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General – Page 2 – WorkCare

WorkCare

Category: General

  • Natural Disaster Preparedness Promotes Resilience

    Natural Disaster Preparedness Promotes Resilience

    Mother Nature and human threats can deliver harsh lessons no matter how well prepared you or your organization may be. Forests regenerate after wildfires, fierce winds, avalanches and volcanic eruptions because they have grown deep, interconnected root systems to withstand these threats. Similarly, people are more resilient when they have a plan and are prepared to join forces in the event of a natural disaster.

    Preparedness involves anticipating and planning for challenges such as a need for medical care, loss of electricity, communication lapses, lack of safe shelter, and limited supplies of fresh water, food, fuel and other necessities. After-effects to consider include exposure to hazardous conditions during clean-up operations, economic impacts and post-traumatic stress.

    Natural disaster victims often experience stress responses such as depression, anxiety, grief and hypervigilance. In addition to basic first-aid knowledge and planning for access to survival essentials such as food, water, shelter and fuel, it’s also important to be aware of ways to protect emotional health during an emergency. Physical and mental self-care enables people to help each other and promotes recovery over time. People with preexisting physical and mental health conditions should be ready to continue with their treatment plans during an emergency and monitor for any new symptoms.

    Preparedness Plan

    Here are some simple ways to be better prepared:

    1. Familiarize yourself with the types of natural disasters that could occur and their effects.
    2. Develop preparedness plans in collaboration with others – businesses, employees, local officials, family members, friends and neighbors.
    3. Create and share an emergency contact list.
    4. Identify ways to reconnect if communication is cut off, such as a meeting place.
    5. Identify evacuation routes and potential shelter (in place or elsewhere).
    6. Make sure your vehicle is in good mechanical condition and has enough fuel/battery storage.
    7. Assemble personal disaster preparedness kits for your home, vehicle(s) and workplace.
    8. Take a natural disaster planning/first-aid course. Join community preparedness activities.

    It’s advisable to tailor plans and supplies to daily routines such as work, school or appointments, as well as personal needs. For example, essential workers, infants, children, frail elderly or disabled people may need special assistance. Other considerations may include:

    • Dietary restrictions and preferences
    • Medications and medical equipment
    • Language, cultural and religious beliefs
    • Care of pets or service animals

    A mock drill to test a preparedness plan can be used to identify any potential gaps or limitations.

    Survival kit supplies should be stored in airtight containers or bags and kept in sturdy backpacks. Enough water to last at least three days during an evacuation and for two weeks at home should be securely stored. Plan on one gallon per person, per day. Emergency supplies should be inspected annually and replaced after expiration dates.

    Essential Communication

    Not knowing what is going on causes confusion and anxiety. It’s a wise practice to follow the directions of emergency response personnel, whose primary job is to protect lives. Regarding communication, plan to have an alternative power source available for a mobile phone and/or computer in case there is no electricity. A text message uses less bandwidth and may be received when a phone call won’t connect.

    Here are some other sources of information:

    • Integrated Public Alert and Warning System: Delivers messages as texts with unique sound and vibration.
    • Emergency Alert System: National public warning system that requires broadcasters, satellite digital audio service and direct broadcast satellite providers, cable television and wireless cable systems to allow authorities to deliver emergency information.
    • NOAA Weather Radio All Hazards (NWR): A nationwide network of radio stations that broadcasts continuous weather information from the nearest National Weather Service office.

    More Recommended Resources

    WorkCare advises companies on preparedness planning and supports the health and safety of employees who respond to natural disasters. Our Incident Intervention telehealth program features 24/7 self-care guidance and referrals to local providers for non-emergency conditions. We also provide work-related injury prevention programs and medical surveillance services for employees with exposure risks. Contact sales@workcare.com to learn more.

  • National Suicide Prevention Month: How You Can Help

    National Suicide Prevention Month: How You Can Help

    September is National Suicide Prevention Month, a life-saving observance that raises awareness about suicide risk and the resources available for prevention. According to the World Health Organization, more than 720,000 people die annually due to suicide. Among teenagers and adults under 30, suicide is the third leading cause of death worldwide.

    In the U.S., there were an estimated 49,449 suicides in 2022, the most recent reporting year, 3 percent higher than in 2021.  This equates to one death every 11 minutes. In addition, more than 13 million adults are annually estimated to seriously consider or attempt suicide. The rate of suicide increased 37 percent between 2000 and 2018, tapered off by 50 percent between 2018 and 2020, and returned to a peak in 2022.

    More men than women die of suicide. Older people have the highest rates of suicide in the U.S., but younger people are at risk, too. Firearms are used in more than 50 percent of suicides, compared to 25 percent by suffocation, 12 percent by poisoning and 8 percent other methods.

    Recognizing Signs

    Anyone can be suicidal regardless of their age, gender, background or occupation. Early recognition of signs of suicidal ideation like these can help save lives:

    • Verbal expressions of wanting to die or feeling hopeless
    • Increased isolation from friends and family
    • Dramatic mood swings
    • Changes in sleeping and eating habits
    • Being bullied, feeling trapped or suffering from unbearable mental and/or physical pain
    • Self-medicating or drinking alcohol to relieve symptoms of depression or anxiety

    How You Can Help

    • Listen actively: If someone you know appears to be at risk, take the time to listen without judgment. Being heard can make a difference.
    • Stay connected: Regular check-ins can make a vulnerable person feel valued and less isolated.
    • Secure firearms: If you have firearms or know someone who does, make sure are stored in a secure, locked location.
    • Encourage professional help: If you see signs of suicidal ideation, suggest that the person seek help from a therapist, counselor or helpline.

    Resources

    National Strategy for Suicide Prevention 2024 – comprehensive, 10-year action plan.

    Suicide Prevention Resource for Action – evidence-based recommendations

    988 Suicide and Crisis Lifeline – 24/7, confidential hotline for anyone in suicidal crisis or emotional distress

    American Foundation for Suicide Prevention  – information on supportive prevention programs and tools in your area

    In the workplace, employees who are educated about signs of suicide ideation are better prepared to respond appropriately when the need arises. Prevention saves lives.

  • Employee Self-care is Not Selfish Care

    Employee Self-care is Not Selfish Care

    In recognition of National Wellness Month, we want to share our thoughts about self-care in the workplace.

    Workforce demographics are a critical consideration. Job tasks, rewards and performance expectations are as varied as the people doing the work. A one-size-fits all approach to workplace wellness programs will not get traction because it fails to address individual needs and workforce diversity, including age, gender identity, health status, racial and ethnic background, and socio-economic factors that affect quality of life.

    Wellness is muti-dimensional and means different things to different people. Consequently, WorkCare’s Wellness Solutions team has adopted these eight dimensions of wellness as the foundation for its service delivery model: financial, intellectual, occupational, social, physical, environmental, spiritual and emotional. The objective is to help employees achieve balance across all eight dimensions to optimize life satisfaction.

    Self-care promotes work-life balance, facilitates social connections that are essential to well-being and helps build resilience. Employers benefit when employees have access to wellness-related resources and activities because they become less vulnerable to stress, illness and injury and feel supported in their journey.

    Why Can You Do?

    The COVID-19 pandemic provided valuable lessons on the importance of self-care. Now, more than ever, people realize that self-care is not selfish care, and that it’s not possible to take good care of others when their own tank is empty.

    To an employer to support workforce population health and self-care, it may be necessary to first audit working conditions from a well-being perspective. There may be areas where reasonable adjustments can be made. For example, provide privacy-protected biometric screening to identify underlying health conditions; manage exposure to extreme temperatures; offer remote or flexible schedule options; facilitate access to fresh water, healthy food choices, educational materials and employee assistance programs; support friendly competitions that promote physical and mental health.

    Here are some additional suggestions:

    • Clearly articulate wellness program benefits so employees understand all the resources that are available to them. Keep it simple. Assist with time management so they can participate.
    • Foster a positive culture around self-care and address stigma associated with mental health interventions when it arises.
    • Don’t assume you know what motivates employees to change behaviors and achieve wellness goals. Ask them “What’s your why?” and about the resources they need.
    • Be a role model. Recognize employees’ efforts to be physically and mentally fit for work and life.

    We recently introduced the WorkCare Wellness Hub app to help employees track their self-care progress. Contact us to learn more.

  • How to De-escalate Incivility in the Workplace

    How to De-escalate Incivility in the Workplace

    Stranded airline passengers were mortified when a fellow traveler cut in line and berated a service agent. Two assembly line employees got into a shouting match about their political preferences and almost exchanged blows. Athletes made crude remarks about a teammate who they blamed for a loss. No one did anything to stop them, fearing they would escalate tensions.

    The Society for Human Resource Management (SHRM) reports American workers experience an estimated 171 million acts of incivility a day. SHRM uses its Civility Index to measure degrees of civility in the workplace. On a scale of 1 to 100, civility was ranked 42.3 in the first quarter of this year; that score is expected to climb for the remainder of the year.

    In a March 2024 survey of 1,611 U.S. employees, SHRM found:

    • 66 percent agreed that incivility reduces productivity
    • 59 percent agreed that incivility affects employee morale
    • 58 percent said they believe American society is uncivil
    • 44 percent who experienced incivility said co-workers were involved
    • 25 percent said their supervisors are effective at handling incivility

    What is Civility?

    A civil society is one in which people listen, are respectful, polite and tolerant of opposing viewpoints. Civility creates a safe container for the exchange of ideas and constructive disagreements. On the flipside, incivility is associated with disrespect, rudeness, hostility, sarcasm and intolerance. In some instances, it can cause fear, induce anger or lead to workplace violence.

    Incivility in the workplace affects the health and well-being of businesses, co-workers, customers and vendors. On an individual level, research shows that anger and hostility can increase a person’s chance of developing heart disease, insomnia, digestive problems and headaches. In addition to low employee morale and productivity loss, incivility is an underlying cause of formal complaints about hostile work environments, harassment and discrimination.

    What About Free Speech?

    The First Amendment of the U.S. Constitution protects individuals’ rights to free speech without government interference. States also have provisions in their constitutions that protect these rights. However, the extent of employees’ free speech rights depend on whether they work for a public or private entity, the state in which they work, applicable federal and state statutes and whether they are protected by a union.

    Private employers can regulate forms of employee speech as long their policies do not violate Section 7 of the National Labor Relations Act, state or local law, attorneys say. (Section 7 gives employees the right to self-organize, join or assist labor organizations, participate in collective bargaining or decline to participate in such activities). For example, private employers can hold employees accountable for inappropriate speech or behaviors that violate codes of conduct, social media use policies, equal employment opportunity rules and guidelines, and other boundaries relative to the work setting.

    Kay Gillespie, WorkCare’s chief human resources officer, recommends the adoption of a comprehensive policy statement that outlines acceptable behaviors (e.g., courtesy, politeness, mutual respect) whether an encounter occurs in person or via digital channels. Such policies include potential disciplinary actions for violations. Training to help employees fulfill workplace civility expectations is advised. Given that a growing number of states are adopting private employee speech protection statutes that specifically relate to political beliefs and activities, she also advises private employers to familiarize themselves with applicable laws in the jurisdictions in which they operate.

    Diffusing Tensions

    Incivility in the workplace is more likely to occur in situations involving personal conflicts or when tensions are high due to social influences. Here are some tips to help diffuse fear, anger and confusion before it escalates in the workplace:

    1. Allow employees to express their feelings in a safe, private place without interrupting them. Paraphrase what you heard and ask for confirmation. When a person feels heard, they tend to calm down.
    2. Show empathy, for example, by saying something like “I can imagine how frustrating this must be for you.” You don’t have to agree with what the person is saying.
    3. Thank employees for bringing complaints to your attention. Take time to hear all sides of an issue before taking any employment action.

    If an employee’s behavior is disruptive or threatening, request support from the human resources department before attempting to have a conversation about observed behaviors. Referral to an employee assistance program, substance abuse or other mental health professional may be appropriate. In some cases, referral to an anger management course may be recommended. Support should also be offered to employees who experience incivility in the workplace in encounters with co-workers, customers or randomly when on duty out in the field.

    WorkCare provides resources for employers to protect and promote total employee health and support sound human resources practices. Contact us to learn more.

  • OSHA’s Proposed Heat Standard Headed for Public Scrutiny

    OSHA’s Proposed Heat Standard Headed for Public Scrutiny

    As anticipated, the federal Occupational Safety and Health Administration (OSHA) released its proposed workplace heat standard on July 2, 2024. The public comment period is currently open and you may submit comments and attachments electronically at www.regulations.gov, Docket No. OSHA-2021-0009 by January 14, 2025.

    If enacted, the standard is expected to substantially decrease the risk of heat-related injuries, illnesses and fatalities for about 36 million U.S. employees. Exposure to heat and humidity can cause symptoms ranging from mild to life-threatening. (Refer to our latest fact sheet on Heat Intolerance and Other Medication Side Effects for recommended preventive measures.)

    Record-breaking temperatures occurring across the nation have increased outdoor exposure risk. The standard would also apply to certain indoor environments.

    “Workers all over the country are passing out, suffering heat stroke and dying from heat exposure from just doing their jobs, and something must be done to protect them,” Assistant Secretary for Occupational Safety and Health Doug Parker said when announcing the proposed rulemaking. “This proposal is an important next step in the process to receive public input to craft a ‘win-win’ final rule that protects workers while being practical and workable for employers.”

    The proposed rule would require employers to develop a comprehensive heat-related injury and illness prevention plan that includes:

    • Methods for heat exposure risk assessments
    • Policies for adequate hydration and rest breaks
    • Measures to control indoor heat
    • Acclimatization periods for new/returning employees
    • Training on heat illness prevention, signs and symptoms
    • Procedures for emergency and first-aid response

    Related Actions

    While the proposed rule undergoes public scrutiny, OSHA said it will continue to hold businesses accountable for heat-related violations of the Occupational Safety and Health Act’s general duty clause, 29 U.S.C. § 654(a)(1) and other applicable regulations. The agency also conducts heat-related inspections under its National Emphasis Program – Outdoor and Indoor Heat-Related Hazards, which targets workplaces with high heat exposure risks. In addition, the agency is prioritizing programmed inspections in agricultural industries that employ temporary, nonimmigrant H-2A workers for seasonal labor.

    California, Colorado Minnesota, Oregon and Washington have adopted their own workplace standards to help prevent heat illness. In Florida and Texas, local governments are not required to provide heat-related protections for outdoor workers.

    In conjunction with the release of the proposed OSHA standard, the Biden Administration announced actions being taken to help protect workers and communities from extreme weather threats. For example:

    • The Department of Homeland Security’s Federal Emergency Management Agency will award nearly $1 billion dollars for 656 projects to help American communities protect against disasters and natural hazards, including extreme heat, storms and flooding.
    • State, local, tribal and territorial leaders will be convened for a White House Summit on extreme heat. U.S. representatives will also meet with global stakeholders to advance heat-related resilience efforts for U.S. workers abroad.
    • A wildfire crisis response plan that involves a $7 billion investment is being used to expand the wildland firefighter workforce, deploy advanced technology to better respond to fires and complete 6.85 million acres of hazardous fuels treatments.

    WorkCare’s occupational health clinicians and subject matter experts are available to consult on workplace heat hazard reduction strategies. Our clients include industries with extreme heat and overexertion exposure risks, including construction, utilities, oil and gas production, heavy manufacturing and mining. Contact us to learn more.

  • Hidden Challenge of Drug Test Cheating in the Workplace

    Hidden Challenge of Drug Test Cheating in the Workplace

    Many companies rely on drug testing to help maintain safe workplaces and protect employees from accidents and injuries associated with substance-related impairments. Now, with advanced technology and access to online instructions on ways to circumvent tests, it’s getting harder to prevent drug test cheating.

    In an analysis of nearly 9.8 million workforce drug tests, Quest Diagnostics found the percentage of employees in the general U.S. workforce whose drug test showed signs of tampering increased by more than six-fold in 2023 compared to 2022, the highest rate in more than 30 years of reporting. Meanwhile, the use of substituted urine specimens in the general U.S. workforce increased by 633 percent and invalid urine specimens increased by 45.2 percent. (A result of substituted or invalid suggests a urine specimen has been tampered with in an attempt to conceal drug use.)

    Not surprisingly, Quest found that increasing rates of substituted or invalid specimens coincide with historically high rates of both general U.S. workforce drug positivity and post-accident marijuana positivity. Suhash Harwani, Ph.D., senior director of science for Workforce Health Solutions at Quest Diagnostics, offers this explanation:

    “The increased rate of both substituted and invalid specimens indicates that some American workers are going to great lengths to attempt to subvert the drug testing process. Given the growing acceptance and use of some drugs, particularly marijuana, it may be unsurprising that some people feel it necessary to try and cheat a drug test. It is possible that our society’s normalization of drug use is fostering environments in which some employees feel it is acceptable to use such drugs without truly understanding the impact they have on workplace safety.”

    Common Drug Test Cheating Methods

    1. Synthetic urine: One of the most common cheating methods involves the use of synthetic urine. Sold online, this product mimics real urine and can often bypass standard drug testing protocols if not carefully monitored.
    2. Detox drinks and pills: These products claim to cleanse the system of drugs temporarily. While their effectiveness varies, they are popular among employees attempting to pass drug tests on short notice.
    3. Adulterants: Some employees add substances to their urine samples to mask the presence of drugs. Common adulterants include bleach, vinegar or commercial products designed specifically for this purpose.
    4. Substitution: Employees may substitute their urine with that of a drug-free individual. This method requires advance planning, but it is challenging to detect without stringent observation protocols.

    Implications for Employers

    The potential consequences of employee cheating on drug tests are significant. Here are some critical implications:

    • Increased accident risk: Employees under the influence of drugs are more likely to be involved in workplace accidents that can cause injuries and fatalities.
    • Productivity loss: Drug use can impair cognitive functions and physical capabilities, creating hazardous conditions and reducing overall productivity.
    • Legal and financial repercussions: Employers may have legal liability in cases involving an employee who was under the influence while working. Related lawsuits can be costly and damage a company’s reputation.

    How WorkCare Helps Mitigates Drug Test Cheating

    WorkCare offers a full range of drug and alcohol testing services and support for drug-free workplace programs. This includes substance testing-related consultations, access to medical review officers (MROs), guidance on written policies and prevention programs, training on ways to help prevent drug test cheating, and referrals to qualified collection sites and labs.

    Contact us today for more information on how to refine your company’s drug and alcohol testing protocols.

  • Reflections on a Holistic Approach to Occupational Health and Safety

    Reflections on a Holistic Approach to Occupational Health and Safety

    I recently spoke at the American Industrial Hygiene Associations’ Connect 2024 Conference and had the opportunity to meet many members of the environment, health, and safety (EH&S) community. My chief takeaway is that the conference serves as a beacon for those who are passionate about workplace health and safety protections.

    As the world of work continues to evolve, the importance of a holistic approach to occupational health and safety has never been more apparent. The conference, held May 20-22 in Columbus, Ohio, featured advocacy on behalf of Total Worker Health®, a phrase trademarked by the National Institute for Occupational Safety and Health (NIOSH) that is widely used in business and industry.

    Innovation and Education

    The conference is a hub of innovation and education where professionals can attend classes, visit exhibits, network and learn from each other. In addition to the core curriculum for industrial hygienists and allied professionals, this year’s conference offered a diverse range of educational sessions on EH&S topics including climate change exposure risk, laboratory safety, human resources management, and my own presentation, Prevention Saves Lives, Time and Money.

    Employee health and safety protections are more than regulatory requirements. They are foundational pillars for the well-being of employees and the success of businesses. A holistic approach involves proper implementation of health and safety protocols and prevention measures. Experience shows that such measures can markedly decrease work-related injuries and illnesses, ensure compliance with applicable laws and industry standards, and lower workers’ compensation costs.

    In addition, this approach:

    • Encourages employee engagement in workplace health and safety, one of the themes for National Safety Month.
    • Supports objectives of corporate social responsibility.
    • Produces operational efficiencies and workforce productivity.
    • Facilitates strategic efforts to attract and retain talent, increase job satisfaction and cultivate a welcoming organizational culture.

    The holistic perspective also covers health issues that might not directly stem from occupational activities but are nonetheless influenced by them, including conditions such obesity, sleep disturbances, cardiovascular disease and certain mental health conditions.

    Looking Forward

    This year’s conference successfully helped attendees view industrial health and safety through the lens of diverse professions and served as a reminder of the collective responsibility we share to foster safer, healthier workplaces. The conference’s focus on Total Worker Health® was a call to action for all stakeholders to embrace a comprehensive view of worker health, safety and well-being, one that transcends traditional boundaries and paves the way for a more resilient and thriving workforce.

    Together, we can shape a future where workplace safety and worker well-being are not just aspirations but realities. Let’s connect, learn, and help lead the way in occupational and industrial health and safety.

    Kála Earley, MBA/MHA, LAT, ATC, CEAS, is the implementation and training manager for WorkCare’s Industrial Athlete Program. Please use this link to contact us.

  • First Response for a Mental Health Crisis at Work

    First Response for a Mental Health Crisis at Work

    A mental health crisis can be triggered by events inside and outside of the workplace, including personal conflicts, pressure to produce, the news, family issues, financial worries and stress, in general. Mental health crises can arise suddenly and unexpectedly, leaving colleagues and people in workplace leadership uncertain about how to respond. We want to take this opportunity to provide some reminders about appropriate steps to take when an employee experiences a mental health crisis at work. An emergency response is warranted when someone is in immediate danger of harming themselves or others.

    When an employee experiences a psychotic episode, symptoms may include hallucinations and/or delusions, incoherent speech and/or behavior that is inappropriate for the situation. Psychosis is associated with mental health conditions such as schizophrenia, bipolar disorder and severe depression. In some cases, it may be triggered by substance use, extreme stress, trauma or physical conditions affecting the brain.

    An estimated 6 million American adults have panic disorder, a type of anxiety disorder associated with panic attacks, according to Mental Health First Aid and the National Council for Mental Wellbeing. Physical symptoms of a panic attack may include shaking, sweating, numbness, dizziness, heart palpitations, chest pain, shortness of breath, and chills or hot flashes. These can also be symptoms of a heart attack. It’s important to quickly assess the situation and call 911 when the underlying cause of symptoms is unclear.

    It is not fully understood what causes panic attacks. Genetics, experiences involving trauma or major stress, having a disposition that is more prone to negative feelings and changes in brain function are believed to be contributing factors, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). While anyone can experience a panic attack, people with panic disorder experience repeated occurrences and may suffer from anxiety and social isolation in anticipation of the next one.

    SAMSHA supports a national, 24/7 helpline to provide immediate intervention during a mental health crisis: 1-800-662-HELP (4357).

    De-escalation

    Mental health first aid is about providing support and encouragement, not attempting to diagnose or treat an employee’s condition. Experts recommend reassuring an employee in crisis that help is on the way. If feasible, the person may be instructed to take slow, deep breaths, which has a calming effect.

    Employers may rely on professionals trained in mental health first aid to assist with de-escalation. The training involves a five-step process:

    1. Assess the risk of self-harm.
    2. Listen with empathy and without judgment.
    3. Provide reassurance and information.
    4. Encourage obtaining professional help.
    5. Encourage self-help and other support strategies.

    There are also courses available via the National Child Traumatic Stress Network on psychological first aid and skills for psychological recovery that are designed for those who respond to disasters.

    Follow-up

    Many companies offer employees access to medical, mental and behavioral health professionals who can assist with the development of a comprehensive assessment and treatment plan in follow-up to a critical situation. WorkCare assists employers with first response in the workplace and the management of referrals to employee assistance programs (EAP) and clinicians who provide mental health fitness-for-work assessments. There are also free or low-cost resources available in most communities for those who do not have access to an EAP.

    In addition to leaning on experts, employers are advised to educate themselves about common disorders. Employers should ensure that affected employees are not discriminated against due to their condition and that they receive the time they need to recover and safely resume work and activities of daily life. Check WorkCare’s resources page to learn more about topics like this and other ways you can support employee health, safety and overall well-being.

  • Prevention Saves: Drive Your Own Health Outcomes

    Prevention Saves: Drive Your Own Health Outcomes

    By Peter P. Greaney, M.D.

    I’m writing, from time to time, about ways in which health care systems fail people and the critical importance of prevention.

    To be good at managing the preventive aspects of your health, you must have knowledge of your risks and intervene at the right time, not when the disease has already manifested. For the unfortunate person featured in this case study, the horse may have already left the stable. His doctors should have started investigating 15 years ago.

    The Case

    A friend of mine called with concerns regarding his memory. Given his family history, it’s understandable that he would be worried about the possibility of early-onset Alzheimer’s disease. Both his father and grandfather developed dementia in their 60s. My friend is 61 years old. I advised him that a thorough evaluation is necessary to identify the cause(s) of his memory decline.

    Step-by-Step Approach

    Diagnosis

    To obtain a correct diagnosis, the following steps are recommended:

    1. Clinical evaluation:
    • A detailed medical history, including specifics of the memory issue, other cognitive symptoms and family history.
    • A review of current medications to rule out any that may contribute to cognitive decline. For example, my friend is a long-term user of Nexium for heartburn, which may have impaired absorption of vital nutrients.
    • An assessment of my friend’s comorbid conditions – in this case, diabetes and hypertension. Poor control can affect cognitive function.
    1. Neuropsychological testing: Formal memory and cognitive testing helps quantify the degree of impairment and identify specific areas of cognitive weakness.
    2. Laboratory tests: Blood tests are used to rule out reversible causes of memory loss, such as vitamin deficiencies (e.g., B12), thyroid dysfunction or metabolic imbalances.
    3. Imaging studies: Structural imaging with MRI or a CT scan is recommended to look for brain changes that can be associated with Alzheimer’s disease. Functional imaging like PET scans can sometimes be used to look for patterns of brain activity associated with Alzheimer’s.
    4. Genetic counseling and testing: Based on family history, genetic counseling may be appropriate to discuss the risks and benefits of testing for genes associated with early-onset Alzheimer’s.

    Treatment Options

    1. Medications: Certain medications may be recommended. Cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) are often used in the early stages of Alzheimer’s to help improve symptoms or slow their progression. Memantine may be added in later stages of the disease.
    2. Lifestyle and comorbid conditions: Regular physical exercise, a healthy diet, cognitive stimulation and social engagement can all be beneficial. Optimal control of comorbid conditions such as diabetes and hypertension is crucial because they can exacerbate cognitive decline.
    3. Supportive care: Counseling and supportive care for Alzheimer’s patients, their caregivers and other family members is recommended to help manage the emotional and practical aspects of the disease.

    Other Considerations

    In this case, the health care provider would also be likely to consider the following as part of the diagnostic process:

    • Planning for the future. Advance directives and care preferences should be discussed early in the evaluation and treatment process. Early intervention is often helpful in managing the symptoms of Alzheimer’s disease and improving quality of life.
    • Medication review to check for any potential drug interactions or side effects that could affect memory.
    • Continuous, effective management of the patient’s blood sugar and blood pressure, as noted above.

    I advised my friend that there was a possibility of Alzheimer’s disease and that he should seek evaluation sooner rather than later. I was too kind to tell him he should have had this evaluation when he was 45 years old. It would be helpful if he had access to an AI-driven, patient-friendly medical authority to act as a “co-pilot” and guide on his health journey.

    In recent years, there has been ongoing research into new treatments for Alzheimer’s disease. One of the newer medications that has been approved by the FDA is Aducanumab, which is designed to reduce amyloid plaques in the brain, a hallmark of Alzheimer’s disease. However, it’s important to note that Aducanumab has been the subject of considerable debate within the medical community regarding its efficacy and the strength of the evidence supporting its approval.

    Until next time…

    Peter P. Greaney, M.D., is an occupational medicine physician, Executive Chairman and Chief Medical Officer at WorkCare. He is an advocate on behalf of people everywhere who deserve the best possible health outcomes, starting with prevention. 

  • Federal Proposal to Reclassify Marijuana as a Schedule III Drug

    Federal Proposal to Reclassify Marijuana as a Schedule III Drug

    The U.S. Department of Health and Human Services last week sent the U.S. Drug Enforcement Agency (DEA) a recommendation to reclassify marijuana under the Controlled Substances Act from Schedule I to Schedule III, a move that represents a major shift in U.S. federal drug policy.

    If enacted, marijuana use would still be illegal at the federal level. However, the proposed reclassification to Schedule III is expected to free up funding for research on human health effects, expand access for medicinal use, and allow state-regulated marijuana industry operators to write off standard expenses and lower their tax burden.

    Drug Schedules

    Schedule I, II and III drugs are differentiated based on their potential for abuse and medical use:

    • Schedule I drugs have the highest potential for abuse and no accepted medical use. They include marijuana, heroin, LSD, ecstasy (MDMA) and peyote.
    • Schedule II drugs have accepted medical uses and a high potential for abuse. Examples include opioids, stimulants and certain depressants.
    • Schedule III substances have lower potential for physical and psychological dependence and certain accepted medical uses with a prescription. Examples include anabolic steroids, ketamine, codeine preparations, certain substances used for opioid addiction treatment, as appetite suppressants and for cancer patients undergoing chemotherapy.

    What’s Next?

    The proposed reclassification must be reviewed and signed off on by the White House Office of Management and Budget and returned to the DEA for a public comment period. According to reports, the DEA will evaluate comments and draft a rule for review by an administrative law judge. After the administrative law review, a final version of the rule will be published. It is not clear how long the process may take or when the change might take effect.

    Cannabis Effects

    The cannabis plant contains more than 100 compounds (or cannabinoids). These include tetrahydrocannabinol (THC), which induces a high, and cannabidiol (CBD), which does not contain psychoactive components. Non-psychoactive cannabis metabolites are stored in the body after THC is metabolized. Metabolites detected on a drug test indicate that marijuana was consumed sometime in the last few weeks and are not a definitive indicator of current impairment. The U.S. Food and Drug Administration has approved one prescription medication that contains a purified form of CBD and two medications made from a synthetic chemical that mimics THC.

    Studies show that psychoactive components may affect memory, concentration, learning and decision-making capabilities, physical coordination, reaction times and emotional stability. They can also increase heart rate and blood pressure. Marijuana smoke can damage lungs.

    Legal Overlaps

    Overlaps between state and federal laws governing the use of marijuana can be tricky for employers to navigate. Medical use of cannabis is legal in 40 states and the District of Columbia; recreational use is allowed in 24 states and Washington, D.C. State laws do not pre-empt federal laws that require applicants or employees to be tested for controlled substances as a condition of employment, for employers to receive federal funding or federal licensing-related benefits, or for employers to enter into a federal contract. Employers with safety-sensitive positions typically have zero-tolerance policies.

    Effective Jan. 1, 2024, California and Washington became the first states in the country to provide protections for individuals who test positive on workplace drug tests for non-psychoactive cannabis metabolites in urine, hair, blood or other bodily fluids. Both states determined that drug tests should focus only on the presence of psychoactive components. Some employers may opt to rely on observations of performance and conduct in lieu of drug test results.

    Potential Consequences

    WorkCare Vice President Jeffrey Jacobs, M.D., M.P.H., a WorkCare occupational physician and Medical Review Officer (MRO), sees advantages and disadvantages to the proposal. On one hand, Schedule III reclassification appears to support expanded medical research and greater allowance for appropriate medicinal uses. On the other hand, he said, “it doesn’t appear to promote workplace safety or society safety. There is enough recent evidence since legalization that there are more injuries and accidents occurring that marijuana plays a role in.”

    If the DEA’s move to reclassify THC as a Schedule III drug is finalized, “it will be interesting to see how the change affects Department of Transportation (DOT) drug testing as well as how those changes may trickle down to non-regulated testing,” said Sarah Johnson, M.D., M.P.H., a WorkCare Associate Medical Director and experienced MRO. “With the new laws in California and Washington, we are already seeing restrictions on employers’ options for maintaining a drug-free workplace. I expect that the reclassification of THC will lead to more states adopting similarly restrictive laws, which could lead to an increase in safety incidents in the workplace.”

    Connections between marijuana use and workplace incidents are already evident. For example, in one controlled study, legalization of recreational marijuana was associated with a 10 percent increase in workplace injuries among those aged 20 to 34, according to findings published in JAMA Health Forum. When only full-time workers were included in the data, there was an 11.9 percent uptick in injury rates.

    In a Canadian study, researchers evaluated the relationship between past-year cannabis use and the risk of workplace injury, differentiating workers who used cannabis before and/or at work (workplace use) from those who only used it outside of work (non-workplace use). Use in the workplace was associated with a nearly two-fold increase in injury risk, while a relationship between non-workplace use and workplace injury was not found.

    According to Quest Diagnostics, which tested more than 6.3 million post-accident specimens in 2022, 7.3 percent of workers tested positive for cannabis immediately after an incident, the highest rate in 25 years. In a 10-year time frame from 2012 to 2022, post-accident marijuana positivity increased by 204 percent. Quest Diagnostics also reported that increases in post-accident marijuana correlated with legalization of marijuana in certain states. The highest rates of positive tests were found in retail trade, accommodation and food services, wholesale trade, and administrative support, waste and remediation service sectors.

    To learn more, refer to WorkCare’s fact sheet on recreational marijuana use protections. Contact our Medical Exams & Travel drug testing team for related medical and compliance guidance here.