Prescription drug use is a growing issue for many employers and with 70% of the population taking some form of prescribed medication, it has likely already had an impact on your workplace. Unlike the use of illicit drugs or the abuse of prescribed medications, legitimately prescribed medications fall into a grey area where they only become a problem if they affect the ability of a worker to do his or her job safely. Unfortunately, some prescriptions do have negative effects, and for employees working in safety-sensitive positions this can be a real issue. (Learn more in Introduction To Safety-Sensitive Positions In The Workplace and Prescription Opioids And Safety Sensitive Work). And, it can translate into potential problems for your company.

Managing the use of illegal drugs and prescription drug abuse in the workplace, particularly with safety-sensitive positions, is simple. It is prohibited and many workplaces even have a zero tolerance policy towards prohibited controlled substances. Dealing with the use of legitimately prescribed medications, even in safety-sensitive positions, can be much more complicated.

First, you must deal with a myriad of regulatory bodies whose purpose is to protect workers’ privacy, particularly in health-related matters, and then you must determine whether there is actually a problem which directly affects the safety of your workers.

Where To Start

There are strong regulations in place for Department of Transportation (DOT) employers with employees in safety-sensitive positions. The DOT drug tests can ascertain whether an employee is using certain prescription medications and the employee is then required to submit proof of their prescription to the Medical Review Officer (MRO). The MRO may require an assertion by the prescribing physician that the employee can do their job safely before issuing a negative result to the employer.

Non-DOT employers, even those with employees involved in safety-sensitive positions, are limited in what they can do to deal with prescription medications in their workplaces. The Americans with Disabilities Act (ADA), the Age Discrimination in Employment Act (ADEA), and the Family Medical Leave Act (FMLA) all weigh in on the topic of what actions you can take with respect to your employees and prescription drug use. Before you do anything, get legal advice regarding the specific state and federal statutes that apply to you.

Here is a general list of what you may and may not do as an employer when it comes to this issue.

You cannot:

• Ask employees or prospective employees about legal prescription drug use, except in very specific circumstances.
• Test employees or prospective employees for legal prescription drug use, except in very specific circumstances.

You must:

• Apply policies regarding the use of prescription medications uniformly to all employees
• Keep your employee medical information strictly confidential
• Restrict your queries and testing for prescription medication to ensure they are related solely to an employee’s job and consistent with business necessity

You can:

• Ask potential new hires if they are able to perform the duties of the job. (Employees are required to notify their employers of any prescriptions they take that have side effects which may affect their job performance).
• Ask an employee or prospective employee about legal prescription drug use if all employees in the same safety-sensitive position are asked the same question.
• Require newly hired employees to have a medical examination and submit the results to the company, but only after a conditional offer of employment has been made.
• Require existing employees to undergo a medical examination and submit the results to the company. The employer will only be given access to the medical examination results, not the full medical records of the employee.
• Determine whether an employee is able to perform the essential functions of the job as stated in the job description
• Make inquiries or require tests if there is evidence that an employee's ability to perform their job safely is being compromised by prescription medication or if the employee poses a direct threat due to a prescription medication.

What prescription medications may be cause for concern?

Prescription medications come in many forms and are delivered for everything from pain relief to treating the symptoms of a variety of physical and mental health conditions. This isn’t a problem for safety-sensitive employees unless there are issues with the specific medication that may put the employee or others at risk. There are, however, side effects for most prescribed medications and even at the correct dosage, these can be an issue in safety-sensitive positions.

Here are some of the potential issues with a few of the most commonly prescribed drugs:

• Depressants including barbiturates and benzodiazepines can cause confusion and poor concentration as well as impaired coordination and memory.
• Antidepressants including selective serotonin reuptake inhibitors, norepinephrine reuptake inhibitors and bupropion can cause sleepiness, insomnia, aggressive or impulsive behavior.
• Opioids and morphine derivatives including codeine, morphine, methadone, opioid pain relievers and fentanyl can trigger numerous side effects. These include weakness, dizziness, confusion, and impaired coordination. There is also a high abuse potential for many of these drugs.
• Stimulants such as amphetamines and methylphenidate can cause feelings of euphoria, loss of coordination, aggressive or impulsive behavior.

Therapeutic Range vs. Abuse

One of the most difficult aspects of the use of prescription medications in safety-sensitive positions is that the effect of these medications is dependent on personal tolerance. Personal tolerance varies widely and what might be okay for one employee can pose significant safety concerns for another. Regardless, there is a defined difference between what is acceptable for therapeutic purposes and what constitutes abuse.

There is an onus on both the employee and the prescribing physician to ensure that the employee in a safety-sensitive position can still fulfill the requirements of the job safely. For most employees, this simply means taking the medication at the prescribed dosage and for the prescribed time frame. Any deviation from this can be considered substance abuse.

Awareness and preparation are your best defence for handling the issue of prescription drug use in safety-sensitive positions. Employers who are not DOT covered, should consider implementing a clear policy regarding prescription medications in the workplace in conjunction with clear drug testing procedures, particularly for safety-sensitive positions. This policy should be evenly applied to all safety-sensitive employees in similar positions and it should be created with legal consultation to ensure it complies with existing state and federal regulations.