medicine use and employability

[Guest guest]

I was just reading an article in a trade journal about medical

marijuana and the issues raised made me think of the recent

posts here that discussed drug testing for employment

purposes.

What caught my eye and made me ponder the implications to

workers is the opinion of a Tennesee physician who states that

any person who is given a prescription for medical marijuana

use " must be considered unfit for employment, and is unfit for

the operation of motor vehicles. Anyone receiving a prescription

must surrender his or her driver's license. "

Naturally, I see this attitude directed towards me (and us)..all you

have to do is substitute prescription opiods for medical

marijuana in this writers statements. Which, I think gives a huge

arena for philosophical sparring. Basically it is, who pays for

those persons who are now " unemployable " ? If we apply such

restricting lifestyle / employment " rules " does society then have

an obligation to give them money to live on? Is it reasonable to

expect these people to learn a new trade? And if so, who

decides which professions are " safe " for patients who use pain

medications?.And if we decide that there are safe jobs, is it

justifiable to force patients to take this job which may not pay a

livable wage (or offers greatly reduced wages from the former

profession)? On the flip side, if society deems that it is

responsible for providing a living wage to patients like us, then

will society also pressure physicians to restrict prescribing

narcotics to chronic pain patients based on the idea that we

cannot afford it? Will this just result in even more

undertreatment of chronic pain? Or will it spur pharmaceuticals

to develop more effective non-narcotic pain relief medication?

I am also very interested in this topic (pre-employment drug

testing) because I may encounter this phenomenon in the near

future if my position is truly eliminated (no word on that yet, I hear

that the lawyers for the college are investigating the impact of the

" transistion " on my ability to offer care to our clinic's patients).

One response on the board was made that truly caught my

attention: that is, if someone is not hired for a new job or fired

from an existing one due to the legal use of narcotic pain killers

that they may be eligible for unemployment pay as well as

qualifying for disability. The logic of this is obvious to me, but

one that I never thought about until Karyn and brought

up the notion that they may not be able to practice their

profession because of the use of medication needed to manage

a chronic disease. The implications of this are profound I

think.....that is, who has to bear the brunt of this disability? The

patient or our society? If we believe that a nurse or other person

in a profession that cannot take the risk that medication will

impair performance, is the patient compelled to find a new

profession? or should she / he be automatically qualified for

long term disability? I know that there are professions now that

operate in a strict manner (pilots and train engineers come to

miind) so I guess we should look to that profession to see how

this issue is handled...but then, these are professions that have

strong unions, which may offer protection to the employees who

are no longer " employable " in his or her profession.

The second implication that I thought of is how do we determine

which medication fits the description of " impairng performance "

to such a degree that the person can no longer practice his / her

profession? Afterall, many medications can affect cognitive and

reasoning ability as well as decreasing reaction time and other

coordination skills. For me personally, I have a very hard time

taking neurontin....I find that my sharpness of mind as well as

coordination is somewhat severely affected. Much more than

when I take my lower dosages of narcotic pain medication. And

this brings up a third point...that is, is there dose related

responses? That is, is it ok to work with 5mgs oxy on board but

not 10mgs?

I guess that like with anything, there is no clear cut way to handle

this. It goes back to the premise that because everyone reacts

differently to different medication that it is impossible to legistate

what drugs (at what doses) make a person " unemployable. " I do

not think a blanket list of " offending " medications can be

determined with any degree of scientific certainty. That all we will

do is be reactionary to public opinion based on unfounded fears.

But I have to admit.....the idea of becoming unemployable solely

based on the medication that a person takes to stay active and

live a quality life is fraught with layered implications that makes

an onion look like a simple structure.

laurie

[Guest guest]

Laurie,

I enjoyed reading your musings on the topic of " Medication Use and

Employability. " It is a worthwhile philosophical debate. And, one that we should

keep

on the forefront.

Karyn E. , RN

Executive Director, PAI

Indianapolis, Indiana