Prescription Pain Relievers - Deaths from Misuse Dramatically

Source: CNN 2008

Home deaths from drug errors soar
Deaths from medication errors at home are up dramatically in last 20 years

Increase steepest in death rates from mixing meds, alcohol, street drugs at home

Researchers cite dramatic rise in home use of prescription painkillers

CHICAGO, Illinois (AP) -- Deaths from medication mistakes at home, such as actor Heath Ledger's accidental overdose, rose dramatically during the past two decades, an analysis of U.S. death certificates finds.


Prescription drug abuse plays a role in the rise in fatalities, but it's unclear how much, researchers said.

The authors blame soaring home use of prescription painkillers and other potent drugs, which 25 years ago were given mainly inside hospitals.

"The amount of medical supervision is going down and the amount of responsibility put on the patient's shoulders is going up," said lead author David P. Phillips of the University of California, San Diego.

The findings, based on nearly 50 million U.S. death certificates, are published in Monday's Archives of Internal Medicine. Of those, more than 224,000 involved fatal medication errors, including overdoses and mixing prescription drugs with alcohol or street drugs.

Deaths from medication mistakes at home increased from 1,132 deaths in 1983 to 12,426in 2004. Adjusted for population growth, that amounts to an increase of more than 700percent during that time.

In contrast, there was only a 5 percent increase in fatal medication errors away from home, including hospitals, and not involving alcohol or street drugs.

Abuse of prescription drugs plays a role, but it's unclear how much. Valid prescriptions taken in error, especially narcotics such as methadone and oxycodone, account for a growing number of deaths, said experts who reviewed the study.

The increases coincided with changing attitudes about painkillers among doctors who now regard pain management as a key to healing. Multiple prescription drugs taken at once -- like the sleeping pills, painkillers and anxiety drugs that killed "Dark Knight" star Ledger -- also play a part, experts said.

"When we see overdoses, we're seeing many more mixed drug overdoses," said Dr. Jeffrey Jentzen, president of the National Association of Medical Examiners and director of autopsies at the University of Michigan in Ann Arbor. Jentzen said autopsies are much more likely to include toxicology tests today than 25 years ago, which would contribute to finding more fatal medication errors as cause of death.

But Phillips said there were no significant increases in other poisonings, such as suicidal overdoses or homicides, so more testing doesn't explain the huge increase. The analysis excluded suicides, homicides and deaths related to side effects.

The increase was steepest in death rates from mixing medicine with alcohol or street drugs at home; that death rate climbed from 0.04 per 100,000 people in 1983 to 1.29 per 100,000 people in 2004.

Many patients ignore the risk of mixing alcohol with prescriptions, said Cynthia Kuhn of Duke University Medical Center, who was not involved in the study.

"They think, 'Oh, one drink won't hurt.' Then they have three or four," Kuhn said.

The increase in deaths was highest among baby boomers, people in their 40s and 50s.

"We're sort of drug happy," said boomer Dr. J. Lyle Bootman, the University of Arizona's pharmacy dean, who was not involved in the research. "We have this general attitude that drugs can fix everything."


People share prescriptions at an alarming rate, Bootman said. One recent study found 23 percent of people say they have loaned their prescription medicine to someone else and 27 percent say they have borrowed someone else's prescription drugs.

Kenneth Kolosh, a statistics expert at the National Safety Council, praised the study but said improved attention to coding location on death certificates may account, in part, for the huge increases the researchers found.

Phillips countered that home deaths from any cause increased relatively little during the time period, so better coding doesn't explain the change.

Michael R. Cohen, president of the Institute for Safe Medication Practices, said more states should require pharmacists to teach patients about dangerous drugs and insurers should pay pharmacists to do so.

Unions Oppose Drug Testing & Safety .. Again

Some Unions just don't get it, preferring to spread misinformation and rely upon scare tactics vs. acting responsibly and in the best interests of safety.


1. Random drug testing is NOT unconstitutional, nor illegal in the United States

2. Teachers should be subject to random drug testing, just as should firefighters, police, and other individuals in occupations where drug abuse would create serious safety issues.

3. Random drug testing via observed speciment collection, has proven to be effective at both detection and deterrence.

(Source: ABC News, KITV.com)

Random Drug Test For Teachers Meets Opposition

Teachers Union Says Drug Test Unconstitutional

HONOLULU -- There are more problems with a plan to randomly drug test school teachers. The union that represents public school teachers now said it can't knowingly agree to a plan it believes is unconstitutional.


The Hawaii State Teachers Association sent a letter to the school board that revealed where the two sides were far apart. The two sides had agreed to have a drug testing plan in place at the end of June, but missed the deadline.


Those eager to begin the new school year said the start is being clouded by drug testing controversy."I hope there is some reasonable resolution to this. It just going to take away from education and that's a shame," principal Mike Haramo said.


"We are starting the school year and they are still talking about it. You just wonder how long it's going to go on for," parent Rikki Wells said.


Wells said he worries it's all about red tape and politics and not enough focus on the children.Dragging it on, going into the courts, the political fees, the arguing back and forth and the truth," Wells said.


The first day of class for most public schools is the end of July, and at some campuses, teachers are to report to work next week.


Others who get random drug tests frequently said the same should apply to teachers.


"I think everyone in the HSTA should be drug tested just for the safety of the children," a construction worker said. Gloria Chi thinks random testing a good idea, but she thinks taking classroom money to pay for it is bad. "BOE should be doing something for the kids for education but the government should really pay for it," Chi said.


And when pressed about what appears to be an about face for the teachers union...


"Random is what teachers agreed to. We agreed to random and reasonable suspicion, but when we got into procedures we found complications of constitutional issues," HSTA Executive Director Mike McCartney said.


McCartney said the latest proposal is unworkable. Both sides have appealed to the labor board to help resolve the conflict.

Drugged Driving - July 2008 - New Laws

Police expect challenges to roadside drug test law
DOUG MACKENZIE
The Cape Breton Post



SYDNEY — Drivers who operate a motor vehicle while high will no longer be able to refuse road side drug tests under new laws which came into affect last week.

Police can now require drivers to submit to roadside tests and also have the power to take suspected drug-impaired drivers to a police station or hospital to get a blood, urine or saliva sample.

Under the old law, police were obliged to tell drivers suspected of being high that roadside tests weren’t mandatory.
While the new law is being heralded by law enforcement officials, they also realize there will be challenges involved with enforcement.
“To us, this is a great thing, it’s another tool in our toolbox in terms of our officers out on the streets dealing with people they believe are drug induced and driving and now we actually have the law in place which gives us the authority to deal with these issues,” said deputy chief Myles Burke, of the Cape Breton Regional Police. “I think this is a great thing for law enforcement and a great thing for the community – it’s a positive step. There will no doubt ... be challenges to the law, challenges to the constitutionality of the demand and even the expertise of the experts themselves …
“This stuff can be challenged, but that’s fine. That comes with every law we’re dealing with, but at the end of the day we will have people here who are certified experts, who will be doing the field testing that is required and will be going to court in cases where they feel someone is driving under the influence of narcotics.”
Burke said training of officers within the traffic safety unit will be the key to successful enforcement of the law and he would like to see experts on call 24/7 to help deal with situations when they arise.
“The training is very specialized and although there are funds available to train officers, it does require a significant commitment and officers have to leave the local area (for training),” said Burke. “One component of the course, the officers are actually trained at a U.S. prison doing testing of people going in and out of the prison. Their field subject testing is actually live at a prison.
“We have requested for the next training course available to have a couple of seats made available. We are very interested in having a couple of our officers trained as experts.”

Parents are the Problem?

The below is demonstrable of the lack of drug education on the part of parents.

Some parents view random drug testing as a "punishment" or "lack of trust", when in reality it is a BENEFIT to students, parents,and schools. It you consider that over 20,000 people die annually due to drug overdose, and millions of students regularly abuse prescription drugs (this is the problem NOT mariujana), and illict drugs such as meth & cocaine... combined with the fact that it take 3.5 years for a parent to learn their child abuses drugs...plus, even trained DRE (drug recognition experts fail to identify a drug abuser 90% of the time... and well, you get the terrible picture.

Concerned about random drug testing


Tuesday, June 24, 2008 12:49 PM CDT



I have been following with interest the subject of Bandera ISD's policy of random drug testing at the middle and high schools.

As the mother of four children, I am concerned about my kids' health and safety when they are at school. I, like all parents, desire an educational environment which nurtures, challenges and supports my children.

However, try as I may, I cannot see how random drug testing is compatible with this goal. The only thing I see it doing is punishing both the innocent and the guilty.

As a former high school teacher, I can attest that, in my experience, it is not very difficult to identify a student who is under the influence of drugs.

Why are such Draconian measures now being proposed to do the same thing that an observant teacher could have done without disturbing the learning environment?

I applaud Mr. Zavorka's recent appeal to school board members to truly think about the implications of this policy before adopting it. He certainly gave me pause.
As C.S. Lewis wrote, "Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive."

The citizens of Bandera should consider this before supporting the random drug testing of their children.

New Specimen Validity Ruling Ineffective

The recent "final rule" for urine-based "Specimen Validity Testing" (outlined below) is clearly of limited value, as it does little to address the prevalent practice of drug abusers cheatig urine tests.

Observed collection is the only method to assure specimen validity.

The ODAPC / DOT / & SAMHSA must stop their "political crumbling" to private interest groups such as large urine laboratories and accept alternative specimen types - oral fluid, hair - where observed specimen collection is the norm.

While the General Workplace can develop effective drug free workplace programs, those subject to Federal Mandated Drug Testing clearly can not.


Summary of Final Rule for Specimen Validity Testing

Published in today’s Federal Register is a Department of Transportation Final Rule:



Procedures for Transportation Workplace Drug and Alcohol Testing Programs





In summary:



1. This Final Rule makes it mandatory for laboratories to test all DOT specimens for specimen validity (i.e., adulterants and urine substitutes) and for laboratories to follow all Department of Health and Human Resources (HHS) protocols for doing so.



2. Observed collections will afford less privacy in order to guard against employee use of items designed specifically to beat the testing process.



a. Directly observed collections will continue to occur only when there is a specific reason to believe that an employee may be attempting, or have sufficient reason, to evade the testing process.



b. Items such as prosthetic devices designed to carry clean urine will be checked for by observers with both male and female donors. The observer will have the employee raise and lower clothing, and then put it back into place for the observed collection.



c. Observed collections will now be required, rather than optional, for all return-to-duty and follow-up drug testing.



3. In an effort to thwart those who would manufacturer products designed to adulterate specimens, the Final Rule will no longer have easy-to-follow tables and charts outlining the adulterants for which laboratories are testing and the scientific cutoff levels at which laboratories are testing them.



4. Definitions in the Final Rule have been changed to harmonize with the HHS.



5. During an invalid result Medical Review Officer (MRO) review, an employee admission of adulterating or substituting a specimen is now a refusal to test.



6. Pursuant to MRO requests, the Final Rule will close the potentially endless loop on invalid specimen results; and employees requiring negative results [for example, pre-employment tests], when they have medical reasons for providing invalid results, will be able to obtain them through medical evaluations to rule out signs and symptoms of drug use.



7. The Final Rule will also streamline and simplify the potential myriad of complicated laboratory-confirmed and MRO-verified drug test results.



8. The Final Rule requires drug testing laboratories to report to DOT semi-annual statistical summaries on all of their DOT testing.



9. The Final Rule effective date is August 25, 2008.

Boston Massachusetts Fire Fighters Union - Not the Norm

Random drug-testing programs are problematic for some unions.

Union leadership claims random drug testing is a violation of workers' right to privacy. Yet, this is appears to be an indefensible position.

Concerns of employee safety and public safety should be the #1 priority with union leaders. Sadly, it may not case for some.

Many non-union employees are required to have a pre-employment drug test and a random drug test. If workers refuse testing, they are terminated. If employees fail a drug test ... they are terminated - (which I don't view as best practice)-, or suspended and subsequently referred to an employee assistance program (EAP), which may or may not be funded by company insurance.

Simple... straight forward... and effective.

Random drug testing, conducted properly, is an effective deterent to on-the-job substance abuse, as well as a detection mechanism. What an employee does at home is not the business of any employer. When employee's behaviors effect the safety of their collegues or the public... it's not only their employers' business... it's their employers' legal obligation.

While many unions have adopted, or at least allowed random drug and alcohol testing, the Boston / Massachusetts Fire Fighters Union has failed to protect its members and the public at large.

No employee, or the public wants a drug or alcohol impaired individual in a safety sensitive position.

The Boston Fire Department had a recent tragedy in which two fatalities tested "positive" for drugs and/or alcohol. Whether this information should have been released to the public the way it was... is certainly questionable. No one should question the bravery of the individual involve, and most would not consider it.

The subsequent stonewalling of the fire fighters unions relative to drug testing is unconscionable, however, and a disgrace to everyone.

Drug Abuse in Construction & The Role of Union Leadership

"A construction work site is no place for an alcohol- or drug-impaired worker," says LI UNA General President Terence M. O'Sullivan. "To limit this risk and, also, to ensure that workers who need help get it, the Laborers support efforts to establish comprehensive drug-free workplace programs in the construction industry."



Abstract

Union stewards, general members, & senior management benefit from training on the many manifestations of substance misuse in the workplace, and their impact on working people and their children, contractors, insurers, and owners. Avitar's novel approach to workplace substance abuse management can assist in providing a framework of knowledge as well as implementation monitoring tools.

Joint development of the training curriculum, drug policy, and testing programs, would, however, require the direct involvement of union management. While Avitar can supply the technical components, to gain organization-wide commitment requires high level of participation and support of union leadership. Arguably, this leadership has been lacking in specific cases.

Unions would benefit by working with contractors, owners, insurers, and innovative drug-free workplace service providers to establish comprehensive drug-free workplace policies that include an education component to demonstrate their commitment to a drug-free workplace, support random testing via observed specimen collection, and provide employee assistance programs.

Random testing via oral is convenient, effective, non-invasive, and targets "on-the-job" drug misuse. Unlike traditional urine-based testing, oral fluid testing;

1. deters substance misuse
2. reduces accidents, workers comp claims and,
2. improves workforce image and quality.


While Construction Union may be aware of the unresolved, and epidemic problem of substance abuse in the construction sector, they may not be aware that a solution exists and the importance of their playing a leading role in mitigating the issue.

Substance abuse diminishes the ability of unions to build membership and mobilize current members.
- It erodes self-esteem and autonomy and undermines union participation, power, and leadership.
- It damages the solidarity of the union community and weakens its ability to withstand employer "attacks".

1. Unfortunately many contractors, owners, and insurers view unions as an impediment to resolution of the substance abuse in the construction sector. The lack of a comprehensive and effective occupational drug-free workplace approach by Unions contributes ineffective, ad-hoc industry practices. Similarly, the AFL-CIO program requiring urine testing and specific vendors, even further delays positive, pro-active change.

2. Unions must be proactive in efforts to deter the abuse of controlled substances and alcohol on construction sites. Laborers, management, and all related constituencies would benefit by developing and negotiating a drug and alcohol testing template programs for all contractors / owners / insurers.

3. A comprehensive drug-free workplace program MUST include:
random drug testing (via observed collection - traditional urine-based testing is relatively ineffective),
education, and
assistance.


Measurement is crucial to the recognition, treatment, and prevention of substance abuse related occupational injuries, and other negative impacts. Deterrence and identification of substance abuse benefits the individuals, their immediate coworkers, workers throughout the industry, and others exposed to the negative impacts of substance misuse. (insurers, owners, contractors, public).



4. What union members do away from work is a private affair as long as they aren't impaired when reporting to work, however, traditional urine drug testing is contrary to this notion. Neither unions nor employers should not be allowed to dictate behaviors while away from work.


5. Deterrence is the goal, however, detection and assitance are true benefits.
Union MAP's (member assistance programs) are underutilized (not used 60% of the time). MAPs serve members as well as health & MMwelfare funds, contractors, owners, alike.
- MAPs help laborers & families access to assistance most needed for personal problems/issues
- MAPs control costs (lack of care created costs far exceeding MAP cost).
Labor organizations can only offer assistance to their members on a variety of health, welfare, and safety issues, including substance use disorders, only if aware of the problem.





Sources and Additional Information:

1. 50% of abuse detected now involves prescription drugs, esp. pain relievers. The abuse / misuse of many popular prescription pain releivers is not tested via traditional DOT-based urine testing.

2. While approximately 15%- 20% of construction workers abuse drugs, the US Bureau of Labor Statistics survey significantly underestimate the incidence of work related injuries and illnesses. The United States does not have a comprehensive national surveillance system for occupational injuries and illnesses. Lacking this system, major sources of US occupational health data include the Bureau of Labor Statistics (BLS) annual survey of occupational injuries and illnesses, workers' compensation records, and physician reporting systems. Data produced by these systems have been described as fragmentary, unreliable, and inconsistent. Moreover, they have been shown to underestimate the incidence of workrelated injuries, illnesses, and even fatalities by as much as several hundred percent. (Occupational injury and illness surveillance: Conceptual filters explain underreporting; Azaroff, Lenore S; Levenstein, Charles; Wegman, David H American Journal of Public Health 09-01-2002 )

3. 77% of adults with substance abuse disorders are employed - Results From the 2004 National Survey on Drug Use and Health: National Findings. DHHS Publication No. (SMA) 05-4062. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2005, p. 72.

4. LIUNA MAPs save money - Detroit, first-quarter 2003 data indicate that the LAP saves the fund about $175,000 annually over the likely cost of service to members if no MAP existed. In Southern Illinois, drug expenditures for the first two quarters since MAP usage was mandated are running more than 50 percent below the previous year's average. In Massachusetts, since the MAP was established in 1991, the Fund has saved about $8.8 million in average length of service and per diem costs for in-patient care.

5. Substance use disorders affect people from all walks of life, workers & families. According to a 2005 Hazelden Foundation survey, more than 69 percent of employed people indicated that if a family member were struggling with abuse or addiction, it would negatively affect their ability to concentrate and be productive at work. In fact, 36 percent of people who are employed admitted that at least one of their coworkers had been distracted, less productive, or missed work because of alcohol/drug abuse or addiction within their family.

6. A key message for labor organizations to communicate to employers is that treatment for substance use disorders has substantial benefits for businesses. Reported job problems, including incomplete work, absenteeism, tardiness, work-related injuries, mistakes, and disagreements with supervisors, are cut by an average of 75 percent among employees who have received treatment for substance use disorders. Furthermore, treatment has a benefit-to-cost ratio of 7:1, with substance use disorder treatment costing $1,583 on average and having a monetary benefit to society of nearly $11,487.

7. Domestic violence is directly related to substance abuse. Despite the obvious importance of involving unions in domestic violence prevention with men, little works has been done is this area. This may reflect fears that unions would not be receptive to addressing domestic violence. Senior office holders within some unions have been hesitant to apply their leadership to this issue, for various reasons. Sometimes union leadership has not understood how widespread domestic violence is. Sometimes they have argued that it is a private matter best left to the couple affected. At other times they have expressed concern but felt pessimistic about their ability to do anything about it. And on other occasions they have felt torn between their desire to protect a worker from disciplinary action or job loss and their conviction that domestic violence is wrong.

- It is every employer's legal responsibility to ensure safety in the workplace. Domestic violence compromises the well-being, job performance, and productivity of valuable employees. Many of the attitudes and gender roles that increase men's risk of using domestic violence also predispose men to other high risk behaviors, such as drug and alcohol abuse, workplace violence, or taking unnecessary safety risks to demonstrate "toughness" to peers.
- Domestic violence is a leading cause of workplace violence; it also creates safety and health risks to everyone in the workplace:
- Since almost one in four women is affected by domestic violence, we can make a conservative estimate that 10% of employees may be affected by domestic violence.
- 24% of abused women said they were either late or missed days of work due to abuse
- 54% of abused women missed up to three full days of work per month.
- 94% of corporate security directors surveyed rank domestic violence as a high security problem at their company.
- Violence against women weakens unions and diminishes their ability to build membership or mobilize current members.
- Domestic violence is a safety and health issue for all members since perpetrators often stalk and harass women at their workplace, possibly jeopardizing co-workers as well. Additionally, domestic violence is a work/family issue, since it has devastating economic and personal consequences for the family.

8. Most union members are in support of drug testing (Discriminating characteristics of union members' attitudes toward drug testing in the workplace, Journal of Labor Research, 2007.)