Prescription Drug Misuse and the Workplace
Prescription drug misuse is second to marijuana use as the nation’s most commonly used illicit drug. It should be known however, that most people do not misuse their prescriptions, including those for pain relievers. While people misuse medicines for different reasons, research has shown that they are most often misused for the condition for which they were prescribed. A common misperception is that prescription drug misuse is without risk because prescription drugs are regulated with legal, medical uses. Prescribed drugs are just as addictive, every bit as potent as illicit drugs like heroin and cocaine. Their misuse has serious adverse effects to the consumer’s health, family life, and employment status.
Types of Prescription Drug Abuse
Prescription drug abuse includes any non-medical use of a prescription drug or using prescription medications in ways that are not specified by health care professionals. It can also include using someone else’s prescription.
Commonly Abused Prescription Drugs
The most popular drugs for abuse are classed in terms of what they do:
Opioids are commonly prescribed because of their effective pain-relieving properties and are abused because of their intense euphoric high. Medications that fall within this class, referred to as prescription narcotics, include morphine, codeine, oxycodone, and hydromorphone. Also included in this group is the highly addictive drug fentanyl with potency of 80 to 100 times stronger than morphine.
Central nervous system depressants are used as tranquilizers and sedatives and help control sleep disorders and anxiety. Like opioids, depressants are easy to obtain. Anti-anxiety or sedative drugs, such as Valium and Xanax, are in this class of drugs. GHB, the “club drug” or “date rape drug,” is also included.
Stimulants such as Ritalin or Adderall are typically used by students in order to help them focus more intensely or to stay up later to study. A more recent trend was for competitive online gaming called “e-sports.” Cocaine is also a stimulant.
Over-the-Counter (OTC) Drug Abuse
OTC drugs such as cough medicines containing dextromethorphan (DXM) are abused for their almost hallucinogenic effects on vision and hearing. They can cause adverse reactions due to medical conditions or other medications the user may already have consumed. Just because they are legally available without a prescription does not mean that they are safe, especially when not used according to directions.
- Severe agitation and anxiety
- Fast, racing heartbeat and higher blood pressure
- Nausea and vomiting
- Muscle spasms, seizures, and tremors
- Intense hallucinations and psychotic episodes
- Suicidal and other harmful thoughts and/or actions
Workplace impacts include reduced productivity, absenteeism, and decreased ability to operating motor vehicles and equipment safely. These signs and symptoms are common among those who misuse narcotics. Misuse of prescription drugs compromises the employer’s ability to maintain a safe and productive work environment and should be addressed immediately.
Here are some workplace behaviors observed with the misuse of prescription drugs:
- Dramatic changes in behavior
- Decrease in work performance
- Failure to fulfill major work obligations.
- Use of substances in situations when it is physically hazardous
- Abrupt mood swings or moodiness
- Personality instability
- Ongoing use of prescription drugs or frequent doctor switching
- Dramatic changes in appearance
- Excessive over-the-counter medicine use
- Always looking for money
Defining the Problem
Here are a few statistics to understand the scope of the problem:
- In 2017, an estimated 18 million people (more than 6 percent of those aged 12 and older) have misused prescription medications at least once in the past year.
- 8% of respondents to the National Survey of Drug Use and Health age 18 years or older reported illicit opioid use in the past year with 63% employed full- or part-time.
- Workers with a current substance use disorder missed nearly 15 days per year while the subset with a pain medication use disorder missed 29 days per year. Most employees average 10.5 days missed while those in recovery from a substance use disorder missed an average 9.5 of days.
- Even employees who take a prescribed regular dose may not be fit for duty, especially in a safety-sensitive position.
- In a workers’ compensation study, injured workers with long-term opioid prescriptions were disabled more than three times longer than injured workers who did not receive opioid prescriptions.
Putting It All Together
Medications prescribed under the care of a medical doctor are a vital treatment tool in modern medicine. Most people use the medicines according to direction. Even then, some people may be adversely affected by the medications in ways that could impact their work. A supervisor or co-worker doesn’t usually know an employee’s medical status but must act upon the observed behaviors affecting the worker’s job function. That includes documenting the observations, speaking with the worker, sending him for medical treatment if warranted, and drug testing. Since most people who abuse illicit drugs or misuse prescription drugs and alcohol work, the process for addressing the problems must be the same whether the worker has diabetes or a substance use problem. When the facts are established, the employer then addresses the next steps actions with the worker in accordance with company policy and procedures.