For some time it has been recognised that there is a need for due diligence in ensuring that illicit drug usage and inappropriate alcohol consumption is removed from the workplace setting. Drug and alcohol testing in certain industries is now the norm.
However it is increasingly being recognised that prescription and some over-the-counter medication can be implicated in problems in the workplace particularly regarding performance, productivity and safety issues pertaining to both individuals and their colleagues. In certain industries this would include third parties such as passengers and the public. Many companies now utilise ‘medication advice’ services from occupational health providers to check that a certain prescribed medication may be ‘safe’ in the workplace.
It is not the objective of this article to highlight any particular problems with specific therapies or treatments but to raise and focus on some of the factors which might be of assistance for employers in optimising the advice they get from their occupational health providers in this area.
Medication is ideally prescribed for an underlying medical condition by a medical practitioner. In most cases this is usually as a result of the individual consulting their doctor because of certain unwanted symptoms. The medication is then prescribed to try and cure, or at least alleviate, these underlying complaints and improve the well-being of the individual.
The employer has a duty of care to ensure that an individual is fit to carry out their duties and equally an employee has the same responsibility regarding their own capabilities. This is very much a leading tenet of the Health and Safety at Work Act. If an individual does not feel capable for whatever reason they should not undertake tasks particularly of a safety-related nature. The DVLA is very clear in their advice to holders of all driving licences that they have a responsibility to inform the DVLA regarding any medical problems that may have driving implications. The onus here is on the individual not to drive if they do not feel capable.
When asking for advice regarding the safety of prescription and/or over-the-counter medicines there are many factors that may need to be taken into account so that appropriate advice can be given in an individual and specific case.
Medication being taken in one situation may have no significant occupational implications but in another may be very significant. One example is aspirin, a treatment that is generally agreed to be a safe medication without significant side-effects in most cases. However, this may have serious implications depending on the underlying condition for which it has been described. For instance, if someone has been prescribed aspirin for a recent cardiovascular event such as a heart attack the underlying condition may be of far more importance to the occupational situation than the medication prescribed.
Antidepressant medication in the form of SSRIs (a group of anti-depressants formally called Selective Serotonin Reuptake Inhibitors) is another example of a treatment which can cause problems in the workplace. They are usually prescribed for mood disorders such as ‘depression’ which can have many different presentations. In these cases it is the underlying condition that must be assessed for occupational capabilities and not the pharmacological qualities of the treatment. There are many examples of prescribed medication which when used for treating one problem would not be an issue but for another condition this may well cause significant concerns.
In my experience as an Occupational Physician I have often been asked by appropriate managers if they could have a list of ‘banned medicines’ so they would not have to contact an advisory service. Although the request is understandable, this is of course not possible because it would depend on the setting of the individual, their job specifications and understanding the pharmacology in relation to the patient and their diagnosis.
Consulting a drug formulary with all the listed potential adverse effects is also limited in its usefulness. Experience is needed in judging the relationship of an individual’s job specifications alongside the underlying diagnosis so as to evaluate whether any potential side-effects have any significant risk related to the possible hazard identified. For the specialist giving advice in this area, knowing only the name of the medication does not give sufficient information. Without the individual diagnosis, background concerns, job specifications (e.g. driving, heights, confined spaces, heavy equipment or whether they are office-based workers etc.) and risk factors it is impossible to give useful and accurate guidance.
There are many reasons why an individual may on a particular day be unfit for work. Often these are socio-domestic, economic or other problems which may have symptomatic consequences on an individual’s concentration and general capabilities. As a rule employers do not contact an occupational provider over the phone as to whether these are contraindicated for employee attending work. Medication and the possible side effects are only one facet that may have a bearing on an individual’s working capabilities and should be seen in that light.
In summary, when asking for medication advice from a provider it is important that not only the medication involved is detailed but also the individual’s job requirements and specifications with the underlying diagnosis, which of course will often be of more significance than the medication itself.
An Occupational Health provider in this area will need to have access to a specialist Occupational Health physician who can then advise on whether a useful decision can be made directly or whether a face-to-face consultation is required. This is particularly relevant in the case of the psychiatric medications that are used for treating such conditions as depression. Here the underlying condition (and whether the individual is capable of concentrating, for example) is far more importance than the actual medicine being prescribed in terms of assessing the overall safe occupational capability of the individual worker.
For more information about Express Medicals’ medication advice line, please call 020 7500 6900
Dr Steve Malleson is chief medical adviser and responsible doctor to Express Medicals