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Suboxone and preplacement

Posted: Tue Aug 27, 2013 8:40 pm
by eddy1
I am wondering how others have handled Suboxone use by an individual when evaluating them during a preplacement exam. I have not been able to obtain a job description, but the position is a laborer/helper type job. Is a note from the prescribing physician clearing them for safety-sensitive work adequate? Or should they be restricted from above ground level work/working with dangerous machinery?

I appreciate all input.

Re: Suboxone and preplacement

Posted: Wed Aug 28, 2013 8:11 am
by Robert Swotinsky MD
There is not medical evidence that chronic (e.g. daily) use of Suboxone is associated with increased accident risk.

Asking the PCP for a letter stating the patient is safe may, or may not, be useful in this context. Most of the time, the PCP is going to say his patient is fine. The PCP is an advocate for his patient. Also, the PCP might correctly anticipate that anything else is going to generate hard feelings and extra work. (By the same token, if a patient who is applying for disability benefits asks his PCP to certify inability to work based on use of Suboxone or another potentially impairing medication, the PCP is likely to sign off on that, too.) Alternatively, the PCP may decline to offer any opinion at all. In this latter case, you'll have delayed decisionmaking and perhaps backed yourself into a corner.

Safety sensitive is a term of art. It means different things to different people. I think of safety sensitive in terms of jobs where momentary incapacitation is likely to cause significant harm. A laborer job doesn't fit this definition.

I would not withhold qualification based on Suboxone, and I wouldn't ask for a letter from the PCP.

Re: Suboxone and preplacement

Posted: Wed Aug 28, 2013 9:13 am
by eddy1
Thank you for your prompt reply.

Re: Suboxone and preplacement

Posted: Wed Aug 28, 2013 3:53 pm
by MaxwellEdison
What about for a school bus driver?

Re: Suboxone and preplacement

Posted: Fri Aug 30, 2013 9:00 am
by Robert Swotinsky MD
It is not uncommon for examiners to apply federal DOT medical standards to school bus drivers, even mini-bus drivers who don't fall under federal statute. In this respect, it would be appropriate to disqualify based on methadone, and take a case-by-case approach to other medicines like suboxone.

Re: Suboxone and preplacement

Posted: Wed Apr 26, 2017 5:06 pm
by Tool4239
Is accessing the state PDMP for a donors records prior to meeting with the party frowned upon or am I just being radical? If a donor is on Suboxone and going to be working in a safety sensitive position this is one way to avert that scenario ahead of time.

Re: Suboxone and preplacement

Posted: Mon Oct 15, 2018 8:03 am
by Daveinfo123
I agree that there can be grey areas of safety sensitive and even some jobs such as a lift truck operator can be very safety sensitive (operating in a busy warehouse, working around public and picking stock at heights) v. not very safety sensitive (occasional lift truck use, no contact with public, in a low volume warehouse, no dock to drive off of and wreck yourself).

Some principles we use for safety sensitive work:
1) Opinion from the prescribing physician as to risk
2) I use neuropsychiatric testing (computerized) where we measure psychomotor speed, reaction time and complex attention usually with symbol digit coding, stoop and shifting attention tests with a UDS showing the medication on board to have some objective evidence that the worker should be competent. This takes about 30 min and costs $25
3) Demonstration of competence in the task.

Why do we do this? Safety for all, Liability for us, and if OSHA asked why did you place this person in the job, we have good evidence.

For many of our workers who are up front about their drug problems and wanting to get back on track, we have a good history.
We have more problems with bipolar workers with poor insight, poor impulse control and tend to self medicate.
It is our opinion, that while someone is on MAT that other medications like benzos are more of the problem than the solution.

In most states, you cannot access the state controlled substances list as a pre-placement tool.