Opiate pain killers principally Codeine are used by 1 in 10 adults in the UK and whilst they are effective at reducing pain in the short term, it is highly likely that when used overtime patients will ask to have their dosage increased with the potential of eventually transitioning to stronger options. This escalation in dosage and strength of medication increases the level of impairment and hence risk to fellow employees, customers or the wider public. Reliance on pain medication coupled with a lack of adequate management procedures can create significant risk and legal implications for employers and for company managers personally.
The National Institute for Health and Care Excellence (NICE) have recently written a consultation draft regarding ‘Chronic pain in over 16s: assessment and management’ [1]. The guideline, which has been drafted by an expert committee, recommends that Health Professionals should not offer opioids, ‘by any route’ to anyone over the age of 16 to manage chronic primary pain. It also recommends that if any individual with chronic primary pain is currently taking opioids, it is the responsibility of the Health Professional to explain the risks of continuing.
In simple terms, ‘Opioids’ is the overarching name for any illegal drug or medicine that is derived from the opium poppy or chemically derived to be of a similar structure with similar effects on the body. Opioids are frequently used as prescription medicines, due to their chemical properties which can relax the body and relieve pain. These properties are a depression of the Central Nervous System causing both a complete slowing of the brain and bodily functions, specifically effecting an individual’s breathing, reaction times and the ability to perform simple tasks. However, opioids can also make individuals feel ‘high’ and euphoric, hence the reason why they are used for non-medical reasons, a well-known example of this is Heroin.
Opioids are used in very different ways, for instance, drug addicts use Heroin, hospitals use Morphine based medicines, doctors prescribe mainly Codeines and pharmacists sell branded medicines with low level Codeine mixed with pain killers such as Paracetamol e.g. Co-codamol. However, taking opioids can be extremely dangerous as they are highly addictive, and overdoses and death are common. To put this in perspective ‘in 2018, opioids were mentioned or implicated in around 80% of drug-related deaths registered in each of the countries of the UK, with the highest proportion in Scotland (86%)’ [2].
This figure is shocking, and it gives an insight into why NICE are recommending that opioids are not prescribed as pain relief anymore. Their research suggests that there is a lack of evidence for effectiveness of opioids, as well as evidence demonstrating long-term harm, most specifically a risk of dependence on the drug. It is also suggested that short-term use of prescription opioids can be harmful for an individual, as they can be the gateway drugs for stronger prescription opioid medication or worse, heroin.
This raises a serious question, why are GP’s are prescribing opioids as a pain relief medication? Professor Martin Marshall, Chair of the Royal College of GPs said ‘GPs and our teams are aware that prescribing pain medication to patients comes with risks, including addiction, and this is something we will discuss with them when developing a treatment plan – and as part of subsequent medication reviews’ [3]. Yet, research suggests that opiate pain killers are ineffective when combatting pain after the first few days/weeks of use, as the body grows accustomed to the medication and the pain returns. Marshall goes on to say, ‘most patients in pain do not want to take medication long-term, and GPs do not want this either, but sometimes medication has been the only thing that brings relief’ [4]. Effectively, causing the start of a downward spiral, as the individual relies on stronger drugs to ease the pain, which then creates a dependency on this feeling of relief.
So how does this effect the UK workforce?
The majority of individuals understand that Heroin is highly addictive and unbelievably difficult to stop taking but what they do not seem to appreciate is medicinal opioids can create a tolerance level, leading to a need for stronger medication to numb the same level of pain. The bottom and appalling line is that 10% of the UK population are taking pain killers and most of these are opiates! With this increasing level of opiate in the body, the person is unable to perform or function correctly. They will be impaired, and this will restrict their ability to make imperative decisions correctly or quickly. This will have an adverse effect on their role, more specifically, they will be unable to function safely whilst driving or operating machinery and they will be more likely to have a serious accident, potentially causing personal injury, third party injury or death. Codeine medications now specifically state ‘do not drive or operate machinery’ on their fact sheet. Any employee who is under the impairment of drugs becomes a liability to the company.
It is easy to assume your workforce is not affected but take into consideration that if 10% of society are using opiate medication, it is very likely that 10% of your employees also fall under this category. Managing drug use in the workplace can be perceived as a complex and uncomfortable problem but DrugWipe can help. Our DrugWipe Dual can detect the main opiate medications used within the UK within five minutes.
If your employee gives an opiate non-negative on the DrugWipe, it is important that a confirmation urine sample is arranged within two hours with a fully accredited laboratory. Please give us a call and we will be able to organise this for you. The laboratory will analyse the sample and highlight the medication involved as well as indicate the levels present at the time of sample. This will then indicate if the medication has been used correctly for therapeutic reasons, or, if an excessive level is present it could potentially demonstrate addiction, which will significantly increase the impairment and hence the risk for you and your company. When you have received the result from the lab you are then able to discuss with and potentially assist the employee in their challenge to reduce or stop their addiction by seeking the help they need.
D.tec are here to support your business with any challenges you are currently facing. We offer fully confidential; 24/7 support and we also provide a range of training courses to suit individual business needs. Unfortunately, this problem is not going away so give us a call today and let us know how we can assist you.
[1] – https://www.nice.org.uk/guidance/GID-NG10069/documents/draft-guideline