FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2315426726> ?p ?o ?g. }

• W2315426726 endingPage "e135" @default.
• W2315426726 startingPage "e134" @default.
• W2315426726 abstract "Extrapolation of data has been used for decades to perform quantitative occupational and environmental risk assessments. Extrapolation has been used to develop nearly every one of the hundreds of occupational chemical, physical, and biological exposure standards in the United States and the rest of the world. Such standards have reduced burdens of occupational injuries, illnesses, and diseases. Industrial hygienists, epidemiologists, and toxicologists have developed criteria for these processes including extrapolation such as “(1) a stable positive association with an adverse health outcome; (2) high overall study quality; (3) no substantial confounding; (4) quantitative exposure assessment for individuals; and (5) evidence of a dose–response relationship” to serve as a basis for extrapolation.1 The US Environmental Protection Agency also regularly extrapolates data.2 It is worth noting that, in contrast with the recent American College of Occupational and Environmental Medicine opioid practice guideline,3 most occupational and environmental risk analyses have relied primarily on animal models. Thus, the extrapolation used in the American College of Occupational and Environmental Medicine guideline on safety sensitive work should be substantially less controversial because it uses human population studies rather than animal studies on the effects of opioids. Dr Swotinsky has suggested that one should only use direct studies of each occupation or task to provide guidance for safe work. His position is that guidance developed from extrapolating 12 large, consistent epidemiological studies of driving activities to nondriving activities that also are safety-sensitive jobs is insufficient; the recommendation not to drive under the influence of opioids should only apply to driving. What he did not state is that the available studies are largely of private drivers. One could therefore take the additional position that there should be no guidance regarding opioid use for any occupation, including those involving work-related driving. Practically, it is nearly impossible to obtain direct data for most safety-sensitive positions. Many relevant populations are too small and/or too isolated for practical or robust descriptive epidemiological studies. In addition, it is likely unethical to expose control groups in cohort studies to a probable risk of injury or death. The philosophical viewpoint in Dr Swotinsky's letter raises the specter of never having guidance on jobs other than those exactly studied. Currently, it is common practice among all occupational health and safety professions and regulatory groups to use evidence from other relevant populations when evidence-based research for the target population is scarce, has never been conducted, or is unethical or impossible to obtain. For example, the Federal Motor Carrier Safety Administration Evidence Reports have noted that “because data from studies of [commercial motor vehicle] CMV drivers with [cardiovascular disease] CVD are scarce, we deemed it worthwhile to examine relevant data from studies that investigate crash risk associated with CVD among more general driver populations. While the generalizability of the findings of these studies to CMV drivers may not be clear, such findings do, at the very least, allow the opportunity to draw evidence-based conclusions about the relationship between CVD and motor vehicle crash risk in general.”4(p27) Similar processes are utilized by Federal Aviation Administration for commercial pilots (Robert Johnson, MD, MPH, MBA. Personal Communication, September 26, 2014).5,6 Is Dr Swotinsky suggesting that the Federal Aviation Administration drop its rules on pilot substance use and allow pilots to fly while under the influence of opioids and/or other drugs that impair performance but have not been directly tested in that occupational setting? Opioids are centrally acting drugs that produce sedation and analgesia, with adverse effects that have been consistently associated with increased risk of motor vehicle crashes.3 The epidemiological and other evidence reviewed uniformly suggests cognitive, reaction, and perceptual impairments that result in motor vehicle crashes. A second systematic review has recently affirmed our findings.7 The evidence demonstrates that both acute and chronic use of opioids impair judgment and pose other safety risks. The burden of proof that the use of potentially impairing substances under such circumstances is not hazardous would be on the makers of these products. Unsurprisingly, none of the medication instructions for opioids have been stripped of warnings to avoid driving and operating machinery. The cognitive and other skills required for safety-sensitive positions overlap to varying degrees with those required to safely operate a vehicle. These include unimpaired alertness, attention, concentration, reaction time, coordination, memory, multi-tasking abilities, perceptual abilities, thought processing, and judgment. Evidence has documented that opioids produce cognitive impairments, perceptual deficits, and slowed reaction times.8–11 Driving can be viewed as the ideal proxy for determination of levels of impairment for other safety-sensitive duties and tasks. Creating the expectation that empirical studies have to be conducted in every particular safety-sensitive setting and for every position, and that no extrapolation is allowed before we can assume that impairment caused by opioid use may pose a risk, places an unreasonable and perhaps at times impossible burden of proof on adopting steps to ensure occupational safety. Adopting that approach could be considered a dereliction of duty, if argued from the opposing side. For example, a person in a safety-sensitive position might bring a tort action against a health provider or occupational health physician who declared the person using opioids fit for duty, if evidence only suggested that opioids impair driving capacity and increased risk, and an injury or death had occurred. It is reasonably foreseeable that if opioids impair driving, they would impair other safety-sensitive duties. No epidemiological evidence is available to suggest that cognitive impairments are not a problem. Excessively narrowing guidance from safety-sensitive work to a population of private automobile drivers is not rational or likely safe from the standpoint of public health. The evidence and widely accepted practices suggest that a truck driver, commercial pilot, or nuclear plant machine operator would be similarly likely to be impaired by opioid use. Such workers should not expose their passengers, coworkers, and the general public to impaired decision making and unsafe performance. Kurt T. Hegmann, MD, MPH FACOEM, FACP Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT Michael S. Weiss, MD, MPH, FACOEM FAAPMR, FAANEM Kirk Bowden, PhD, NAADAC Fernando Branco, MD Kimberly DuBrueler, PharmD, RPh Charl Els, MBChB, FCPsych, MMed Psych, ABAM, MROCC Jeffrey S. Harris, MD, MPH, FACOEM Steven Mandel, MD David W. McKinney, MD, MPH Rafael Miguel, MD Kathryn L. Mueller, MD, MPH FACOEM Robert J. Nadig, MD, MPH, FACOEM Michael I. Schaffer, PhD, MS, DABFT NRCC-TC Larry Studt, MD James B. Talmage, MD, FACOEM Russell L. Travis, MD Thomas Winters, MD FACOEM, FACPM Matthew S. Thiese, PhD, MSPH Ulrike Ott, PhDc, MSPH" @default.
• W2315426726 created "2016-06-24" @default.
• W2315426726 creator A5003495786 @default.
• W2315426726 creator A5006526401 @default.
• W2315426726 creator A5010967395 @default.
• W2315426726 creator A5016666048 @default.
• W2315426726 creator A5026564932 @default.
• W2315426726 creator A5030483353 @default.
• W2315426726 creator A5031856005 @default.
• W2315426726 creator A5038265544 @default.
• W2315426726 creator A5046367279 @default.
• W2315426726 creator A5055792421 @default.
• W2315426726 creator A5059314361 @default.
• W2315426726 creator A5062464703 @default.
• W2315426726 creator A5063737974 @default.
• W2315426726 creator A5069132112 @default.
• W2315426726 creator A5073028184 @default.
• W2315426726 creator A5081152665 @default.
• W2315426726 creator A5083593906 @default.
• W2315426726 creator A5089763364 @default.
• W2315426726 creator A5090833138 @default.
• W2315426726 date "2014-11-01" @default.
• W2315426726 modified "2023-09-23" @default.
• W2315426726 title "Opioids and Safety-Sensitive Work" @default.
• W2315426726 cites W1967552594 @default.
• W2315426726 cites W1987762304 @default.
• W2315426726 cites W2006966480 @default.
• W2315426726 cites W2077312718 @default.
• W2315426726 doi "https://doi.org/10.1097/jom.0000000000000341" @default.
• W2315426726 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/25376423" @default.
• W2315426726 hasPublicationYear "2014" @default.
• W2315426726 type Work @default.
• W2315426726 sameAs 2315426726 @default.
• W2315426726 citedByCount "5" @default.
• W2315426726 countsByYear W23154267262015 @default.
• W2315426726 countsByYear W23154267262016 @default.
• W2315426726 countsByYear W23154267262019 @default.
• W2315426726 countsByYear W23154267262020 @default.
• W2315426726 countsByYear W23154267262022 @default.
• W2315426726 crossrefType "journal-article" @default.
• W2315426726 hasAuthorship W2315426726A5003495786 @default.
• W2315426726 hasAuthorship W2315426726A5006526401 @default.
• W2315426726 hasAuthorship W2315426726A5010967395 @default.
• W2315426726 hasAuthorship W2315426726A5016666048 @default.
• W2315426726 hasAuthorship W2315426726A5026564932 @default.
• W2315426726 hasAuthorship W2315426726A5030483353 @default.
• W2315426726 hasAuthorship W2315426726A5031856005 @default.
• W2315426726 hasAuthorship W2315426726A5038265544 @default.
• W2315426726 hasAuthorship W2315426726A5046367279 @default.
• W2315426726 hasAuthorship W2315426726A5055792421 @default.
• W2315426726 hasAuthorship W2315426726A5059314361 @default.
• W2315426726 hasAuthorship W2315426726A5062464703 @default.
• W2315426726 hasAuthorship W2315426726A5063737974 @default.
• W2315426726 hasAuthorship W2315426726A5069132112 @default.
• W2315426726 hasAuthorship W2315426726A5073028184 @default.
• W2315426726 hasAuthorship W2315426726A5081152665 @default.
• W2315426726 hasAuthorship W2315426726A5083593906 @default.
• W2315426726 hasAuthorship W2315426726A5089763364 @default.
• W2315426726 hasAuthorship W2315426726A5090833138 @default.
• W2315426726 hasBestOaLocation W23154267261 @default.
• W2315426726 hasConcept C142724271 @default.
• W2315426726 hasConcept C187155963 @default.
• W2315426726 hasConcept C71924100 @default.
• W2315426726 hasConceptScore W2315426726C142724271 @default.
• W2315426726 hasConceptScore W2315426726C187155963 @default.
• W2315426726 hasConceptScore W2315426726C71924100 @default.
• W2315426726 hasIssue "11" @default.
• W2315426726 hasLocation W23154267261 @default.
• W2315426726 hasLocation W23154267262 @default.
• W2315426726 hasLocation W23154267263 @default.
• W2315426726 hasOpenAccess W2315426726 @default.
• W2315426726 hasPrimaryLocation W23154267261 @default.
• W2315426726 hasRelatedWork W1489783725 @default.
• W2315426726 hasRelatedWork W1506200166 @default.
• W2315426726 hasRelatedWork W2039318446 @default.
• W2315426726 hasRelatedWork W2048182022 @default.
• W2315426726 hasRelatedWork W2080531066 @default.
• W2315426726 hasRelatedWork W2604872355 @default.
• W2315426726 hasRelatedWork W2748952813 @default.
• W2315426726 hasRelatedWork W2899084033 @default.
• W2315426726 hasRelatedWork W3032375762 @default.
• W2315426726 hasRelatedWork W3108674512 @default.
• W2315426726 hasVolume "56" @default.
• W2315426726 isParatext "false" @default.
• W2315426726 isRetracted "false" @default.
• W2315426726 magId "2315426726" @default.
• W2315426726 workType "article" @default.