Substance use disorder (SUD) is often viewed as a public health issue, but for safety professionals, it is increasingly a workplace risk management challenge.

Millions of Americans experiencing substance misuse are part of the workforce, and the impacts show up in ways safety leaders recognize immediately: increased incident rates, higher workers’ compensation claims, absenteeism, and reduced situational awareness on the job. 

For organizations focused on injury prevention and operational reliability, substance misuse is not a peripheral issue, it is a direct threat to workplace safety performance.

The Hidden Risk: Prescription Drug Diversion

While illicit drugs often dominate safety discussions, many cases of substance misuse begin with medications that were legally prescribed.

Prescription opioids and other controlled substances remain widely used to treat workplace and non-workplace injuries. Once dispensed, however, these medications are frequently stored unsecured in homes, vehicles, or even workplaces.

This creates conditions for prescription drug diversion — when medications intended for one individual are accessed by others.

Research consistently shows that most individuals who misuse prescription painkillers obtain them from friends or family members rather than from drug dealers. 

For safety professionals, this presents a critical challenge:

• Employees may be exposed to controlled substances outside of medical supervision
• Misuse can begin unintentionally and escalate
• Impairment risks may not be immediately visible through traditional workplace controls

In safety-sensitive environments, even minor impairment can increase the likelihood of incidents, near misses, and serious injuries.

Why This Matters for Safety Programs

Substance misuse directly affects key safety performance indicators, including:

• incident and injury rates
• near-miss frequency
• workers’ compensation claims
• return-to-work outcomes
• overall safety culture

Employees affected by substance misuse, or by stressors within their household, may experience reduced concentration, slower reaction times, and impaired judgment.

Traditional approaches such as drug testing and Employee Assistance Programs (EAPs) are important, but they are reactive controls. By the time they are triggered, the safety risk may already be present.

For safety leaders, this creates a gap:

How do you reduce risk before impairment reaches the workplace?

A Prevention-Based Control: Securing Access to Medications

One emerging approach is to treat prescription drug access as a hazard control issue, similar to how organizations manage exposure to chemicals, tools, or other risks.

Locking prescription vials (LPVs) provide a simple but effective control by restricting unauthorized access to medications. These containers allow patients to secure prescriptions with a combination lock, ensuring only the intended user can access them. 

From a safety perspective, this aligns with a familiar principle: When access to a hazard is controlled, risk is reduced.

A useful precedent is the Poison Prevention Packaging Act of 1970, which introduced child-resistant packaging and significantly reduced accidental poisonings. 

Similarly, limiting access to controlled medications can reduce diversion and help prevent misuse before it begins.

Integrating Medication Safety into EHS Programs

Safety leaders can incorporate prescription drug diversion prevention into existing programs without significant operational burden.

Practical steps include:

1. Awareness and Training
    Include medication safety and diversion risks in safety meetings, onboarding, or toolbox talks.
2. Workforce Education
    Provide clear guidance on safe storage of controlled medications at home and, where applicable, at work.
3. Distribution of Secure Storage Tools
    Offer locking prescription vials through wellness programs, safety initiatives, or employee assistance programs.
4. Alignment with Existing Policies
    Integrate medication safety into broader impairment, fitness-for-duty, and workplace safety policies.
5. Collaboration Across Functions
    Coordinate with HR, benefits, and risk management teams to ensure a consistent approach.

Strengthening Safety Culture Beyond the Worksite

Safety culture does not stop at the facility gate. Many risk factors that affect workplace safety originate outside the workplace, including fatigue, stress, and substance misuse. Addressing these upstream factors is consistent with a proactive safety management approach.

By helping employees reduce exposure to controlled substances through better storage and awareness, organizations can:

• reduce impairment-related risks
• support safer decision-making on the job
• reinforce a culture of prevention
• improve overall workforce health and reliability

A Practical Step Forward

For safety professionals, the goal is always the same: reduce risk before incidents occur.

Prescription drug diversion represents an often-overlooked pathway to workplace impairment. Addressing it does not require complex systems or significant capital investment,  it can begin with simple, practical controls that limit access and raise awareness.

As organizations continue to evolve their safety strategies, incorporating prevention-focused measures like secure medication storage can play a meaningful role in protecting workers and strengthening overall safety performance.