The widespread use of opioid medicines such as codeine to treat pain prompts concerns about workplace impairment, codeine side effects, lifelong addiction and even deaths. So, why are these helpful yet sometimes dangerous medicines still being prescribed and worryingly, why in such increasing numbers?
The term “Opioids” includes everything from illegal Heroin, the controlled medicines Morphine and Tramadol, and extend to the more common painkiller medications such as Codeine. Other issues like Morphine addiction and upsetting morphine side effects are of concern to GP’s. As is taking prescribed painkillers, tramadol side effects, and even codeine side effects are worse in some people than others, even codeine addiction.
Opioid medicines – including morphine, tramadol and more recently fentanyl – are used to treat pain caused by everything from heart attacks to cancer. They are highly effective useful forms of painkillers and work by reducing the sensation of pain.
Opioids are much stronger than many of the other options like aspirin and paracetamol and are among the world’s most commonly prescribed painkillers. They can be given to patients in a variety of ways and in many different forms; orally, through injection, patches, lozenges or under-the-tongue tablets.
However opioids also affect other areas of the brain and the Central Nervous System and opioids are known as suppressants and carry strong impairing effects on many parts and functions of the body. High doses can dangerously reduce the rate of breathing, the root cause of almost all the 2,000 opioid overdose deaths in England during 2016. This is the highest since records began and largely relate to illegal heroin rather than opioid medicines.
In England, GPs prescribed nearly 24 million opioid-based painkillers prescriptions in 2017 alone. That is a rise of 10 million prescriptions, some 2/3rds more than the 14 million in 2007. More worrying is that during 2017, some 2 million working-age people took prescription painkillers, opioids, that were not prescribed for them.
From Dtec’s perspective, with results from our hundreds of customers, we see the codeine results coming through and have noted that it is our workplace customers who provide the better Educational steps and on-going toolbox talks, that see the least codeine detections. We can help by highlighting those codeine positives that seem at first glance to be more than therapeutic.
What are opioids?
§ A large group of drugs used mainly to treat pain
§ Includes naturally occurring chemicals like morphine and codeine, as well as synthetic drugs
§ Codeine, morphine and methadone are among opioids judged by the World Health Organization as essential for treatment of pain and end-of-life care
§ Some opioid medications – methadone and buprenorphine – are used to help people break their addictions to stronger opioids like heroin
Distressing reactions
Despite the benefits of opioids, there are clear problems associated with these medicines, and for decades, scientists have tried to develop opioids that work without causing the problems of addiction and misuse.
Some manufacturers deliberately add extra ingredients to cause a distressing reaction. Adding the antidote naloxone to opioid tablets, largely has no side-effects if the medication is taken correctly by mouth, but if the tablet is crushed and injected by a dependent user, it causes severe “cold turkey” withdrawal symptoms to try and stop them abusing the medicine.
A particular problem occurs when the need for pain relief is long-term – when the evidence for the benefit of opioids is less clear as the body becomes more used to the opioids, and the level required for the same effect increases. Addiction ensues.
This addiction is seen across many people using opioids for pain control, and with time, more and more is needed, all the while, they are building up all the side effects and levels of impairment.
For people with acute pain, opioids can be used alongside other drugs – including commonplace painkillers like paracetamol, ibuprofen and aspirin but with the Doctors advice, these other painkillers should be used as the regular pain killers, with the opioids kept for bouts of severe pain.
Workplace concerns
Anyone in a safety critical role at work, or even driving to and from work should take extreme care to make sure they are not impaired and putting themselves and others at risk. Most companies require an employee to declare such medication in confidence to a manager or HR, at which point a risk assessment will be made and if necessary, temporary job adjustments created.
DrugWipe will detect opioids of all forms and they will show as a non-negative (positive) Opiate screen. This level of detection is necessary because of the potential degree of impairment and the addictive nature of the medicines. Companies that supply screeners with a significantly lesser opioid sensitivity, supposedly so ‘they don’t trigger on codeines’ will risk to miss the Heroin users. On confirmation of the urine sample at the laboratory, they will firstly see the type of opioid, whether it is illegal Heroin, or if it is a Morphine or Codeine based medicine, which should have been declared, and secondly, the lab will also see the levels of the medicinal opioids to see if it is at a good therapeutic level or if it is abuse.
With this information, the company can revert to the Drug and Alcohol policy and
help, with other medicines like aspirin, paracetamol or ibuprofen,
advise on safer job roles, or
discipline the employee for either not declaring the medicine or knowingly being impaired at work.
A note of caution. Someone using illegal Heroin is likely to try and mask it during workplace drug screening, by saying they are taking Codeine and that is the reason for the non-negative (positive) drug screen. Hence any opiate positive screen should always be checked with the urine sample to the laboratory. The lab will see exactly what is happening.
A technical note: DrugWipe does not react to Tramadol.
Simple solutions
Dtec International can help with the policy, the management training and the employee education, along with the best equipment available to perform alcohol and drug screens. See D.Tec homepage or you may find it helpful to take a look at this BBC article, BBC Health.