Opioids in the Workplace

Search Counselor

Login

Columns - From the Addiction Physician

Wednesday, 01 December 2010 11:06

A small business runs a machine shop where employees are responsible for operating equipment that punches holes through metal plates. The tolerance for error is small. Each punch must be within a few millimeters of the specified center point. The equipment itself is high powered and it takes several employees to position the metal plate, and then another to push the appropriate button to engage the machine. If the button is pushed at the wrong time, the metal plate is potentially wasted, and human injury may occur. After many years of employment, Ms. Jones makes a mistake, pushing the button before the plate is properly engaged in the harness. A fellow employee loses a portion of one finger as a result.
In the ensuing investigation, Ms. Jones is found to have been under significant stress. She is in the midst of a divorce, recently lost her mother, and is having serious economic difficulty. She took on a second job six months before the accident, and according to fellow employees, frequently complains of fatigue while at work. Per company policy, Ms. Jones is drug tested following the accident. She tests positive for oxycodone, and admits that she has been taking this medication, as prescribed, for five years to treat her fibromyalgia. Her dose has not changed in four years, and she said it effectively treats her chronic pain.
At another company across town, Mr. Smith finds himself in a similar position. Following his involvement in an accident that resulted in personal injury to another employee, Mr. Smith tests positive for oxycodone. Mr. Smith is not taking it under a physician’s prescription; rather, he has been buying the drug on the street for several years. Mr. Smith reports that his dosage varies, and that he had actually been using less oxycodone at the time of the accident.

Should Ms. Jones and Mr. Smith be treated similarly with respect to their work? We know from a medical standpoint that Mr. Smith’s history is consistent with opioid dependence, while Ms. Jones’ history is not. For the sake of our discussion, let’s say that a full evaluation of both parties reveals that Mr. Smith has addictive illness and Ms. Jones does not. Both individuals were using the opioid at the time of the accident. One can argue that Ms. Jones was fully tolerant to her dose, and was unlikely to be experiencing any sedation or cognitive slowing as a result of her prescription, and that the incident was simply an accident. One could further state that her personal stress and the fatigue brought on by her second job might have increased the likelihood of an accident.

With Mr. Smith, if we take his statement as to his pattern of use as true, his accident might also have been a straightforward error, not due to his use of the oxycodone. But, can we take his statement as true? Can we even know for sure that Ms. Jones’ fatigue did not lead her to mistakenly take an extra oxycodone? Should either party be fired? Should both individuals be held equally to blame for their mistake? Or, is one more responsible than the other?

The rapid increase in the rate of prescription substance use in this country (both as prescribed and not) has sparked a controversy regarding the inclusion of prescription benzodiazepines and opioids in routine urine drug testing. If an employee is found to be taking a prescribed sedative-hypnotic or prescribed opioid, what should the next step be? Should steps taken differ if the employee is a school teacher, city administrator, utility worker, fire fighter or police officer? What if the company has an existing drug-free policy for its employees? In such situations, employees may not know the differences between Seroquel, Ambien and Rozerem, all of which can be prescribed as sleep aides. Remarkably, Ambien is the only controlled substance among these three drugs, but it is the Seroquel that might cause more daytime sedation. How should employers define the difference between acceptable and unacceptable?

One possible approach is to copy that of the Federal Aviation Administration (FAA), which specifically identifies drugs that are acceptable for pilots. However, the FAA’s restrictive approach does not allow for any of the mood stabilizers, and only recently has allowed for any of the antidepressants. A significant portion of the population would find themselves out of work, at least temporarily, were all employers to follow FAA regulations. Another approach would be to present evidence of impairment resulting from specific medications; but there is almost no such literature, even for opioids and sedative-hypnotics. It seems absurd to use the legal versus illegal distinction in an environment where many legal drugs are just as or even more impairing than some illegal drugs.

So what should happen? And how can we, the clinicians involved in the field of substance use, weigh in on this topic of national interest? Please send me your solutions at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Stuart Gitlow, MD, MPH, MBA, a psychiatrist, is a member of the American Medical Association’s Council on Science & Public Health, and an officer of the American Society of Addiction Medicine. This column represents his personal opinion and does not imply any position or
policy taken by either the AMA or ASAM.

Comments

Add New

RSS

ttanks - Opiods in the work place

|74.215.210.xxx |2011-03-06 06:51:07

Diagnosis Treatment ongoing compliance and follow up by a doctor. This is the
law. Why did the worker perscribed not share the informatio earlier. This is
the only question in her case.

Buying drugs on the street is illegal. This
will put business and person at risk for law suits and loss of job with no
supportive services.. Doctors have license to perscribe if they comply with
rule of AMA there should be no problem.