The Federal Department of Transportation (DOT) will require that employers falling under their drug testing programs and regulations must include opioids as of January 1, 2018. The final ruling was published in the Federal Register on November 13, 2017, nearly a year after the change was initially proposed.

Why Add Opioids?

Opioids are a class of drugs that work with the brain and nerve cells to relieve pain. They can be naturally derived from plants, synthetically produced in a laboratory, or a combination of the two methods. While humans have used a form of opioids for thousands of years, it was the introduction of pain relief in prescription pill form in the 1990s that has led to a crisis of abuse that has fundamentally changed the way that the medical community addresses pain and placed a heavy burden on law enforcement. (Learn more in "A Look At Prescription Drug Abuse Statistics".)

The action is a response to the growing opioid crisis in the United States. Abuse and addiction of prescription medications have reached epidemic proportions, resulting in more deaths in Americans age 50 and under than any other cause. Other facts to consider:

• Two million people are addicted to opioid medications.
• Nearly 21 million people are affected by substance abuse.
• About 100 people are killed every day by an opioid overdose.
• Opioid abuse costs the country $80 billion a year due to health care, lost productivity, and legal action.

Doctors prescribe opioids to relieve pain following surgery or injury, as well as for chronic pain. These drugs are quite effective for eliminating discomfort; however, they also produce a sense of euphoria. Most people discontinue the medications as directed, but others continue to take them to achieve the blissful feelings. (Learn more in "How Prescription Opioids Affect the Workplace".) Over time, the dose must increase and people must take the opioids to prevent withdrawal symptoms. (Learn more in "Signs of Drug Use in Employees: Behaviors That Might Signal Drug Use on the Job".) Eventually there is a risk of overdose and death.

DOT Regulation

The DOT’s testing regulation addresses the current situation and the need to provide public safety for all Americans. (Learn more in "Prescription Opioids and Safety Sensitive Work".) In 1991, Congress passed the Omnibus Transportation Employee Testing Act, called Part 40, recognizing the need for oversight of a drug- and alcohol-free transportation industry. The Act required DOT agencies to implement drug and alcohol testing of safety-sensitive employees to protect the traveling public and workers. (Learn more in "Are Prescription Opioids in the Workplace Really a Problem?")

“The opioid crisis is a threat to public safety when it involves safety-sensitive employees involved in the operation of any kind of vehicle or transport,” said Secretary Elaine L. Chao. “The ability to test for a broader range of opioids will advance transportation safety significantly and provide another deterrence to opioid abuse, which will better protect the public and ultimately save lives.”

Four prescription semi-synthetic opioid medications will be added to mandatoryurine drug screening. Their generic names are similar, as are the reasons for their initial use. They all provide fast and effective pain relief, as well as a feeling of relaxation and euphoria.

The Drug Enforcement Administration (DEA) classifies these opioids as Schedule II drugs: “Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous.”

The New Drugs to be Included in Testing

• Hydrocodone: Prescribed for moderate to severe pain, as well as to treat coughs. It’s often combined with acetaminophen (Tylenol) or ibuprofen (Advil) for pain relief. Common brands are Vicodin, Lorcet, Lortab, Norco, Xodol, and Hycet.
• Hydromorphone: Prescribed for acute pain, such as after surgery. It’s also used to manage severe chronic pain. The brand name is Dilaudid.
• Oxycodone: Prescribed for moderate to moderately severe pain. One of the most dangerous opioids, the brand names include OxyContin, Roxicodone, and Oxect.
• Oxymorphone: Prescribed for moderate to severe pain. It’s highly addictive; in June 2017, the FDA asked the manufacturer to remove it from the market. However, generic versions are still available. The brand name is Opana.

All four opioid substances can impair thought and decision making. They also reduce reaction time. In a survey reported by the National Safety Council, 70 percent of employers said their workplace had been affected by abuse of prescription drugs. (Learn more in "What Employers Need to Know about Prescriptions in the Workplace".) Almost 40 percent saw an increase in increased absenteeism; 40 percent were aware of employees using prescription drugs at work; and 30 percent reported a drop in job performance related to prescription drugs.

New Rules Must be Implemented Quickly

Employers have no time to lose in order to meet the implementation date of January 1, 2018. (Learn more in "Positive Proactive Steps Employers can Take to Deal with Opioids in the Workplace".) The DOT Summary of Changes provides instructions to all agencies and parties involved in the ruling. Laboratories, urine sample collectors, alcohol technicians, and Medical Review Officers should refer to the final rule for specifics.

Employers themselves will need to urgently address some operational issues:

• Contracts with testing agencies should be updated.
• Workplace drug and alcohol policies and procedures should be revised.
• Corporate and/or employment attorneys should review all changes.
• Managers and supervisors should be trained on the DOT final rule.
• Employees should be notified and educated on testing changes.
• All steps should be carefully documented.

Budgets will need to be adjusted for additional testing fees, as well as the costs for legal counsel and employee training.

Summary

The DOT mandate is part of the government’s action to stop the opioid crisis from growing. As part of the 2016 21st Century Cures Act, $1 billion in grants for prevention and treatment programs has been distributed to all 50 states and U.S. territories. In August 2017, Attorney General Jeff Sessions announced that the Department of Justice would launch the Opioid Fraud and Abuse Detection Unit, to identify and prosecute anyone who illegally obtains or distributes opioids.