prescription drugs in the workplace meeting the challenge

Prescription Drugs in the WorkplaceMeeting the Challenge

David K. Roberts, Ph.D.

Legacy Laboratory Services- MetroLab Toxicology

July 12, 2012

Why are Prescription Drugs a Challenge?

Prescription drugs with abuse potential are the challenge!

April 19, 2023 LEGACY HEALTH 3

OK Not OK

Legally prescribed Diverted, spousal use

Used responsibly Abused

Can cause impairment- accident risk

Can cause addiction

• Performance problems

• Absenteeism issues

• Increased health care costs


Prescription Drugs with Abuse Potential – The Usual Suspects- part 1

Drug Class Trade Name Generic Name

Amphetamines Adderall Amphetamine

Ritalin Methylphenidate

Benzodiazepines Xanax Alprazolam

Klonopin Clonazepam

Valium Diazepam

Ativan Lorazepam

Restoril Temazepam

Medical marijuana Pot THC

Nonbenzodiazepine hypnotic Ambien Zolpidem


Prescription Drugs with Abuse Potential – The Usual Suspects part 2

Drug Class Trade Name Generic Name

Opioids Suboxone Buprenorphrine

Duragesic Fentanyl

Lortab Hydrocodone

Dilaudid Hydromorphone

Dolophine Methadone

MS Contin Morphine

Oxycontin Oxycodone

Opana Oxymorphone

US Center For Disease Control- Summary


Other Prescription Drug Issues Prescribed by a trusted professional

Typically over prescribed- 30 days instead of 3

Widely prescribed

Pharmaceutically pure

No street drug stigma

Active orally

Potent

Legitimate needs vs abuse potential

Abuse potential of prescription drugs, particularly opioids, is having significant societal issues!



Opioid Prevalence (DAWN)

Emergency Dept Visits Involving Opioids

0

20,000

40,000

60,000

80,000

100,000

120,000

2004 2005 2006 2007 2008

year

visi

ts

Codeine

Hydrocodone

Fentanyl

Hydromorphone

Methadone

Morphine

Oxycodone


Illegal Drug Prevalence (DAWN)

Emergency Dept Visits Involving Illegal Drugs

0

50,000

100,000

150,000

200,000

2004 2005 2006 2007 2008

year

visi

ts

Heroin

Cocaine

Marijuana

Meth/amphetamines


Benzodiazepine Prevalence (DAWN)

Emergency Dept Visits involving Benzodiazepines

0

20,000

40,000

60,000

80,000

100,000

120,000

2004 2005 2006 2007 2008

year

# vi

sits

Alprazolam

Clonazepam

Lorazepam

Diazepam

Temazepam


Drug Prevalence Comparisons (DAWN)

Drug ED Visits Comparison

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

2004 2005 2006 2007 2008

year

# vi

sits

Illegal Drugs

Opioids

Benzodiazepines


Prescription vs Illegal Drugs: ED Visits

Drug Class ED Visits

0

100,000

200,000

300,000

400,000

500,000

600,000

2004 2005 2006 2007 2008

year

# vi

sits Prescription Drugs

Illegal Drugs

In Oregon Prescription Drug Deaths > Traffic Deaths


Hydrocodone (with acetaminophen)


Hydrocodone- the Most Prescribed Opioid Hydrocodone is absorbed and then metabolized to

Hydromorphone

Hydromorphone is 7 – 10 times more potent than morphine!


Oxycodone


Oxycodone- “Hillbilly Heroin” Oxycodone is absorbed and then metabolized into Oxymorphone

Oxymorphone is ~10 times more potent than morphine!


Opioid Addiction


Opioids indirectly enhances dopamine Excess dopamine can cause intense pleasure

Drug AddictionA Behavior Disorder

Chronic

Relapsing

Complex cascade of neurochemical events

Result in Compulsive drug seeking behavior

Persists even if the face of negative consequences


Meeting The Prescription Drug Challenge


Step Issue Comments

1 Policy Policy always comes first- don’t forget a legal review!

2 Panel You can’t find it if you don’t test for it- make sure your company is using the right panel!

3 Consistency Use the same panel for all your testing regardless of reason- avoid collector errors.

4 Require Disclosure & Train Supervisors

Require confidential employee disclosure- policy (non)compliance may be critical. A trained supervisor can provide evidence for impairment.

5 MRO Use a board certified MRO- sorting through legitimate vs illegitimate prescription medication is better left to a professional.

Step 1- No Testing Without a Policy

www.drugfreeworkplace.gov

Always Hire an Employment Lawyer to Review Your Policy


http://www.drugfreeworkplace.gov/


Step 2- Use the Right Panel.“Urine 8”- Illegal + Prescription Drugs

Test Drug Class Cutoff Make sure cutoff is appropriate

1 Amphetamines 500 ng/mL New more sensitive DOT cutoff

2 Benzodiazepines 200 ng/mL Need lower cutoff & special screening test for Alprazolam

3 Cocaine 150 ng/mL New more sensitive DOT cutoff

4 Opiates 300 ng/mL Need low cutoff for Hydrocodone

5 Heroin 10 ng/mL New test included in each panel- can be positive by itself!

6 Oxycodone 100 ng/mL Required to reliably detect Oxycotin, Percodan, Percocet

7 Methadone 300 ng/mL Increasingly common prescription drug

8 Marijuana 50 ng/mL DOT cutoff to exclude passive exposure

.


Other Drug Step 2 Panel ConsiderationsOut with the OLD screening tests:

Propoxyphene, MDMA, Barbiturates, Methaqualone, PCP, Amphetamine 1,000, Cocaine 300,

In with the NEW / relevant screening tests:

Oxycodone, Methadone, Benzodiazepines, Heroin, Amphetamine 500, Cocaine 150,

Out with the OLD confirmation tests:

“DOT Opiates”: Morphine and Codeine only

In with the NEW / relevant “Expanded Opiates” confirmation tests (will be in DOT panel in 2 years):

Morphine and Codeine 2000

Hydrocodone / Hydromorphone 150

Oxycodone / Oxymorphone 100

Consistency & DisclosureStep 3: Consistency helps reduce errors. If you have only one panel you will avoid “the wrong panel” syndrome. Keep it simple.

Step 4: Important issues if you have a post accident or reasonable suspicion drug screen.

If a prescription drug is detected and it was legally prescribed- policy becomes paramount.

The MRO will NOT be able to determine impairment using urine drug levels.

If the employee failed to disclose a detected prescription drug- you will have a policy violation.

If a trained supervisor documented objective evidence of impairment- you have a policy violation.


Step 5: A Board Certified MRO Board certified MROs can

•investigate prescriptions without violating HIPAA laws.

•Interview donors regarding their medical conditions.

•Review chain of custody documents.

•Legally provide a safety concern if an employee has a detectable prescription drug that could cause on the job impairment and result in increased accident risk

SAFETY CONCERN: A legally prescribed Hydrocodone is detected in Joe’s urine in a pre-employment drug test for a fork lift operator.

Reported Negative after an interview- no safety concern: A legally prescribed Alprazolam metabolite is detected in Suzy’s pre-employment drug test for a receptionist.


Prescription Drugs in the Workplace- Meeting the Challenge Summary

Prescription drugs represent a significant business threat

Policy comes first in order to protect your business

Don’t forget your lawyer

Make sure your panel covers the main prescription drug threats

Amphetamines

Benzodiazepines

Opioids

Use the same panel every time- keep it simple

Communicate your policy and require that employee’s disclose prescription drugs that could cause impairment

Train your supervisors to recognize drug impairment

Use a board certified MRO


Questions????

Thank you!

prescription drugs in the workplace meeting the challenge

Documents

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