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DRUGS AT WORK Dominic Cadden Published in Sun-Herald's Sunday Life For some white-collar workers, a caffeine hit, a Berocca and the latest breakfast cereal with a catchy slogan just isn’t enough to get them through their day any more. Increasingly, beta-blockers may replace the Berocca, codeine goes with the coffee and perhaps a sprinkle of Ritalin with the Weeties. For a growing number of office soldiers, prescription and pharmacy only medications have become weapons to battle the stress, anxiety and fatigue that have become an accepted part of the job. In the 2004 National Drug Strategy Household Survey, 11 per cent of Australians over 14 (an estimated 1.9 million people) said that they had used someone else's prescription drugs in the last 12 months. “There’s a problem of perception,” says Donna Bull, CEO of the Alcohol and other Drugs Council of Australia. “Because these substances are generally easily obtained and would otherwise be given out by a doctor, people don’t see themselves as doing anything very wrong or consider the medications harmful. “Most people think it’s mainly truck drivers who misuse prescription drugs, but that’s because they’re in the news and tested more frequently,” Bull says. “But hospitality workers would be among the biggest users of prescription drugs for non-medical purposes, probably to help them cope with their long hours, shift work and a lot of time spent on their feet.” Perhaps even more disturbing are figures from a 2002 study published in the Journal of Drug Issues, which pointed to prescription drug abuse by health care professionals including physicians, nurses, dentists and anaesthetists. For example, 40 per cent of pharmacists – for whom access to drugs obviously poses no problem – reported illegally using some form of potentially addictive, mindaltering prescription drug. A Sydney doctor working as a locum for GPs freely admitted to using Dexadrine while on the job. “I often have a long commute [from the northern beaches] to a very busy practice where I’m unfamiliar with the patients and the way things are run,” says the man in his fifties, whose shift started at 8:30am and could run as long as 7pm. “I have to be on my game, so after lunch I take half a tab and it sees me through the rest of the day.” Dexadrine is a product containing dextroamphetamine, the only psychostimulant drug prescribed through the PBS. Dextroamphetamine produces increased alertness, wakefulness, energy and self-confidence. It is often used for ADHD and established cases of narcolepsy, an uncommon condition characterised by overwhelming excessive daytime sleepiness, however the US Air Force uses dextroamphetamine as its "go-pill" to help pilots on long missions remain focused and alert. NASA has also used the drug to combat fatigue in astronauts. Stress is another key factor that makes workers turn to prescription meds, which is perhaps why tranquilliser and opioid drugs are so popular. "The two prescription groups that we usually see are opiates – everything from morphine through to codeine – and benzodiazepines, which are your tranquillisers,” says Andrew Leibie, Principal Scientific Consultant for d:tec Australia, a comprehensive, national drug testing service. “It’s not uncommon for people to grab a tranquilliser tablet from someone else. What sometimes happens is someone will say, the missus is only a little thing and she takes one a night, so I took two or three, when the dose is half a tablet a night,” Leibie says. “Then you have someone completely bombed out for the next few days.”

In 1989, a software development manager began working with a South Melbourne firm developing programs for digital photography. Stressed by tight deadlines in a business with low cash flow, the second-in-charge soon turned to opioid and tranquilliser drugs to take the edge off the pressures of work. “We had a lot of interaction with creative types – photographers, artists and so on, and it seemed everyone was taking something," says the father of two today, now living in Rosebery, Sydney. Within a year, his creative contacts had Introduced him to drugs such as OxyContin and Xanax, although he says he would "take whatever I could get my hands on. For about 10 years I was going [after taking] some drug or other,” he says. "Within a couple of hours I'd feel a calmness, kind of numbing, and I'd just drift through the long days. They made me feel like nothing or no-one could stress me.” He says that while it was common to swap medications with photographers and artists who he came into contact with, perhaps the best source was his wife. "She was an even bigger drug addict than me," he says. "I think that she could go to the doctor and there'd be less suspicion and questions asked if she asked for something for pain or sleep because she was a woman." Ironically, when taken for too long, the side-effects of benzodiazepines (the active ingredient of many tranquilliser drugs) include anxiety and sleeplessness – the very problems that they are supposed to relieve. In 2002, the National Drug Strategy Household Survey asked respondents how they obtained medications that were not prescribed for them. Relatives, friend or acquaintances were by far the most popular source, accounting for over half the drugs. We know relatively little about the methods by which pharmaceuticals are diverted, but this one-off survey question seems to back up the theory from Darwin academic, Dr Bridie O’Reilly, who suggests that supply is driven mainly by small-scale diversion from legitimate prescriptions rather than the involvement of organised crime or large-scale theft from pharmacies or manufacturers in Australia. Dr O’Reilly says prescription drugs are relatively easy to obtain from a diffuse network of users, friends of users, dealers and suppliers, some of whom also sell other drugs, such as methamphetamine, heroin and/or cannabis. "Forging prescriptions has become much harder since most are now generated from a doctor’s computer," says Aaron Hall from the Australian Pharmaceutical Association of Australia. He says that the real problem in recent years has come from “doctor shopping”, where people go to different doctors to get multiple prescriptions. Now even this is source is under threat, thanks to a special hotline that became available to doctors and pharmacists in February 2005. “Pharmacists can call at the Health Insurance Commission (HIC) to dob in suspected doctor shoppers, plus any pharmacist can refuse to supply someone if they suspect their request is not genuine,” Hall says. “But really, the ultimate backstop is the HIC itself. All PBS prescriptions go into a database when they’re filled. The HIC will look at those and pick up a person who goes to six different doctors.” Dr. Choong-Siew Yong, Vice President of the Australian Medical Association, says that doctors now receive specific training in spotting people who seek prescriptions for reasons other than their own health. “You become quite attuned to the various stories patients tell, and patterns begin to emerge,” Dr Yong says. “They’ll say that they’re travelling or just passing through and they forgot their medication, or they’ll come in and describe the drug they’re after by name. And as soon as there’s a new doctor in a practice, you can be sure that there’ll be a number of people booking in to ask him or her for prescriptions."

Dr Yong warns that the drugs that are more of a problem are those that are most addictive – opioid drugs such as Valium and codeine, but says the AMA is concerned by the leakage of amphetamine medications for non-medical purposes, which he can only speculate are used to aid alertness. Dr Yong says that these drugs don’t give the high of street amphetamines, but they can cause problems with expression, hallucinations and even sensations of things crawling on the skin. “We know that there is an active black market in the sale of dexamphetaminebased medications such as ADHD medications, but they’re actually very controlled. Only specialists can prescribe them, primarily paediatricians and psychiatrists, but people sell them. It’s hard to see where the black market comes from.” ADHD medications are often referred to as “kiddie speed” because they are an amphetamine-like stimulant. Several medications, such as Ritalin, contain methylphenidate, which has a similar chemical structure to cocaine, although when taken as prescribed, methylphenidate is absorbed into the body at a much slower rate than cocaine. “It’s another class of drug that’s sought after to combat fatigue, along with antinarcolepsy drugs,” says Dr Yong. “However they don’t replace the benefit you get from sleep and rest. Your eventual performance begins to decline along with your health, leaving you more prone to lifestyle conditions such as obesity, high blood pressure and heart disease.” As a casual worker, one Sydney graphic designer has little choice but to accept the deadlines requested by employers. “I’m going into someone else’s office and there’s all these distractions and crazy hours, travelling over an hour to get into the city,” he says. “I find Ritalin really helps me zone out [office distractions] and focus, plus it perks me up a bit, too.” The 27-year-old has little trouble accessing the drug through his two teenage sisters, who trade or buy pills at school. “I’m only using them a few days a month, so it’s not a lot that I’m getting at a time,” he says. “I don’t feel that different, but people say they see me change – I become very quiet and unresponsive.” He takes double the recommended dose “because obviously, I’m bigger than a kid” and says he notices a dry mouth and some blurry vision as side effects, plus some sleeplessness persisting after he finishes taking the drug. Beta-blockers are another class of drug in use among the office crowd. Betablockers are most commonly used for high blood pressure. Before they were banned from sports, they were also popular with athletes in precision sports such as shooting and archery, because they slowed the heart rate and helped them keep a steady hand. An actress in musical theatre overheard a friend who worked in office jobs talking about their experiments with beta-blockers to calm nerves before presentations and other speaking engagements. “I’d had a lifelong fear of singing to audiences,” she says, “so I justified using beta-blockers by telling myself that they were necessary in order for me to provide the service for which I’d been hired.” She took half-doses an hour before a performance and the effects lasted three to four hours. “It took away my nerves, but my heartbeat became so slow that I became very tired. In fact, it sometimes took away from my performance. There was a doctor on cast, and when he felt my pulse and how cold my extremities were from lack of circulation, he said, ‘this isn’t supposed to happen’.” Dr Yong says that beta-blockers do have a legitimate place in treating anxiety, but warns that any medication can effect you adversely especially in a situation

where you are taking the medication intermittently. For instance, the use of betablockers in the absence of some type of cardiac dysfunction may result in lowered blood pressure or decreased heart rate and might also induce tiredness and a decrease in endurance. “The whole point of prescriptions is that you get the right medication for what you need.” For this reason, Dr. Yong is critical of online pharmacies that bypass face-to-face consultations with a doctor. “You may not receive the proper instructions or even the drugs that you need, or they may be for a condition that you don’t actually have,” he says. “We also know that overseas online suppliers will sell you expired drugs from 'grey manufacturers' (companies that may have no relationship with the producer of goods that they purport to represent or distribute) that either sell expired goods or basically fake the effects of a drug – what’s in them is not what appears on the label.” Up until recently, workers in Australian white-collar industries have been able to abuse prescription drugs in the workplace without fear of challenge, but this may well be changing. Currently only select industries, such as rail safety, have across-the-board drug testing required by legislation. For the vast bulk of workplaces, it comes down to company policy - and a clear drug testing policy must be in place before any boss springs urine tests on a worker. The advent of Australian Workplace Agreements (AWA) encourages employers to map out policies that pertain to the employment relationship, including whether an employee is fit for work as proven through drug tests. “Over the past two years we have seen a 140 per cent increase in all forms of workplace testing in Australia,” says Andrew Leibie from d:tec. “We don’t yet test for any businesses with an exclusively white collar workforce, such as banks and financial institutions, although in the USA they talk quite a lot about pre-promotion drug testing in the office.” Despite the less intrusive nature of saliva swabs, all of d:tec's drug tests are done with urine, as there is no standard in Australia to detect the presence of drugs in saliva but there is one for urine. Testing can either be done on-site, with results in three to six minutes, or samples can be taken to a toxicology laboratory. Onsite screening has the advantage that workers who produce negative screening samples can be sent back to work immediately, while laboratory testing, which usually returns results in 48 hours, is a good option for companies that want to test their employees themselves, but do not want the testers to have to deal with people who screen positive on site. It is also more accurate and eliminates the possibility of false positive results. Tests by d:tec determine the presence of opiates, such as painkillers (e.g. Oxycontin and codeine drugs such as Panadeine Forte), cocaine, methamphetamines (including pseudoephedrine), marijuana and benzodiazepines, such as muscle relaxants (e.g. Valium), relaxants (e.g. Mogadon) and sleeping pills (e.g. Serapax, Normison). Leibie notes that they don’t look for blood pressure medication and Viagra, both of which are sources of embarrassment for some men. “We still go more into the blue collar industries, but almost without exception, these companies will get everyone tested – the truck drivers and the miners of course, but also the accountants and everyone else in the admin office. Qantas is one Australian company that has drug testing to include all staff, a policy that has been in place since 2003 despite heated debates with union officials at the time. Regulation 256 of the Civil Aviation Regulations 1988 prohibits the use of drug and alcohol by aircraft crew and air traffic controllers while on duty and for eight hours prior to duty, however even companies

operating in telephone sales on behalf of Qantas are warned that they may be required to have their urine tested for drugs and alcohol. Qantas follows a random selection procedure, although drug and alcohol tests may also be required prior to employment, after accidents or incidents or upon reasonable suspicion. Dr Peter Holland, from the Australian Centre for Research on Employment and Work at Monash University, says that workplace drug testing in white-collar industries is largely accepted in the UK and the USA, but the issue seems to be an “industrial relations battlefield” in Australia. According to a national survey of 1800 firms in the UK by the Chartered Institute of Personnel and Development, five per cent of all businesses have a policy of randomly testing employees for drugs, while nine percent of all businesses conduct pre-employment testing for drugs. In the USA, workplace drug testing has been well established since the 1980s, even in white-collar industries. Figures from the American Management Association indicate that even in financial services 35.8 per cent of all new hires are tested for drugs and another 18.8 per cent of other employees are also tested. “Introducing drug testing in Australia says to workers, ‘We don’t trust you to come to work and be responsible’,” says Dr. Holland. “Current drug tests seem to be as much about what you’ve done in your social life as what you’re doing at work. Drug tests are one thing for safety when it comes to someone driving a 200-tonne truck. But are they really necessary when you sit in an office?” Dr. Holland acknowledges that some substances may effect judgement, but says these issues are best overcome with ‘fitness for duty’ tests instead of a blood or urine sample. Fitness for duty tests are a non-invasive method of assessing whether a worker is whether workers are in a condition where the there is no impairment to the skills required for their work tasks. Dr. Holland has seen some rudimentary fitness for duty tests that have included testing reactions to numbers and figures and how well workers follow a ball around the screen. “Besides, any drug tests in white-collar industries miss the point,” Dr Holland says. He points to the longer average work hours of Australian workers compared to most other OECD countries (Australia comes tenth out of 28 OECD countries at 1816 work hours per year according to the OECD Factbook 2006), the high rate of casual workers and industrial relations laws that contribute to a perception of job insecurity only add to work-related stress. Another contributing factor is our reluctance to take a break. A report by Tourism Australia published in May 2006, No Leave, No Life, shows that Australian workers have stockpiled a staggering 70 million annual leave days. More than 60 percent of full-time Australian workers do not use their full annual leave entitlement in a year and more than one third of full-time workers do not take any annual leave in a year at all. Of the workers surveyed for the report, 48 per cent cited lack of resourcing and back up while on leave as the most significant barrier to taking leave, while 46 percent indicating that the increased workload before and after leave makes the holiday less than worthwhile, particularly working through the email build-up on return from leave. “Another difference between white collar workers as opposed to blue collar workers is that we all bring emails and mobile phones home with us, which is another stress factor,” Dr. Holland says. “Is there a complete break between the workplace and home? Really bad fatigue can effect your reaction speed and decision-making ability as much as a blood alcohol limit four times above the limit. Employers have to ask whether they’re creating an environment that contributes to the problem.”

Drugs at work