Substance Use and Workplace Safety

Dr. John Cutbill

Date: September 7th 11 am to 3 pm Theater Room


The potential concern regarding substance use and workplace safety is growing in complexity with the increasing acceptance and use of marijuana (cannabis) for either recreational or medical purposes. Marijuana is the most encountered substance in workplace drug testing, specifically the primary psychoactive cannabinoid THC.

Legalized cannabis is expected to increase patterns of use. Stronger forms of cannabis using extraction techniques (eg, shatter, budder and Butane Hash Oil) are yielding THC levels > 80%. There are very few medical conditions with substantial evidence of the effectiveness of cannabinoids. The most consistent effects of medical cannabinoids are adverse effects.

Cannabis is not an approved drug or medicine in Canada and not the first ‘medication’ of choice. Despite increasing number of registered ‘Medical marijuana’ users in Canada, the therapeutic use of cannabis is only as a last resort in specific situations as indicated in the 2018 Clinical Practice Guidelines for Medical Cannabinoids in Primary Care from the College of Family Physicians of Canada. Use of cannabis during adolescence may adversely impact brain maturation as well as increased risk of addiction. Some research suggests the use of cannabinoids and opioids in combination may allow for lowered opioid dosages. Impairment due to substance use should not be confused with acute intoxication just like alcohol.

Cannabinoid impairment effects are acute, residual and long-term and are often subtle, have more individual variance and affect higher levels of neurocognitive executive functioning. There are no current standards for testing cannabis or opioid-related impairment. Impairing effects are additive and even synergistic with combined use of alcohol, cannabis and/or opioids. Driving is often used as a proxy for the determination of impairment for other safety-sensitive duties. A risk assessment and stratification of Safety Sensitive duties in the workplace will assist in making informed decisions on the use of cannabis by workers.

Learning Objectives:

1. Marijuana health effects – what does the evidence tell us?
2. Marijuana just another prescription drug?
3. Should Marijuana be the first ‘medication’ of choice?
4. Marijuana and age of use – what’s the impact?
5. Marijuana – an alternative to Opioids?
6. Alcohol, Opioids and Marijuana impairment – what’s the difference?
7. MRO verification of Negative with a Safety Advisory – what does it mean?
8. Risk stratification – are all jobs Safety Sensitive?
9. Medical fitness for work – any guidance?


Dr. John W. Cutbill, MSc, MD, Dip Sport Med, FCBOM, FCFP, MRO

DR. JOHN W. CUTBILL is certified in occupational medicine, sport medicine and family medicine. He has been awarded Fellowships from the Canadian Board of Occupational Medicine and the College of Family Physicians of Canada. He is the Consultant Corporate Physician for Canadian Pacific, and Consultant Chief Medical Officer for several railways. While Chief Medical Officer for Canadian Pacific he was responsible for the development of the corporate fitness to work medical policy, and alcohol and drug policy (including substance testing). He is a member and former Chairperson of the Medical Advisory Group of the Railway Association of Canada responsible for medical fitness guidelines for employees occupying safety-critical positions in the Canadian railway industry, including medical guidelines for substance use disorders. He is a certified Medical Review Officer providing consultant services to several clients. He has provided expert testimony related to both medical fitness to work and substance testing. He has been recognized by the Canadian Human Rights Tribunal as an expert in addictions and fitness to work.

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