Implicancias del Estudio

“Prescription drug abuse is a silent epidemic that is stealing thousands of lives and tearing apart communities and families across America,” said Gil Kerlikowske, Director of National Drug Control (CDC, 2011a, para. 4). In the 2012 forward in the National Drug Control Strategy, President Obama stated, “Prescription drug abuse continues to claim American lives, and those who take drugs and drive threaten safety on our Nation’s roadways” (Executive Office of the President of the United States, 2012, p. iii).

Expanded Panel

The Five Panel drug screen should be expanded to include medications which are known to cause impairment such as synthetic narcotics, benzodiazepines, muscle relaxants, sodium oxybate, and sedating over-the-counter antihistamines. Testing for these substances will identify employees who are impaired, act as a deterrant for abuse, and assist with gathering data to

determine the scope of the problem. The cost associated with the expanded panel would increase; however, the cost is minimal when compared to the risk of the safety of employees, coworkers, and the public at large.

Prescription Drug Monitoring Programs

The strategies outlined in the 2012 National Drug Control Strategy focus on the Harold Rogers Prescription Drug Monitoring Programs (PDMP). The National Alliance for Model State Drug Laws (NAMSDL) is the technical assistance provider for PDMP and serves as a resource for governors, state legislators, attorneys general, drug and alcohol professionals, community leaders, the recovering community, and others with an interest in comprehensive and effective

62 state drug and alcohol laws, policies, and programs. PDMP provides grants to individual states that wish to enhance the monitoring of prescriptions and sales of controlled substances. PDMP impacts the probability of prescription drug abuse both directly and indirectly to reduce the likelihood of abuse. PDMP serves to affect prescription drug abuse directly by holding supplies constant and indirectly by operating through the supply of controlled substances (Simeone & Holland, 2006). States are eligible to receive the grant if they have a plan in place for a statute or regulation which requires submission of controlled substance prescription data into a central database. The state may select their scope of coverage, for example include Schedule II drugs, Schedule III drugs, Schedule IV drugs, or Schedule V drugs; however, the coverage is

cumulative such that those states that select Schedule III drugs will also include Schedule II. Access to this database is controlled by the state but available to law officers, pharmacists and providers (Simeone & Holland, 2006).

MROs and SAPs should be required to verify prescriptions with the PDMP. They should discuss the prescribed medications with the treating provider to ensure that the employee is not performing safety-sensitive duties while taking over-the-counter or prescribed medications which may cause impairment.

Training

Employers, employees, MROs, and SAPs should be required to receive annual training regarding medications which may cause impairment and reporting requirements. Supervisors and employees should be trained in behavior observation so that any behaviors of impairment are reported and the employee in question is removed from safety-sensitive duty pending further review. Education should also be made available to ensure that employees understand the association between substance abuse and employee cost in medical premiums. Company policy

63 should enforce these requirements and should include consequences of failing to comply with the requirements.

Research

Research is needed to find ways to detect attempts to falsify drug test results. Additional research is needed to determine the efficacy of saliva specimen collection in lieu of urine collection. This collection modality can easily be obtained under direct observation and is non- invasive with no known side effects. Research is also needed to further evaluate medications known to cause impairment and determine the cut-off point for impairment.

The OHN should perform literature reviews to keep abreast of medications that cause impairment. The OHN should also be well-versed on methods of specimen substitution or subversion.

In conclusion, the purpose of the DOT’s drug and alcohol program is to protect the safety of employees, co-workers, and the traveling public. Measures should be taken to deter any impairing substance – regardless of whether or not the substance has been legally obtained. The OHN can manage the DOT drug and alcohol program to assure the employee is free from impairing substances, thereby reducing financial and human resources costs to the employer and society.

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