Medications and Work Safety: Risks for Workers on Prescription Drugs and Hazardous Drug Exposure

Imagine you’re a nurse handling chemotherapy drugs every day. You wear gloves, you follow the protocol, but your skin still gets irritated. Or maybe you’re a warehouse worker taking painkillers for a back injury, and you feel drowsy during your shift. These aren’t rare situations-they’re everyday realities for millions of workers. The truth is, medications can make workplaces safer or more dangerous, depending on who’s taking them and how they’re handled.

Two Sides of the Same Coin

There are two main ways medications affect work safety. One is when workers take prescription drugs that change how their bodies and minds work. The other is when workers are exposed to dangerous drugs as part of their job. Both are serious. Both are often ignored.

Workers on opioids or benzodiazepines are at higher risk of accidents. A 2017 study in the Journal of Occupational and Environmental Medicine found that people using both types of drugs together were 84% more likely to fall at work. That’s not a small number. It’s a major red flag. Opioids slow reaction time. Benzodiazepines cause dizziness and confusion. Combine them, and you’ve got a recipe for injury.

Meanwhile, healthcare workers handling chemotherapy drugs, antivirals, or hormone therapies face a different kind of danger. These aren’t just pills you swallow-they’re chemicals that can get into your skin, lungs, or bloodstream through tiny spills, vapors, or contaminated surfaces. According to NIOSH’s 2024 list, there are 370 hazardous drugs in healthcare settings. Of those, 267 are cancer-fighting drugs. Even small, repeated exposures can lead to serious health problems over time.

How Exposure Happens

Most people think if you’re not injecting or swallowing a drug, you’re safe. That’s not true. Exposure happens in quiet, unnoticed ways.

Thirty-eight percent of hazardous drug exposures come from breathing in tiny particles or vapors-like when a nurse opens a vial or flushes a line. Twenty-nine percent happen when liquid splashes onto skin or eyes. Another 22% come from touching surfaces that have traces of the drug on them-doorknobs, IV poles, computer keyboards. Even your phone can become a carrier.

One nurse on Reddit shared that after three years of handling chemo drugs, she developed chronic rashes. Surface tests in her unit showed detectable levels in 68% of work areas-even though she followed all safety rules. That’s not her fault. That’s a system failure.

And it’s not just nurses. Pharmacists, lab techs, cleaners, even doctors in surgery centers are at risk. The CDC estimates 8 million U.S. healthcare workers are potentially exposed. Most don’t even know how dangerous it is.

The Health Consequences

Short-term effects are obvious: nausea, headaches, skin rashes, hair loss. But the long-term damage is what keeps experts up at night.

A 2022 CDC meta-analysis of 47 studies found that healthcare workers exposed to hazardous drugs had 2.3 times the risk of reproductive problems-miscarriages, birth defects, infertility. That’s not theoretical. That’s happening right now.

For cancer risk, the numbers are even more alarming. OSHA’s 2022 review of 12 long-term studies showed healthcare workers handling antineoplastic drugs had 3.4 times higher rates of certain cancers, including leukemia and breast cancer. These aren’t rare cases. These are patterns.

And it’s not just the drugs themselves. The stress of the job leads people to self-medicate. A NIOSH director said in 2018 that workplace stress drives more workers to use benzodiazepines, which then make them more vulnerable to accidents. It’s a cycle: stress → medication → impairment → injury → more stress.

What’s Being Done

There are rules. There are guidelines. But they’re not enough.

OSHA’s Hazard Communication Standard (29 CFR 1910.1200) requires employers to label hazardous substances and train workers. But it only applies to about 6.2 million U.S. workplaces. That leaves 1.8 million healthcare workers-mostly in small clinics and private practices-without federal protection.

USP General Chapter 800, implemented in 2019, is stronger. It covers compounding pharmacies and requires specific engineering controls, ventilation, and PPE. But it only protects around 58,000 workers. The rest? Left to guesswork.

Some places are doing better. Mayo Clinic cut hazardous drug exposures by 89% between 2015 and 2020 by installing closed-system transfer devices, improving ventilation, and training staff. Surface contamination dropped from 42% to 4.7% in six months at one pharmacy after adopting NIOSH’s 2024 guidelines.

Unionized workers have 22% fewer medication-related incidents than non-unionized ones, according to AFL-CIO data. Why? Because unions push for safety protocols, proper training, and reporting without fear of retaliation.

What Works-and What Doesn’t

Engineering controls are the most effective. Closed-system transfer devices reduce surface contamination by 94.7%. Negative-pressure cabinets and high-efficiency air filters help too. But 31% of facilities have cabinets that don’t work properly. 27% have ventilation systems that can’t keep up.

PPE-gloves, gowns, masks-is necessary, but it’s not enough. CDC studies show 43% of workers don’t wear PPE correctly. They skip gloves to feel better. They reuse masks. They don’t change gowns between tasks. Training helps, but only if it’s ongoing. NIOSH says it takes 16-24 hours of initial training, plus 4-8 hours every year.

Drug-free workplace policies sound good, but they backfire. A 2021 editorial in the Journal of Occupational Rehabilitation found that 32% of workers lost their jobs because they used legally prescribed medications-even when they showed no signs of impairment. That’s not safety. That’s discrimination.

What works better? Accommodation. Flexible scheduling. Medication reviews with occupational health professionals. If a worker needs opioids for chronic pain, can they switch to non-opioid alternatives? Can their shift be adjusted to avoid operating heavy machinery? Can they be moved to a role with less risk?

The Future Is Here

Change is coming, but slowly.

NIOSH removed liraglutide and pertuzumab from its hazardous drugs list in early 2024 because new data showed lower risk. That’s progress. The FDA now requires boxed warnings on 27 antineoplastic drugs about occupational exposure risks. That’s a first.

AI is being tested at Johns Hopkins to predict exposure risks in real time. The system uses sensors and machine learning to flag high-risk moments-like when a vial is opened or a line is disconnected. Phase 1 trials showed 92% accuracy.

OSHA is working on a new rule that could set a legal limit for surface contamination: 0.1 ng/cm². That’s tiny. But it’s the kind of hard standard that forces real change.

Large employers are starting to include medication safety in their wellness programs. Sixty-three percent plan to expand these efforts in 2024-2025. That’s the right direction.

What You Can Do

If you’re a worker:

• Know what drugs you’re handling or taking. Check the NIOSH 2024 list if you’re in healthcare.
• Report symptoms-even if they seem minor. Skin rashes, nausea, dizziness aren’t normal.
• Ask for training. Don’t assume you already know how to do it safely.
• Use PPE correctly. Change gloves between tasks. Wash hands after removing them.
• If you’re on opioids or benzodiazepines, talk to your doctor about alternatives. Don’t hide it. Your safety matters.

If you’re an employer:

• Don’t rely on PPE alone. Install engineering controls. Closed-system transfer devices are worth every dollar.
• Test surfaces regularly. If you can’t measure contamination, you can’t control it.
• Train every year. Make it mandatory. Document it.
• Don’t punish people for taking necessary medications. Work with them to find safe solutions.
• Join the conversation. Advocate for stronger regulations in your state or industry.

The bottom line: Medications aren’t just personal health issues. They’re workplace safety issues. Whether you’re taking them or handling them, the risks are real. Ignoring them doesn’t make them go away. It just makes accidents more likely.

The tools to protect workers exist. The data is clear. The question isn’t whether we can do better. It’s whether we’re willing to.