One for the road

December 1, 2004 By    

Richard Smith, the Staten Island Ferry pilot who crashed his ferry into a dock and killed 11 people in October 2003, recently acknowledged that he passed out at the controls after taking tramadol (a pain relief medication) and Tylenol PM, two drugs with side effects that can include drowsiness.

Reports of impaired workers normally refer to the influence of alcohol and illegal drugs. There are many other types of impairment, however, that can cause equally serious problems on the job. And as peak demand during winter’s coldest months collides with the height of cold and flu season, workers frequently rely on an assortment of prescription and over-the-counter medicines to push them through the year’s longest work days.

“These are major problems for employees who drive, who work with heavy machinery or on industrial machines, or who are involved in construction work,” says Lynne Stebbins, R.N., president and CEO of Stebbins Safety Services, a workplace safety consulting firm in Freehold, N.J.

While prescription medications can cause side effects, over-the-counter medications present some of the most common and serious problems associated with job impairment, according to Stebbins.

Many consumers assume if something is available over-the-counter it is completely safe and does not have side effects. Warnings often are more carefully noted on prescription medications, even though there are more over-the-counter drugs being used.

In fact, some prescription medications (particularly antihistamines) do not cause the drowsiness that their over-the-counter counterparts do.

“In my opinion, over-the-counter antihistamines are the most common cause of impairment in the workplace,” Stebbins says. “A large number of employees take these routinely.”

Prescription and over-the-counter medicines that can cause drowsiness include: analgesics (pain relievers), anti-anxiety medication, allergy medicines (antihistamines), blood sugar medicines, antidepressants, tranquilizers, blood pressure medicines, motion sickness medicines, ulcer medicines, antibiotics, anti-seizure medicines, sedatives, cough syrups and decongestants.

According to the National Transportation Safety Board, the three most commonly used over-the-counter medications that cause drowsiness are pain relievers, antihistamines and antidepressants. Studies published by Vanderbilt University verify that taking sedating antidepressants even 10 hours before driving is equivalent to driving drunk.

While over-the-counter drug package contain warnings related to drowsiness and other side effects, they are often hidden in small print in the midst of hundreds of other words. In fact, the National Transportation Safety Board reports that on many labels these warnings are no larger than 1/16 of an inch in height. By comparison, warnings not only are more noticeable on prescription medications, but are supplemented by verbal warnings from prescribing physicians and pharmacists.

Some over-the-counter medications contain a wide range of medications. A single pill can contain an antihistamine, a decongestant and a pain reliever.

Dr. John Weiler, professor emeritus with the University of Iowa, agrees with all of these concerns.

“A number of over-the-counter drugs, such as antihistamines, are a problem,” he says. “People should not be taking them if they are going to be driving or operating machinery.”


Of all of the over-the-counter drugs, antihistamines are the most commonly used and of the greatest concern in terms of driver drowsiness. Some 50 million people suffer from allergies in the United States. Despite their negative side effects, 47 percent of allergy sufferers continue to use them, according to a study in the Journal of Allergy and Clinical Immunology.

A survey conducted by Schering-Plough HealthCare products found that 57 percent of allergy sufferers reported their ability to focus is negatively affected by the “medicine haze” associated with common over-the-counter allergy medicines.

“Research we conducted with driving simulators showed that impairment of some over-the-counter drugs was worse than it was with alcohol,” says Weiler.

Another study conducted in Europe found that a single dose of Benadryl, one of the most popular over-the-counter antihistamines, is equivalent to a blood-alcohol content of .09. A rating of .08 makes drivers legally drunk in most of the United States.

Drugs and Accidents

The National Transportation Safety Board has found numerous traffic accidents caused by the standard use of over-the-counter medicines. According to testimony given by NTSB Vice Chair Carol Carmody, the board has investigated over 150 accidents in which prescription or over-the-counter medicines have caused or contributed to the accidents, and its findings point to even higher rates of incident.

“We at the Safety Board believe that the numbers may be even higher. The reason is that only a small percentage of people are ever tested for the presence of over-the-counter medicines and prescription drugs following an accident.”

The Journal of the American Medical Association shows 16,000 auto accidents attributed to impairment from prescription and over-the-counter drugs each year. And a story in USA Today reported sedating antihistamines contribute to about 600 auto fatalities and almost 50,000 auto injuries each year.

To put it all in perspective: When the Federal Aviation Administration conducted toxicology tests on pilots who had been killed in plane crashes, they found that 9 percent had alcohol in their systems, 15 percent had prescription medications in the systems, and 21 percent had over-the-counter medications in their systems.

Government Intervention

The problem of over-the-counter drugs and driver impairment is so serious that the U.S. Department of Transportation is attempting to coordinate a number of initiatives to address it.

“We would like to see the DOT develop specific guidelines for employers and operators on what medications are approved for use,” says Garber. “We believe that there is sufficient information available publicly to be able to identify certain drugs for which there are no known side effects that would interfere with the transportation of a vehicle.”

He says the medical literature identifies many of these. Unfortunately, he says, there is currently a lack of such guidance available in a single location.

In March 2004, Ellen Engleman Conners, chairman of the NTSB, sent a letter to DOT Secretary Norman Mineta outlining NTSB’s recommendations regarding over-the-counter medicines. Recommendations include establishing comprehensive toxicological testing requirements for a sample of fatal highway, railroad, transit, and marine accidents to ensure the identification of the role played by common prescription and over-the-counter medicines.

It also is calling for a list of approved medications that can be safely used while operating a vehicle while asking the FDA to establish a clear, consistent and easily recognizable warning label for all prescription and over-the-counter medications that may interfere with an individual’s ability to operate a vehicle.

“We have a recommendation out to the FDA for labeling requirements of over-the-counter drugs that could cause driver impairment,” says Garber. “We are also suggesting to the DOT that the National Highway Traffic Safety Administration and the FDA work together to develop some of these concepts.”

NTSB reasons the FDA has the required medical knowledge, and the NHTSA has the required driver evaluation knowledge. “Together, they should be able to develop some protocols,” Garber says.

Several European countries require drug manufacturers to color-code their packages with symbols that indicate which drugs may induce drowsiness or otherwise impair a person’s ability to drive safely or operate machinery.

Given the statistics, employers are encouraged to initiate a program to ensure drivers do not drive under the influence of any medications. See the sidebar for strategies to address the issue in your business.

Strategies for your company to deal with worker impairment

There are a number of steps employers should take to address the problem of over-the-counter medications in the workplace.

First, educate employees to the problems of over-the-counter medications and how to address them. Experts say your awareness program should include information on the following, at minimum:

The importance of getting a sufficient amount of sleep.

The importance of taking prescription medication and over-the-counter medicines as prescribed by physicians and/or on the packages.

How to identify side effects they may be experiencing.

The importance of checking with their physicians if they do experience side effects.

The importance of telling their supervisors if they feel impaired as a result or medications, lack of sleep, or other causes.

Second, work with physicians. For example, there may be some viable alternatives to standard over-the-counter medications that cause impairment.

“For instance, first-generation antihistamines, which are now largely over-the-counter, tend to cause drowsiness,” says Lynne Stebbins, president and CEO of Stebbins Safety Services, Inc.

“Employees should check with their physicians to see about getting prescriptions for second-generation antihistamines, which are non-drowsy.”

First-generation (over-the-counter) antihistamines can cause drowsiness, impaired coordination, inability to concentrate and dizziness. Second-generation antihistamines — most notably the three industry leaders: Claritin, Allegra and Zyrtec — do not have these side effects. Claritin, once available only by prescription, is now available over-the-counter.

“If people need to take antihistamines, there is no reason they should not be taking a non-sedating version, such as Claritin, which is now available over-the-counter, or Allegra, which is available by prescription,” says Dr. John Weiler, professor emeritus at the University of Iowa.

Third, create an environment where employees don’t feel threatened to report to their supervisors when they are impaired due to the use of over-the-counter medications.

“The supervisor should then find another job for them to do that day that is less dangerous,” says Stebbins.

She maintains that swapping work assignments is better than telling the employee not to report to work in the first place, or sending them home if they already have arrived at work, as that approach will discourage the employee from ever reporting impairment again.

Fourth, supervisors should be trained to look for signs of impairment, such as lack of concentration, lethargy, agitation, or other behavior the employee does not commonly display.

Fifth, address issues related to long-term impairment. “You don’t want to allow employees to abuse your flexibility,” Stebbins says.

For example, if an employee comes in to work two or more times a week claiming to be impaired because of over-the-counter medications, you can’t always be expected to find alternate work for the employee. In this situation, Stebbins recommends trying to find another permanent position for the employee, one where safety will not be an issue.

“It is important to reassign this person to a different job where their safety and the safety of others will not be compromised,” she says.

She also recommends getting the employee’s physician involved to discuss what the employee’s capabilities and limitations are.

Ferrellgas Partners

Preventing driver inattention is a key step toward improving overall safety at Ferrellgas Partners, the nation’s second largest propane retailer.

“Our accident investigations show that the most common cause of accidents is driver inattention,” says Cliff Slisz, manager of safety.

As a result, the company has scheduled a series of safety meetings devoted specifically to routine distractions found in the everyday demands of the job: trying to find an address, reaching for a cup of coffee or answering a cell phone. Anything that diverts the driver’s complete focus from the road requires special attention.

“For example, we tell our drivers that, when they want to reach for coffee or a cell phone, they need to pull over to the side of the road,” Slisz explains.

Fatigue is another obvious concern in driver safety. Ferrellgas emphasizes the importance of getting proper rest, working within the hours-of-service limits, taking breaks, and having proper equipment — such as appropriate mirrors, working windshield wipers, tires and brakes — in good condition.

Some changes in the works for inexperienced employees with commercial drivers licenses could further help reduce road fatigue, Slisz says. New employees with less than year of experience will go through special training, including wellness training, hours of service training and whistle-blower driver disqualification.

To date, Slisz says he know of no cases of drivers having accidents at Ferrellgas as a result of using over-the-counter or prescription drugs. If drivers are involved in anything more than a “fender bender,” they are sent for a drug test, he says.

“We rarely find a positive test result, even for legal drugs such as over-the-counter and prescription drugs,” he observes.

Slisz credits a strong company policy against using these drugs while driving. Another reason is the company’s training program that emphasizes the problems with taking these drugs.

“We also tell employees that, if they are taking medications that could affect their alertness, they need to tell us,” he says.

“In these cases, we may have them do something else for that day.”

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