Buprenorphine in safety-sensitive positions

ABSTRACT

The permissibility of buprenorphine in safety-sensitive positions is a controversial topic. As an opioid medication, concerns have arisen regarding the potential for impairment and any effects that this would have on an employee’s ability to safely perform job duties. While there are no definitive guidelines on the use of buprenorphine for those employed in safety-sensitive lines of work, most employers do not permit its use under any circumstance due to the potential risk of harm to the public. In addition to overlooking the fact that buprenorphine is a well-established and life-saving treatment for opioid use disorder (OUD), there are many flaws in making this determination. For one, buprenorphine is a partial mu opioid agonist which makes it inherently unique in comparison to other opioids. Most studies on impairment have examined acute use of full agonist opioids instead of chronic dosing of buprenorphine. Furthermore, assessments of impairment are not tailored to the tasks required of specific positions. Importantly, policies banning buprenorphine may contribute to treatment discontinuation and stigma, which can lead to relapse and overdose. Considering the morbidity and mortality associated with OUD, along with the surge in overdose deaths during the COVID19 pandemic, buprenorphine policies should be considered carefully. Given the lack of evidence showing definitive and specific impairments as a result of chronic buprenorphine use, coupled with the consequences of universal bans on its use, determinations on the permissibility of buprenorphine treatment for safety-sensitive positions should be made on a case-by-case basis.

KEYWORDS:

• Buprenorphine
• safety-sensitive
• impairment
• opioid use disorder
• disability
• occupational health
• drug-testing

Disclosure statement

There was no direct source of funding provided for this project. Dr. Saxon receives indirect support from the Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System. He has served on an advisory board for Indivior, Inc. and on an advisory board with travel support from Alkermes, Inc. Dr. Hill has served as a consultant for Greenwich Biosciences and is an author for Wolters-Kluwer. The content of his article, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect the policies of these indirect sources of support.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.