Choosing Wisely:

Don’t prescribe opioids for treatment of chronic or acute pain for workers who perform safety-sensitive jobs such as operating motor vehicles, forklifts, cranes, or other heavy equipment.

Rationale and Comments: The use of both strong and weak opioids has been consistently associated with increased risk of motor vehicle crashes as opioids produce sedation and hinder or impair higher cognitive function. Evidence suggests higher risk with acute opioid use, but risk remains elevated throughout treatment with any opioid and reverses on cessation. Workers who operate motor vehicles/heavy equipment should be precluded from performing these or other safety-sensitive job functions while under treatment with opioids.
Sponsoring Organizations:
  • American College of Occupational and Environmental Medicine
  • Sources:
  • American College of Occupational and Environmental Medicine guidelines
  • Disciplines:
  • Neurologic
  • References: • Weiss MS, Bowden K, Branco F, et al. Opioids Guideline [Internet]. In: Hegmann K, ed. ACOEM’s Occupational Medicine Practice Guidelines. 3rd ed revised. Westminster, CO: Reed Group Ltd. Forthcoming 2014 March. p. 11.

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