Amtrak OIG Opioid Opinion

Some Amtrak employees are at risk of protracted prescription painkiller popping, Amtrak’s internal OIG (Office of Inspector General) says in a 40-page report, “SAFETY AND SECURITY: Expanded Random Drug Testing Could Help Further Detect and Deter Prescription Opioid Misuse.” The report notes that Amtrak “could strengthen its ability to detect and deter prescription opioid misuse among employees conducting safety-related work by expanding its random drug testing program.”

The OIG analyzed “de-identified” prescription and medical claims from fiscal year 2019 for 11,356 Amtrak employees who performed safety-related work, and found 113 who met one or more of the CDC (Centers for Disease Control and Prevention) indicators of potential opioid use disorder or overdose. For example, the OIG found one conductor who overdosed on opioids at the beginning of the year and subsequently filled seven prescriptions for oxycodone, “which put the employee at risk for a future overdose,” OIG said.

The OIG also found 68 of those 113 had co-prescriptions with benzodiazepines, “which are regularly detected with opioids in overdose deaths.” In addition, 42 employees had “high prescription dosages”—the equivalent of “at least 10 tablets per day of Vicodin for at least three months,” which the CDC suggests doubles a patient’s risk of an overdose.

Fourteen employees with opioid prescriptions also had prescriptions for naloxone, which reverses the effects of an overdose; the CDC recommends physicians consider prescribing naloxone to patients “who present elevated overdose risks.” And five employees had prescriptions for more than seven days, “even though they were not diagnosed with a condition that indicates chronic pain.” It’s recommended that physicians prescribe the “lowest effective dose for the shortest duration possible—which should rarely exceed seven days—following acute events like surgery or dental procedures.” (Note: The total does not add up to 113 because “some employees exhibited more than one risk factor.”)

Additionally, OIG’s analysis of prescription drug claims data shows that 1,157 employees in safety-related positions (10% of the total) filled a prescription while they were “in active duty,” putting them “at risk for being impaired while at work.”

OIG Recommends Next Steps, Amtrak Responds

The OIG report included four key recommendations for enhancing “Amtrak’s ability to detect and deter prescription opioid misuse by employees in safety-related positions.” They were submitted to Amtrak Executive Vice President/Chief Human Resources Officer Quiana Spain. Spain, in agreement with all four, provided Amtrak’s plans to address them. OIG’s summary of her (management’s) response follows.

• “Recommendation 1: Management agreed with our recommendation to identify all positions the company considers to be safety-related. The target completion date is December 31, 2020.

• “Recommendation 2: Management agreed with our recommendation to identify whether additional prescription opioids are potentially impairing and of substantial concern for safety-related work. Management stated that the company will review industry data and practices to help ensure that its random drug testing program covers the full range of opioids that present safety risks. The target completion date is August 31, 2021.

• “Recommendation 3: Management agreed with our recommendation to develop a strategy to negotiate with unions to expand the company’s random drug testing program. Management stated that most of the company’s collective bargaining agreements are open for amendment effective January 1, 2022, and negotiations will begin in 2021. During these negotiations, the company will propose expanding random drug testing to cover additional positions and any additional prescription opioids that are potentially impairing and of substantial concern for safety-related work. The target completion date is December 31, 2021.

• “Recommendation 4: Management agreed with our recommendation to work through the Benefits group to identify and require detailed summary statistics and other metrics from the benefit administrators, in compliance with HIPAA privacy laws, to support company efforts to detect and deter prescription opioid misuse. Management stated that the Benefits group will meet regularly with the benefit administrators to discuss industry trends and insights from their prescription opioid and substance abuse initiatives. The target completion date is January 30, 2021.”

DOWNLOAD THE FULL OIG SAFETY AND SECURITY REPORT (INCLUDING AMTRAK’S COMPLETE RESPONSE):

Railway Age Executive Editor Marybeth Luczak contributed to this report.