A Protocol to Evaluate Drug-Related Workplace Impairment

Abstract

The dramatic increase in the use and abuse of prescription controlled substances, cannabis, and a rapidly evolving array of legal and illegal psychotropic drugs has led to a growing concern by employers about workplace impairment, incidents, and accidents. The Federal Workplace Drug Testing Programs, which serve as a template for most private sector programs, focus on a small group of illicit drugs, but disregard the wider spectrum of legal and illegal psychotropic drugs and prescription controlled substances. We propose a protocol for the evaluation of workplace impairment, based on comprehensive drug and alcohol testing at the time of suspected impairment, followed expeditiously by a comprehensive physician evaluation, including a focused medical history with an emphasis on controlled substance use, physical and mental status examinations, evaluation of employee adherence to prescription medication instructions, additional drug testing if indicated, use of collateral sources of information, and querying of state prescription monitoring databases. Finally, we propose suggestions for optimizing the evaluation of drug-related workplace impairment.

Characterizing the Interrelationships of Prescription Opioid and Benzodiazepine Drugs With Worker Health and Workplace Hazards

“…132,133 Drug-free workplace programs have been associated with a reduction in drug use in some industries. 134 Workplace drug testing programs have an important role in mitigating adverse impacts of substances such as marijuana or heroin. 134 However, PD use may not be detected in most programs, as the results of the drug test are reported to the employer as negative, if a legitimate prescription is supplied.…”

“…134 Workplace drug testing programs have an important role in mitigating adverse impacts of substances such as marijuana or heroin. 134 However, PD use may not be detected in most programs, as the results of the drug test are reported to the employer as negative, if a legitimate prescription is supplied. 134,135 Legitimate does not mean lack of adverse effects, however, as approximately 60% of all opioid analgesic overdoses occur among patients who have a legitimate prescription.…”

“…134 However, PD use may not be detected in most programs, as the results of the drug test are reported to the employer as negative, if a legitimate prescription is supplied. 134,135 Legitimate does not mean lack of adverse effects, however, as approximately 60% of all opioid analgesic overdoses occur among patients who have a legitimate prescription. 134,136 Indications that marijuana use may vary inversely with opioids use was suggested by an ecological study showing that states with medical cannabis laws saw 24.8% lower mean annual opioid overdose mortality rate (−37.5% to −9.5%; P = 0.003) than states without these laws.…”