Cathy – One important question is what is the severe pain due to that this person is being treated for?  Is she able to perform the essential job functions with this pain?  What is the job she’s been offered? 


ACOEM just came out this month with practice guidelines on opioids and safety-sensitive work [JOEM 56(7) e46-52, July 2014].  They recommend against acute or chronic opioid use for patients who perform safety sensitive jobs, which they define to include tasks involving high levels of cognitive function and judgment.  This standard could easily be applied to nurses, physicians and others in the healthcare setting. 


A lot depends on the job.  I agree with others that a second opinion with a substance abuse professional would be wise for a, hopefully unbiased, opinion about whether she can safely and consistently perform the essential functions of the job, and that the applicant be monitored by her prescriber with periodic urine drug screens per the currently accepted practice recommendations. 


James Garb, MD FACOEM

Medical Director, Occupational Health Services

Cape Cod Healthcare

Hyannis, MA


From: MCOH-EH [] On Behalf Of Senior, Cathy (DRMC)
Sent: Wednesday, July 30, 2014 10:59 AM
Subject: [MCOH-EH] Methadone




We have a candidate for hire which is a known methadone user. This candidate does have a legal prescription for the drug but it makes me alittle nervous. We are considering doing random drug screens for a period of time just to be assurred that this person is not taking anything not prescribed. The candidate relates that the methadone is prescribed for severe pain and has been on it for the past year. Any thoughts and past experiences with this would be greatly appreciated.


Cathy Senior RN BSN CDE

Employee Health Director

Penn Highlands DuBois

100 Hospital Avenue

P.O. Box 447

DuBois Pa 15801

Phone 814-375-3392

Fax 814-372-2610