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Journal of Pain & Palliative Care Pharmacotherapy Volume 27, 2013 - Issue 1
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COMMENTARY

A Protocol to Evaluate Drug-Related Workplace Impairment

Gary M. ReisfieldGary M. Reisfield, MD, is Assistant Professor and Chief of Pain Management Services, Divisions of Addiction Medicine and Forensic Psychiatry, Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA. Theodore Shults, MD, is President of the American Association of Medical Review Officers, Inc., Research Triangle Park, North Carolina, USA. Jason Demery, PhD, is Clinical Assistant Professor of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA. Robert DuPont, MD, is former head of National Institute of Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA.Correspondence[email protected]
,
Theodore ShultsGary M. Reisfield, MD, is Assistant Professor and Chief of Pain Management Services, Divisions of Addiction Medicine and Forensic Psychiatry, Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA. Theodore Shults, MD, is President of the American Association of Medical Review Officers, Inc., Research Triangle Park, North Carolina, USA. Jason Demery, PhD, is Clinical Assistant Professor of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA. Robert DuPont, MD, is former head of National Institute of Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA.
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Jason DemeryGary M. Reisfield, MD, is Assistant Professor and Chief of Pain Management Services, Divisions of Addiction Medicine and Forensic Psychiatry, Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA. Theodore Shults, MD, is President of the American Association of Medical Review Officers, Inc., Research Triangle Park, North Carolina, USA. Jason Demery, PhD, is Clinical Assistant Professor of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA. Robert DuPont, MD, is former head of National Institute of Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA.
&
Robert DuPontGary M. Reisfield, MD, is Assistant Professor and Chief of Pain Management Services, Divisions of Addiction Medicine and Forensic Psychiatry, Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA. Theodore Shults, MD, is President of the American Association of Medical Review Officers, Inc., Research Triangle Park, North Carolina, USA. Jason Demery, PhD, is Clinical Assistant Professor of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA. Robert DuPont, MD, is former head of National Institute of Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA.
Pages 43-48 | Published online: 25 Mar 2013
 
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ABSTRACT

The dramatic increase in the use and abuse of prescription controlled substances, cannabis, and a rapidly evolving array of legal and illegal psychotropic drugs has led to a growing concern by employers about workplace impairment, incidents, and accidents. The Federal Workplace Drug Testing Programs, which serve as a template for most private sector programs, focus on a small group of illicit drugs, but disregard the wider spectrum of legal and illegal psychotropic drugs and prescription controlled substances. We propose a protocol for the evaluation of workplace impairment, based on comprehensive drug and alcohol testing at the time of suspected impairment, followed expeditiously by a comprehensive physician evaluation, including a focused medical history with an emphasis on controlled substance use, physical and mental status examinations, evaluation of employee adherence to prescription medication instructions, additional drug testing if indicated, use of collateral sources of information, and querying of state prescription monitoring databases. Finally, we propose suggestions for optimizing the evaluation of drug-related workplace impairment.

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