse totaled $830 million in 2013, a number that has likely risen in recent years.

Opioid abusers, while only representing 4.5 percent of opioid users in the U.S., account for 40 percent of opioid prescription spending, according to a 2016 study by San Francisco-based health care information firm Castlight Health Inc.

Employers are worried, and should be, according to a 2016 survey by the International Foundation of Employee Benefit Plans.

A third of employers in the survey reported that prescription drug addiction is at least somewhat prevalent among their workforce and that more than two-thirds believe that substance abuse challenges are greater now than five years ago.

Action is needed because abusers of the prescriptions largely leave employers holding the bag. The average employer medical costs were nearly twice as much for opioid abusers, $19,450, than non-abusers, $10,583, in 2015, according to the Castlight report.

By contrast, healthcare costs for employed smokers, who have higher rates of lung disease, heart disease, cancers and other smoking-related illnesses cost employers $2,055.77 more than nonsmokers, according to a 2013 study by peer-reviewed journal Tobacco Control. Add in production loss from smoke breaks and the total cost to employers is $5,816, well below the $8,800 in associated health care-only costs of opioid abusers, according to the study.

Yet employers are unprepared for the swelling costs. Currently only a quarter of employers have conducted a prescription drug claims analysis to identify possible abuse, according to the IFEBP survey.

Kate Kohn-Parrott, president and CEO of the Greater Detroit Area Health Council, said employers must start realizing the threat to their business that they are, unfortunately, perpetuating.

"At one level, employers are paying for the drugs and when people get addicted, they don't come to work," she said. "Most (employers) don't realize they are actually paying for their employees' decline in productivity. We have to get education into the employer network."

The GDAHC is in the early stages of creating an employer task force to engage the business community to develop its role in damming the flood of opioid abuse.

"We need to get employers to start recognizing a role in the social fabric of their community," Kohn-Parrott said. "A healthy community is a healthy workforce and that leads to reduced costs for employers."

Wayne County, excluding Detroit, has seen the largest increase in opioid prescriptions in Southeast Michigan between 2009 and 2015, rising 51 percent. However, they are on the rise everywhere — opioid prescriptions rose 38 percent in Macomb County, 35 percent in Livingston County, 34 percent in Oakland County and 22 percent in Washtenaw County.

The average opioid abuser is older, lower-income and in pain, according to the Castlight study.

Opioid prescribing peaks in the 45-64 age group, due in part to increasing prevalence of chronic pain with age, according to a recent CDC report.

Opioid abusers most commonly see doctors for issues relating to joint, neck, abdominal and back pain, according to the study. Age also appears to play a role. The opioid abuse rate is nearly four times higher for baby boomers, with an average abuse rate of 7.4 percent, than millennials, with an average abuse rate of 2 percent.

Income also plays a critical role in whether an individual abuses opioids. Those with an opioid prescription earning less than $40,000 are more than twice as likely to abuse their prescription than those earning more than $84,000 annually, according to the Castlight study.

But Darlene Owens, director of substance use disorder initiatives at the Detroit Wayne County Mental Health Authority, said her centers are seeing a rise in professionals or former professionals addicted to opioids.

"It's impacting everyone all across the board," Owens said. "We've had doctors, nurses and lawyers come in that have recently lost their jobs. More and more people are using. We've never seen this much abuse of prescription drugs before."

For Nasser, his addiction led him to steal painkillers from the medicine cabinets of Empire's middle- and upper-class customers — a move that landed him a misdemeanor charge and the loss of his job. Desperation led him to heroin use and burglary, which led to a stint in Wayne County jail. He lost custody of his two children as well.

"Everyone's medicine cabinet had (opioids)," Nasser said, who has been clean for nearly 10 months and is finishing a term in rehabilitation at Detroit Rescue Mission Ministries. "I'm not surprised (opioids) are getting worse. It's now the norm. These drugs take over your life and it doesn't discriminate on who you are or how much money you make."

And it's not just abusers and their employers feeling the pain, Kohn-Parrott said.

"Not only are we seeing those addicted to opioids losing their jobs, we're seeing family members losing jobs too," Kohn-Parrott said. "They are missing work to take care of their family that is addicted. It's heartbreaking and only leading to more dire situations and poverty."

Tragically, the death toll is rising.

In 2015, 52,404 people in the U.S. died from drug overdoses, nearly half of which were caused by natural and synthetic opioids, according to the Centers for Disease Control and Prevention. In Michigan, 1,981 people died from drug overdoses in 2015, up 13.5 percent from 2014, according to the latest available state data.

Coupled with heroin, a natural or semisynthetic opioid when mixed with fentanyl, opioid overdose deaths in Michigan surpassed traffic fatalities in 2014 and gun deaths in 2015, according to data from the Michigan Department of Health and Human Services. In 2015, nine out of every 100,000 residents in Macomb County and 7.3 in every 100,000 residents in Wayne County died from an opioid, including heroin, overdose.

"We're begging people; we have services available to you," Owens said. "We're changing lives, but right now it's a losing battle. We've got a long way to go."

Castlight's study recommends employers work with the company's benefits director to identify the medical conditions most tied to opioid abuse, such as joint pain and depression, among its workforce. Then take a critical look at that population and access their benefits programs to lead employees to better decisions around opioid use.

"Whether it's guiding an employee away from an unnecessary back surgery (and the resulting opioid prescriptions) or offering programs that provide access to opioid abuse treatment, Castlight believes that data and analytics are part of the solution," the study said. "A solution that will enable employers to effectively address opioid abuse head on, and confront significant health, cost and productivity and personal consequences linked to the crisis."

Kohn-Parrott is asking employers to step up and help generate solutions as more and more lives are lost each day.

"We need help," Kohn-Parrott said. "Everyone is feeling pressured and stressed by the issue and there's a way employers can help, but I don't know the answer to that right now. We're trying to find out."

Nasser, who plans to work as a siding installer for his uncle's company Michigan Lake Builders when he leaves rehab in August, said he bears responsibility for his addiction, but believes educated employers can play a role in stemming the opioid crisis.

"The pills are way worse than heroin. I definitely would have been open to a (employer-sponsored) rehab program, to anything they offered really; I was out of control and looking for a way out," he said. "Getting locked up was a blessing. I never wanted to live like this. I'm a hard worker and I've changed the way I think about life. I hope that's enough."