With the emergence of synthetic opioids, there has been a significant increase in prescription usage within the last 10 to 15 years to treat chronic and acute pain. Not surprisingly, there is a high rate of addiction to these prescription drugs. It is estimated that approximately 22% of all admissions to drug rehabilitation programs are for prescription drug abuse. Even without abuse, there are concerns if an employee is taking prescription opiates as they are prescribed for a legitimate medical condition because of potential trouble this could pose to safety sensitive work.
In July 2014, the American College of Occupational and Environmental Medicine (ACOEM) released a report titled “ACOEM Practice Guidelines: Opioids and Safety-Sensitive Work”. A multidisciplinary panel of experts reviewed all available research articles (up to Oct 2013) that deal with opiates, driving, and other safety sensitive functions. The search encompassed 7 research databases and originally identified 21,478 article abstracts. Using a set guideline agreed upon by the multidisciplinary team of 18 experts in their respective fields, they narrowed the inclusion down to 12 studies that met the criteria they set out.
The recommendation given by the Evidence-based Practice Opioids Panel is as follows:
"Acute or chronic opioid use is not recommended for patients who perform safety-sensitive jobs. These jobs include operating motor vehicles, other modes of transportation, forklift driving, overhead crane operation, heavy equipment operation, sharps work (eg, knives, box cutters, needles), work with injury risks (eg, heights) and tasks involving high levels of cognitive function and judgment."
Increased Risk When Driving
The panel was not able to find any research directly relating to safety sensitive functions other than driving a motor vehicle, but suggest that driving a motor vehicle has similar tasks to other safety sensitive functions with respect to cognitive function, hand-eye coordination, reflexes, and reaction times. Due to this, they felt confident in extending the findings of these studies to all safety sensitive duties. They went on to say that in all of the large studies of working age adults the increased risk of motor vehicle crashes due to weak and strong opioids ranges from a 29% increase to an 800% increase versus non-medicated drivers.
The intended user of the guideline is a front line healthcare practitioner. The report goes on to say that: “these are recommendations for practitioners” to use in conjunction with other available resources, and the particular circumstances presented by the individual patient.
Widespread Use of Opioid Medications
What does this mean for companies that have employees in safety sensitive positions? In Canada, it is estimated that there are 23 daily doses per 1000 population per day of opioids (23 people out of 1000 have a prescription for and are using opioids on any given day). These people are at a significantly greater risk of having an accident while performing safety sensitive functions.
Opioid Impairment Continues Longer Than Previously Thought
It was previously believed that acute opioid exposure was related with safety sensitive impairment, but it subsided after a few weeks on the drug. There is now more evidence showing that the impairment continues into the chronic phase of being on opioids. Many research articles are indicating that there is a steady increase in the use of opioids for pain relief. Companies that are looking for ways to improve their workplace safety might want to give some consideration to implementing policies surrounding opioids and education for their workers to the risk of using opioids while in safety sensitive environments.
Company Actions to Mitigate Accident Risk from Opioid Medication Use
Three ideas come to mind that a company could consider incorporating to reduce the risk of accidents due to opioid medications.
Companies can incorporate a section into their drug and alcohol policy that all new employees fill out a post-offer pre-employment questionnaire identifying if a worker is using opioids or other medications that can cause increased risk with safety sensitive duties, like benzodiazepines.
Companies can also request of workers that if they start using a prescription of opioids that they identify it to their supervisors or safety personnel when they start the prescription.
Perform a medical evaluation of workers taking opioids to determine if they are capable of safety sensitive functions. During the medical evaluation a healthcare practitioner should give a clear determination of whether the worker is capable of safety sensitive functions. During the medical evaluation have the healthcare practitioner determine if there are other medication options for the employee that do not pose a safety sensitive risk, and are non-opioid based medications. The company may also consider offering a modification of duties if needed.
A company may also choose to implement a policy stating workers that are taking opioids are not permitted to perform safety sensitive duties. This option would be the safest route to take with regards to reducing the risk of accidents, but would likely face litigation or arbitration. While there is evidence to support this type of policy, there is not enough current case law to predict if a court or arbitrator will find for the employee or the employer in these cases currently.