Buprenorphine in safety-sensitive positions.

The permissibility of buprenorphine in safety-sensitive positions is a controversial topic. As an opioid medication, concerns have arisen regarding the potential for impairment and any effects that this would have on an employee's ability to safely perform job duties. While there are no definitive guidelines on the use of buprenorphine for those employed in safety-sensitive lines of work, most employers do not permit its use under any circumstance due to the potential risk of harm to the public. In addition to overlooking the fact that buprenorphine is a well-established and life-saving treatment for opioid use disorder (OUD), there are many flaws in making this determination. For one, buprenorphine is a partial mu opioid agonist which makes it inherently unique in comparison to other opioids. Most studies on impairment have examined acute use of full agonist opioids instead of chronic dosing of buprenorphine. Furthermore, assessments of impairment are not tailored to the tasks required of specific positions. Importantly, policies banning buprenorphine may contribute to treatment discontinuation and stigma, which can lead to relapse and overdose. Considering the morbidity and mortality associated with OUD, along with the surge in overdose deaths during the COVID19 pandemic, buprenorphine policies should be considered carefully. Given the lack of evidence showing definitive and specific impairments as a result of chronic buprenorphine use, coupled with the consequences of universal bans on its use, determinations on the permissibility of buprenorphine treatment for safety-sensitive positions should be made on a case-by-case basis.