Planes, trains and fire stations: Drug safety for workers in risky industries

Is it safe for railroad engineers to take beta blockers for hypertension? What about firefighters, truck drivers, or Navy fighter pilots? A panel of occupational health experts discussed different classes of medications and whether they’re deemed safe for workers in various high-risk professions. Perspectives included:

• Naval aviation: Capt. Kris Belland, DO, MPH, the executive officer at the Navy Medicine Operational Training Center in Pensacola, Florida.
• Firefighting: P. Lance Walker, DO, MPH, who’s co-principal of SiteMed North American, a company that provides annual physicals for fire departments. Dr. Walker is also associate medical director for the Georgia Power Company.
• Railroad work: Scott C. Jones, DO, MPH, medical director of Missouri Employers Mutual, a workers’ compensation insurance company, and former medical director for Union Pacific Railroad.
• Addiction considerations: Anthony H. Dekker, DO, an addiction medicine specialist who serves as a primary care and telemedicine physician at the Northern Arizona VA Health Care System in Prescott.

Here are four key takeaways:

1. Industry drug safety standards differ

Many drugs and health conditions are considered deal-breakers for Navy fighter pilots because they aren’t compatible with the physical and psychological rigors of flying, Dr. Belland said. But Dr. Jones noted that the railroad industry has fewer absolute regulations about drugs that can and cannot be taken; instead, physicians must evaluate whether the worker’s symptoms and the drug’s side effects pose a safety risk. Medical marijuana is considered unsafe in all the industries discussed.

2. Warn workers who take ADD drugs not to overuse stimulants

“Picture a firefighter who’s on ADD meds and drinks three cups of coffee in the morning, four energy drinks in the afternoon and experiences an adrenaline rush when he’s called to fight a fire,” Dr. Walker said. “The stacking of stimulants can pose a serious risk.” He recommends physicians counsel such patients about not overusing stimulants and document that they’ve done so.

3. For anxiety, consider non-pharmacologic options

Dr. Dekker described a meditation and yoga program at Fort Belvoir (Virginia) Community Hospital, a military hospital where he served as the director of addiction medicine. Visitors to the hospital grounds were sometimes startled to find yoga mats and meditation sessions in progress on the front lawn, he said, but the benefits were tangible for military personnel with anxiety and PTSD. “A pill is not always the answer, especially for anxiety,” he noted.

4. See the big picture when treating patients with high-risk jobs

When evaluating whether a patient can perform his or her job safely, consider the side effects of medication as well as underlying health conditions. For example, a medication that increases the risk of dehydration or impact’s the body’s ability to regulate temperature could be dangerous for a firefighter.