Getting Serious About Painkillers

"No matter how much a person tries to concentrate behind the wheel, their brain is not functioning properly, and therefore motor performance and operation are severely impaired."

Editor's note: Recent publications by SAMHSA and other authorities warn that prescription painkiller abuse and misuse is a major problem. Opiate addiction specialist Clare W. Kavin, administrative director of the Waismann Method answered questions by e-mail on Dec. 16, 2010, from OH&S Editor Jerry Laws. She discussed the problem's impact on the workplace and explained what employers should do to combat it.

Q: I've read articles warning of prescription painkiller misuse by the general public but seen little about the problem in the workforce. What are the sources for data on this, and what data do we have about current levels of misuse in the U.S. working population?

A: Since prescription painkiller abuse is something that is affecting a significant number of the population, there is no doubt that this problem will have direct consequences in the workplace. A study released by the Substance Abuse and Mental Health Services Administration (SAMHSA) last summer showed a 400 percent increase in the number of hospital treatment admissions involving prescription pain relievers. Another study by the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health & Human Services, revealed that hospital admissions for drug-related conditions for adults between 45 and 64 years old grew 117 percent between 1997 and 2008 (from 30,100 to 65,400).

More specifically tied to the workplace is data from the Drug Testing Index released by Quest Diagnostics in September 2010, which showed that the number of employees testing positive for opiates rose by 18 percent within just one year, from 2008 to 2009, with an overall 40 percent increase between 2005 and 2009.

Q: Are employers aware of this problem, and are they addressing it?

A: Employers are certainly aware of the potential of prescription painkiller misuse in the workplace, especially since the problem of individuals abusing these drugs has been on a steady increase in recent years.

Since these drugs are mainly prescribed by physicians and an employer cannot override a decision made by a medical professional, it puts them in a legal bind. Unless the employee is a threat to himself or others during work hours, the employer is unfortunately powerless, even if the quality of work is declining.

Q: What are the safety, health, and productivity implications for employers?

A: As revealed by additional data from the Drug Testing Index, post-accident drug tests found opiates up to four times more often than in pre-employment tests, indicating that these drugs are potentially a contributor to accidents in the workplace. Therefore, employers should be aware that the misuse of prescription painkillers, such as hydrocodone or oxycontin, can put the safety of employees and those around them in jeopardy, as well as minimize productivity.

Q: What are your recommendations for employers?

A: Employers should try to implement drug testing when they can, and they should always be on the lookout for signs that their employees may be misusing prescription pain medications. These signs can include decreased productivity, the inability to complete simple day-to-day tasks or putting extra effort in completing these simple tasks, and appearing to care less about the quality of work.

When an employer discovers that an employee may have a problem, they should offer various treatment options that can help with their painkiller dependency. For example, the Waismann Method rapid opiate detoxification procedure allows an employee to return to work opiate free within a matter of days. Options such as these are important to keep in mind, especially for those who cannot afford to take weeks or months off of work, which is typically how long the detoxification process takes at most treatment centers.

Employers should also be aware of a doctor's responsibility when prescribing medications to their employees. Doctors need to know a patient's job description to ensure that they are able to safely complete their tasks if under the care of certain prescription medications. They need to understand that they are not only dealing with a patient with a symptom, but a patient who has responsibilities such as job performance, which can affect the safety and productivity of themselves and those around them.

In order for an employee to keep working while taking prescription medications, a doctor should provide a letter releasing the patient to work under their job description, while taking responsibility for them regardless of what their job capacity is. This would give the employer less liability and make doctors more careful when prescribing their patients because they know they would have a certain responsibility for any consequences the employee and their co-workers could potentially face because of these drugs.

Q: Beyond the DOT-regulated industries, workplace drug testing is largely voluntary for private-sector employers, I believe. How prevalent are pre-hire testing and testing of current employees today in the private sector?

A: Pre-hire testing and testing of current employees is becoming more prevalent nowadays in the private sector because employers understand that a worker under the influence of not only prescription, but illicit drugs, can be a tremendous liability to their business. By implementing drug tests both before and during the course of employment, a business can significantly lower any potential risks toward safety and productivity -- saving time, money, and troubles in the long run.

Q: Testing current employees is rarely done, as I understand it, except post-accident. Are data available indicating how frequently opiate use is a factor in workplace accidents and casualties?

A: As stated earlier, the Drug Testing Index released by Quest Diagnostics on an annual basis, has shown that recently in 2009, post-accident drug tests found opiates in 3.7 percent of those tested, compared to 0.78 percent in pre-employment tests, particularly in the case of hydrocodone -- a powerful, habit forming opiate that can easily lead to both physical and psychological dependence.

Q: Texting while driving/distracted driving has gotten a lot of attention this year. Should we be more concerned about opiates, alcohol, or cell phones when it comes to road safety?

A: The use of opiates, alcohol, and even cell phones should absolutely be of concern to drivers. While a cell phone you can always put down, being under the influence of alcohol or a controlled substance is something one actually cannot control. A recent survey released by the Substance Abuse and Mental Health Services Administration indicated that in an average year, 10 million individuals drive under the influence of drugs, and 30 million drive under the influence of alcohol. These numbers are quite staggering, since driving under the influence is the leading cause of car accidents. No matter how much a person tries to concentrate behind the wheel, their brain is not functioning properly, and therefore motor performance and operation are severely impaired.

This article originally appeared in the February 2011 issue of Occupational Health & Safety.

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