Prescription drug misuse in the workplace

Illicit drug use and alcohol misuse are now recognised as factors that can affect health and safety in the workplace. The same may not be true for prescription drugs.

Prescription drugs, when used without a prescription and without the supervision of a doctor, can also have adverse effects. Workers can become sleepy, anxious, depressed or confused from the improper use of prescription drugs. In addition, when these drugs are used improperly, they can pose risks to employees, their co-workers and the overall workplace itself. The risks associated with non-medical use of prescription drugs in workplaces can escalate when workers’ jobs require caution and safety to prevent injury, such as those of transportation workers, assembly line workers, construction workers, nuclear power plant workers and the like.

What is prescription drug misuse?

Prescription drug misuse can be defined as the use of prescription or over-the-counter pain relievers, prescribed stimulants or sedatives without a prescription of the respondent’s own or simply using the prescription drug for the effect the drug causes. This definition covers a wide range of behaviours, which could vary from misusing prescription medications to get high, stay awake or get to sleep to using someone else’s medication to address a legitimate medical need.

Often, it is the case that this sort of behaviour can lead to lead to addiction, misdiagnosis of illnesses, life-threatening circumstances and death.

Is prescription drug misuse a problem in Australia?

In Australia as a part of the National Drug Strategy, a survey is conducted every three years by the Australian Institute of Health and Welfare which measures the prevalence of alcohol, tobacco and drug use, and attitudes toward these substances, across Australia.

In the last survey, for the very first time, prescription medications were included among the questions and Table 1 summarises its findings for the prescription medication. The striking finding is that almost one in 10 people between the ages of 20-29 used prescription medications for non-medical purposes. The regular users appear to be around 1% of the population, which is way higher than illicit substance users.

If we look at the trends in economies and cultures similar to that of Australia, such as the US and Canada, prescription medication misuse is now their number one problem.

Table 1: Use of pharmaceuticals for non-medical purposes, people aged between 20-40 , AIHW, 2010*

	% of usage per age range
Period	20-29	30-39	40+
In lifetime	10.3	9.7	6.2
In last 12 months	5.6	4.5	3.8
In last month	2.1	1.8	2.1
In last week	0.9	1.0	1.1

*National Drug Strategy Household Survey 2010, Australian Institute of Health and Welfare

It is important to note that prescription drugs are safe when they are taken as directed by a treating doctor. Fear of complications related to taking these medications long term should not stop an individual from taking medications that can help treat his or her problems, nor prevent a doctor from prescribing appropriate medications. Proper usage of prescription drugs can help workers protect their health and thus perform more productively in the workplace.

However, when taken for non-medical or recreational purposes, prescription drugs are no safer than illicit or street drugs. The misconception of prescription drugs as legal and ‘safe’, even when abused, is particularly strong among young adults.

How do people get access to prescription medication?

The most common way of obtaining these type of medications is generally from friends and relatives. Young people refer to obtaining drugs from older relatives as ‘fossil fossicking’. Other ways of acquiring prescription drugs include ‘doctor shopping’ to get multiple prescriptions, taking them from a friend or relative, or buying them from a friend, relative or dealer.

The internet is not a common source for obtaining these kinds of medications for Australians. However, people who travel to Asian and Southeast Asian countries where most medications are sold over the counter without a script tend to bring back large quantities of these medications and then sell them back in Australia.

What are the most commonly misused drugs?

Painkillers: This group of medications includes morphine, codeine and oxycodone. These drugs can cause feelings of euphoria or a high. Some users alter the method of ingestion to intensify these feelings (eg, snorting or injecting OxyContin). Since these drugs can affect breathing, even a single dose can be dangerous in an individual who has never used this type of medication. Mixing painkillers with other substances such as alcohol or antihistamines is equally risky since it increases the risk of respiratory depression.

Sedatives are used to treat anxiety and sleep disorders and include barbiturates and benzodiazepines. These drugs produce a calming effect by slowing normal brain function. The body quickly adapts to some of these drugs, thus requiring greater doses to achieve the same effect. It is dangerous to suddenly stop taking these drugs, which can lead to seizures and other harmful side effects. These medications should not be combined with painkillers or alcohol, since together they can slow the heart and respiration to the point of death.

Stimulants, which are used to treat sleep disorder narcolepsy and attention-deficit hyperactivity disorder, include methylphenidate and dexamphetamine. Misuse of stimulants produce a sense of euphoria and can lead to addiction. Stimulants are sometimes abused for ‘performance enhancement’ (eg, weight loss, better focus, increased attention) as well as to get high. These drugs can decrease sleep and appetite, which can lead to malnutrition, and increase blood pressure, heart rate and body temperature, which can lead to serious cardiovascular complications such as stroke. Abuse can also lead to paranoia and feelings of hostility.

What are the risks associated with workplace prescription medication misuse?

Risks associated with this type of substance misuse are no different than alcohol or illicit substance misuse and can be summarised as:

• higher healthcare expenses for injuries and illnesses;
• higher rates of absenteeism;
• reductions in job productivity and performance;
• more workers compensation and disability claims; and
• safety and other risks for employers.

What can be done in the workplace?

Employers can play an important role in preventing the unhealthy and hazardous use of substances including prescription medications by:

• sending the message that drinking and illicit drug use are not condoned;
• combating the stigma against seeking help and telling employees they can seek treatment confidentially without jeopardising their jobs;
• incorporating information on the appropriate use of alcohol and legal substances like prescription medications into overall wellness and risk prevention strategies;
• providing factual information on the harmful health effects of excessive use of alcohol; and
• reminding employees that excessive or binge drinking outside of work has an impact on safety and job performance at work.

Is there a treatment?

Like other chronic diseases, addiction - a disease of the brain - can be treated. Usually, treatment includes detoxification and drug treatment or behavioural interventions - or a combination of all of these.

Detoxification is a process of supervised withdrawal from a drug; it is often the first step in a drug treatment program.

Behavioural treatments may include individual therapy, group counselling, contingency management or cognitive behavioural therapy, each of which helps individuals learn how to handle situations that may trigger cravings or use and how to handle relapse.

Drug or pharmacological treatments can be used to counter the effects of the drug on the brain, relieve withdrawal symptoms and overcome cravings.

No single treatment is appropriate for all individuals. Frequently, multiple treatment rounds may be needed for an individual to fully recover.

Assessments

Assess Medical Group can assist organisations by providing independent specialist medical assessment and reviews of cases related to substance misuse that could be helpful in deciding what course of action needs to be taken.