Today’s drivers fight fatigue, even if they are “clean” and well-rested
By William Atkinson
When MC Magazine last covered the topic of driver safety (Winter 2003), the focus of the article was on the two primary causes of accidents (substance abuse and recklessness), and a common cause of injuries (ergonomics issues). Since that time, some government agencies and other experts have been shedding light on another serious cause of vehicular accidents: fatigue.
While drivers can experience fatigue due to their own lifestyles (e.g., staying up too late at night), most precasters do a good job of helping drivers prevent fatigue-related accidents by the way they schedule drivers.
Despite the best efforts and intentions of employers, though, a new and insidious cause of fatigue is being brought to light – one that few employers and employees are even aware of. This is the use of certain prescription and over-the-counter (OTC) medications.
A new concern
When one thinks of impaired workers, the first things that usually come to mind are alcohol and illegal drug impairment. These are, indeed, serious problems. However, there are a number of other types of impairment that can lead to equally or even more serious problems, such as increased accidents and injuries.
Leading the pack are prescription and OTC medications. “These are major problems for employees who drive, who work with heavy industrial machines, or who are involved in construction work,” points out Lynne Stebbins, R.N., president and CEO of Stebbins Safety Services Inc. in Freehold, N.J.
While prescription medications can cause problems, OTC medications present some of the most common and serious problems associated with job impairment, according to Stebbins. There are several reasons:
• They are used more commonly than prescription medications.
• Warnings are usually more carefully noted on prescription medications than on OTC medications.
• Many people assume that if something is available OTC, it is completely safe and does not have any side effects.
• Certain prescription medications (particularly antihistamines) do not cause the drowsiness that their OTC counterparts do (discussed in detail later).
“In my opinion, OTC antihistamines are the most common cause of impairment in the workplace,” says Stebbins. “A large number of employees take these routinely.”
Prescription and OTC medicines that can cause drowsiness include analgesics (pain relievers), antianxiety medication, allergy medicines (antihistamines), blood-sugar medicines, antidepressants, tranquilizers, blood pressure medicines, motion sickness medicines, ulcer medicines, antibiotics, antiseizure medicines, cough syrups and decongestants. According to the National Transportation Safety Board (NTSB), the three most commonly used OTC medications that cause drowsiness are pain relievers, antihistamines and antidepressants.
According to a report published by Vanderbilt University, taking sedating antidepressants even 10 hours before driving is equivalent to driving drunk.
While OTC drug packages do contain warnings related to drowsiness and other side effects, they are often hidden in very small print in the midst of hundreds or even thousands of other words, few of which users even bother to glance at, much less read. In fact, the NTSB reports that on many labels, these warnings are no larger than 1/16 of an inch in height. It also notes that such warnings are usually much more noticeable on prescription medications, and that the latter are also usually supplemented by verbal warnings from prescibing physicians as well as pharmacists.
“In addition, some OTC medications contain a wide range of medications,” says Stebbins. “A single pill can contain an antihistamine, a decongestant and a pain reliever.”
John Weiler, M.D., professor emeritus with the University of Iowa, agrees with these concerns. “A number of OTC 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 OTC drugs, antihistamines are the most commonly used and of the greatest concern in terms of driver drowsiness. Approximately 50 million people suffer from allergies in the United States. Yet, despite the negative side effects of OTC antihistamines, a survey reported in the Journal of Allergy and Clinical Immunology found that 47 percent of allergy sufferers continue to use them.
A survey conducted by Schering-Plough HealthCare products found that more than half (57 percent) of surveyed allergy sufferers reported that their ability to focus is negatively affected by the “medicine haze” (drowsiness) associated with common OTC allergy medicines.
“Some research we conducted with driving simulators showed that impairment of some OTC drugs was worse than it was with alcohol,” says Weiler.
According to a study conducted in Europe, a single dose of Benadryl, one of the most popular OTC antihistamines, is equivalent to a blood-alcohol content of .09, higher than the .08 that makes drivers legally drunk in most U.S. states.
OTC drugs and accidents
Mitchell Garber, M.D., medical officer for the NTSB, says, “We have seen numerous traffic accidents caused by the use of sedating OTC medicines.”
The Journal of the American Medical Association reports that 16,000 auto accidents are attributed to impairment from prescription and OTC drugs each year. And a story in USA Today reported that sedating antihistamines contribute to approximately 600 auto fatalities and almost 50,000 auto injuries each year.
According to Carol Carmody, vice chairman of the NTSB, “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.”
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 their systems, and 21 percent had OTC medications in their systems.
The problem of OTC drugs and driver impairment is becoming so serious that the U.S. Department of Transportation (DOT) 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 notes that medical literature identifies many of these. Unfortunately, though, there is currently a lack of such guidance available in a single location. “This presents a problem,” he says.
Several European countries already require OTC 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 alarming statistics, it makes sense for any employer to initiate a program to make sure that drivers do not drive while under the influence of OTC medications that cause drowsiness. See the sidebar “OTC Strategies” for some recommendations in this area.
“With liability exposures being what they are, every company needs to take driver safety very seriously,” emphasizes Joe Glowaski, safety director of Atlantic Precast in Tullytown, Pa. “This issue is of the utmost importance, whether you have one truck or a thousand. We constantly remind our drivers that what they are driving is a weapon.”