To the Editor:
The Evidence-Based Practice Guidelines Panel's recent recommendation would exclude opioid users from a wide range of nondriving activities.1 The evidence base consists of 12 studies about motor vehicle crashes and no studies about nondriving activities. Review of these 12 studies finds an association, and perhaps causal connection, between prescription opioid use and motor vehicle crashes. (A March 2014 report for the Federal Motor Carrier Safety Administration presents similar evidence.2) Based on this evidence and consensus of panel members, the guidelines recommend exclusion of opioid-using workers from safety-sensitive jobs.
The guidelines define safety-sensitive as motor vehicle operation and “other modes of transportation, forklift driving, overhead crane operation, heavy equipment operation, works with sharps, work with risk of injury (e.g., heights) and tasks involving high-levels of cognitive function.”1 In support of this expanded definition, the guidelines cite eight articles about cognitive deficits associated with opioid use and/or pain. The guidelines present no analysis of those studies or of the risk of opioid use in nondriving jobs.
The guidelines’ definition of “safety-sensitive” is vague and encompasses many (most?) workers. Given the prevalence of opioid use—4.2 million US adults taking opioids regularly in any given week per one study3—millions of adults could be deemed unfit for work. The guidelines acknowledge that this may extend too far, but justify this because one cannot test an opioid user's safety. It seems equally important to note that there is not a demonstrated serious safety hazard from prescription opioid use and this broad range of nondriving activities.
Our society—not doctors in particular—has decided that driving with drugs/alcohol in one's system is bad, and unnecessary opioid use should be curtailed. The guidelines reflect this. But they may be cited as a basis for excluding prescription opioid users from jobs without good reason. The guidelines’ analysis is based on studies of motor vehicle operation. The conclusion from that analysis should apply just to driving activities.
Editor, MRO Update
1. Hegmann K, Weiss M, Bowden K, et al. ACOEM Practice Guidelines: opioids and safety-sensitive work. J Occup Environ Med. 2014;56:e46–e53.
2. Brittle C, Fiedler K, Cotterman C. Schedule II Opioids and Stimulants & CMV Crash Risk and Driver Performance. Evidence Report and Systematic Review. Prepared for the Federal Motor Carrier Safety Administration. Monkton, MD: Acclaro Research Solutions Inc; March 21, 2014.
3. Kelly J, Cook S, Kaufman D, et al. Prevalence and characteristics of opioid use in the US adult population. Pain. 2008;138:5087–5113.