Medications

Introduction

The educated and motivated law enforcement officer (LEO) who is taking certain medications can be capable of safe and effective job performance. However, other medications may place the LEO at unreasonable risk for sudden incapacitation or may otherwise jeopardize his or her ability to safely perform job functions (as described in the chapter on Essential Job Tasks). Therefore, an individualized assessment of the LEO’s medications and the disorder for which they are being taken should be performed to ensure safe and effective job performance. The evaluation for the effects of medications should include:

• central nervous system (CNS) depression (e.g., drowsiness, decreased reaction time);
• CNS stimulation;
• altered cognitive function;
• autonomic nervous system disturbance (e.g., thermoregulation, abnormal heart rate, orthostatic hypotension);
• equilibrium disturbance;
• anticoagulation, risk of bleeding, and other coagulation disturbances;
• vision changes; and
• behavioral changes and judgment impairment.

The condition for which the medication is prescribed, rather than medication itself, may require that the LEO be restricted from certain job functions. Some medications may require specific monitoring of their effect to ensure that the LEO can safely and effectively perform the required job tasks. The police physician will need to consider not only the individual medications, but also any drug interactions.

This document is intended as a guide for physicians who medically evaluate LEO. The police physician who is performing this evaluation must still perform a complete individualized assessment.

While efforts have been taken to make this document as comprehensive as possible, new medications will continue to be available. In 2008, the Food and Drug Administration (FDA) approved 24 new drugs and a larger number of new formulations of currently available medications.[1] (The Agency approved a similar number of new in 2009.) Therefore, new or unlisted medications should be evaluated by the police physician on a case-by-case basis. Consideration should be given to using medications in the same class as a reference. In addition, new side effects related to medications referenced in this document may have been identified after this document was written. Therefore, the police physician should always refer to current medication resources such as the Physicians’ Desk Reference before prescribing a medication.

To provide guidance concerning the effect of medications (at recommended therapeutic dosages), the following medication categories are offered based on the potential effects on the LEO’s ability to safely perform job functions or the risk of sudden incapacitation:

• A (Acceptable) – These medications are unlikely to adversely impact performance of job functions. Therefore, they are generally acceptable for use while on duty. Police physicians should continue to individually assess a particular LEO for issues related to the medication or the condition for which it is being taken.
• T (Temporary) – These medications may have an effect at the beginning of treatment. Medical evaluation should consider provision of appropriate restrictions on a temporary basis at the beginning of treatment until it can be ascertained that the effects of the medication are unlikely to cause sudden incapacitation or inability to safely perform certain job functions. Some effects may only be present while the LEO accommodates to the medication. If these effect(s) persist, consideration should be given for an alternative medication or the LEO may need continued restrictions. Depending on the medication, the police physician may need to either evaluate on-the-job performance in a restricted duty setting or perform ancillary examinations to determine the effect on the individual LEO.
• S (Shift) – These medications are known to have effects of short duration that may adversely impact performance of job functions. These medications may be taken while the LEO is off duty with adequate time before returning to duty for the resolution of any effects that would adversely affect performance. This may often be two recommended dosing periods, depending on the duration of action of the medication.[2] If a specific time period is available, it will be noted in the entry for the medication. The duration of the restriction assumes that that medication will be taken according to recommended dosing.
• R (Restricted) – These medications are known to have an effect that will very likely adversely impact safety or performance of job functions. Medical evaluation should consider provision of appropriate restrictions for LEOs taking or affected by these medications.
• D (Diagnosis) – The diagnosis for which the medication is prescribed, rather than the medication itself, may require evaluation for medical restriction.

Safe alternative concept: When medically appropriate, medications in Categories R, S, and T should be evaluated for replacement by Category A medications of the same class or of similar therapeutic effects – e.g., prescribe Claritin (loratadine) instead of Zyrtec (cetirizine).

Process Description
The Task Group reviewed each medication and its side effects, as described in the Physicians’ Desk Reference and listed references. Medications with minimal side effects (according to the consensus of the Task Group) were placed in Category A. Medications with known short-term sedative effects (according to the consensus of the Task Group) were place in Category S. The few medications listed in Category R had significant side effects (consensus of the Task Group) and in most of the cases could be easily substituted with safer alternative medications. Medications listed in Category T are those with a side-effect profile that could interfere with the job performance and should have case-by-case review by the police physician before the LEO is allowed to return to unrestricted duty (consensus of the Task Group).[1]Accessed 6/18/09 at www.pharmamanufacturing.com/industrynews/2009/018.html.[2]National Transportation Safety Board Safety Recommendation, reference A-00-4 through –6, January 13, 2000. See www.ntsb.gov/recs/letters/2000/a00_4_6.pdf.