– After his own troubled youth, Phillip Cohen made it a practice to hire people at his woodworking business who have also struggled with addiction and mental health issues. But when an employee died from a drug overdose, he adopted a zero-tolerance policy.

“I think I have saved lives,” said the owner of Cohen Architectural Woodworking in St. James, Mo. — an area hit very hard by the nation’s growing opioid epidemic. Opioids range from prescription pain medicine like oxycodone to illegal drugs like heroin.

Cohen still hires former drug addicts, felons and people who have been traumatized in life. One person, now a top employee, was hired right after he finished drug rehabilitation. Another used to sell illegal drugs. Still, Cohen said, if a worker fails a periodic random drug or alcohol test, “we’ll fire them on the spot.”

The epidemic of drug use — a report from the surgeon general last year said that 20 million Americans have a substance use disorder — is forcing many small business owners to think about what they would do if they suspect an employee is abusing drugs or alcohol.

From 1999 to 2015, the number of overdose deaths from opioids and heroin quadrupled, the National Institute on Drug Abuse said. The government also reported more than 15 million adults with what’s called alcohol use disorder in 2015.

More than 70 percent of employers with 50 or more workers have been affected by prescription drugs, according to a survey released this year by the National Safety Council. But more than 80 percent don’t have a comprehensive drug-free workplace policy.

Although Cohen understood the dangers of drugs and knew that some staffers had a history of substance abuse, he wasn’t prepared when a worker overdosed in 2010, three days after the staffer attended a leadership conference.

“I didn’t care what people did at first,” says Cohen, whose workers use saws and other potentially dangerous machinery to create reception desks, cabinets and furniture for businesses, schools and health care facilities. But the devastating death of an employee prompted him to hire an attorney to write a tough drug policy that workers must read and sign.

“You have to draw the line somewhere,” says Cohen, who also brings in counselors and people who run support groups to help staffers who are struggling with personal problems.

Many small business owners don’t think ahead and create a written policy on alcohol and substance abuse, said employment law attorney Shira Forman. That forces them to be reactive, trying to figure out what to do when presented with an employee who shows up drunk, high or hung over, whose work is suffering or who causes an accident.

“It’s often not something that an employer knows how to deal with until they’re confronted with a scenario,” says Forman, who works at Sheppard, Mullin, Richter & Hampton in New York.

At Abbey Research, a market research firm based in Philadelphia, the substance abuse policy calls for employees to be suspended if they fail a random drug test or tell management they have a drug problem.

Their jobs will be held until they pass a drug test, since the company wants to give people a second chance, said Kristen Donnelly, who is in charge of human resources. But if they fail a second time, they will be fired.

The company, which seeks to help people who are struggling economically and personally, is located in a neighborhood where drug use has taken a toll. Two staffers have been suspended and then fired for drug use in the 18 months since Donnelly has headed HR.

But even afterward, the company has helped them find resources aimed at getting them back on their feet. “First and foremost they’re human beings,” Donnelly says, “and they’re human beings with a disease.”