Fitness for Duty - Narcotic/pupils question

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Kbourke

Fitness for Duty - Narcotic/pupils question

Post by Kbourke » Wed Nov 06, 2013 7:12 pm

Colleagues:

Assessing a young man for fitness to work in safety-sensitive industrial workplace (non-DOT). Referred to me as he had been narcotic "non neg" on his workplace screen... but MRO reported as negative as he had concurrent Rx's for OxyNeo 60 mg TID (YES, TID).

I saw him in office, complete exam and >60min interview. SUM: he wasn't impaired in my opinion at that time, and says he was/is still on Oxy Neo TID.

Pupils were 6mm reducing quickly to 4mm and with accommodation, however. I thought the peripheral effects of narcotics (like pupillary ones) did not diminish even with ongoing/chronic use of the drugs, and therefore am concerned re: is he taking them at all? Yes, I can get a urine test for qualitative .... but it could be non-zero based upon even the smallest dose/use recently.

Any experience re: the pupils part?

Thanks,

Kevin Bourke
Halifax, NS



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Re: Fitness for Duty - Narcotic/pupils question

Post by Robert Swotinsky MD » Tue Mar 18, 2014 10:59 am

Use of oxycodone -- in this case, Oxy-Neo, which is a tamper-resistant form of the drug -- can raise safety concerns. In this case, it sounds like the MRO alerted the employer and suggested the local examiner determine if the guy is safe to work. As you've indicated in your post, clinical findings define impairment.

He is prescribed 270 morphine-equivalent dose (MED)/day. At >= 120 MED/day, risk of overdose is high. That is, this person is at increased risk of overdose or other adverse effects of oxycodone because of the amount prescribed. If the job is truly safety-sensitive, it would seem unacceptable given the dose. It may also be useful to know why he is taking it.

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