Safety First – Updated National Standard for Rail Safety Workers

Under the Rail Safety National Law (RSNL), rail transport operators must ensure they effectively manage health-related risks affecting rail safety workers. The National Standard for Health Assessment of Rail Safety Workers serves as a comprehensive guide to help operators fulfill these regulatory requirements.

The updated edition of the National Standard for Health Assessment of Rail Safety Workers, effective from 11 November 2024, enhances the framework for rail operators and workers to better address health-related risk factors. While the Standard primarily focuses on health assessment protocols and excludes specific drug and alcohol testing requirements, part 3 offers valuable insights in addressing the evolving challenges related to prescription medications.

Section 3.4.8 explicitly prohibits rail safety workers from using medicinal cannabis and psychedelics, aligning with Rail Safety National Law requirements. The section also addresses precautionary measures regarding stimulant medications used in treating attention deficit hyperactivity disorder (ADHD).

Rail safety workers are prohibited from performing or attempting to perform rail safety work with any detectable presence of alcohol or ‘prescribed drugs’ in their system. These substances remain prohibited even when legally prescribed, as in the case of medicinal cannabis (detailed below).

Prescribed drugs include:

  • delta-9-tetrahydrocannabinol (THC)
  • methylamphetamine (methamphetamine)
  • 3,4-methylenedioxymethylamphetamine (MDMA)
  • any additional substances designated as prescribed drugs by national regulations for this section’s purposes.

Rail transport operators or authorised Regulator appointees may conduct drug and alcohol testing for rail safety workers. These tests are administered under the operator’s Drug and Alcohol Management Program. Drug testing may identify the ‘prescribed drugs’ noted above as well as a range of other drugs and metabolites. Under the RSNL it is an offence to carry out rail safety work while under the influence of alcohol or drugs with rail transport operators having a duty to ensure workers do not carry out work if they are impaired by alcohol or any drugs, prescribed or otherwise.

Medically prescribed medicines — general considerations

Medications affecting the central nervous system can potentially impact a rail safety worker’s performance. For instance, central nervous system depressants may diminish alertness, lengthen reaction times, and compromise decision-making capabilities, similar to alcohol’s effects. Furthermore, behavior-altering medications might amplify negative behavioral patterns and encourage risky conduct.

During health assessments, rail safety workers must document all current prescription and over-the-counter medications on their Health Questionnaire. This documentation enables the Authorised Health Professional to evaluate potential impacts and provide appropriate guidance. When evaluating a rail safety worker’s fitness for duty and providing guidance to both workers and employers, the Authorised Health Professional must evaluate:

  • The purpose of the prescribed medication, the condition’s intensity, and the individual’s treatment response, including how the medication may assist in managing health aspects that could affect work safety and the potential consequences of leaving the condition untreated (refer to relevant Standard chapters).
  • The worker’s comprehension and awareness of their medical condition and its compliance implications.
  • The possibility of medication side effects compromising work safety, including risks of drowsiness, delayed responses, compromised motor co-ordination, visual disturbances, low blood pressure, or lightheadedness. This assessment should consider the heightened risks associated with:
    • using multiple medications that could affect cognitive function simultaneously, including occasional alcohol consumption.

While the effects of specific medication categories are extensively documented, individual responses may vary. Although systematic studies of safety impacts in rail environments are limited, research on driving performance and accident risks provides valuable insights into potential hazards. While numerous medications affect the central nervous system, most don’t significantly increase accident risks when used as prescribed and after treatment stabilization, with benzodiazepines and THC being notable exceptions.

Benzodiazepines are well known to increase the risk of a crash/incident. If a hypnotic is needed, a shorter acting drug is preferred. Tolerance to the sedative effects of the longer- acting benzodiazepines used in the treatment of anxiety gradually reduces their adverse impact on driving skills. Benzodiazepine use will be identified in a random drug test (urine test) and rail safety workers should be advised accordingly.

Antidepressants – although antidepressants are one of the more commonly detected drug groups in fatally injured drivers, this tends to reflect their wide use in the community. The ability to impair is greater with sedating tricyclic antidepressants, such as amitriptyline and dothiepin, than it is with the less sedating serotonin and mixed re-uptake inhibitors such as fluoxetine and sertraline. However, antidepressants can reduce the psychomotor and cognitive impairment caused by depression and return mood towards normal. This can improve driving and work performance.

Antipsychotics – this diverse class of drugs can improve performance if substantial psychotic-related cognitive deficits are present. However, most antipsychotics are sedating and have the potential to adversely affect driving skills (work performance) by blocking central dopaminergic and other receptors. Older drugs such as chlorpromazine have strong sedation effects due to their additional actions on the cholinergic and histamine receptors. Some newer drugs are also sedating, such as clozapine, olanzapine and quetiapine, while others, such as aripiprazole, risperidone and ziprasidone, are less sedating. Sedation may be a particular problem early in treatment and at higher doses.

Opioids – Opioid analgesics are central nervous system depressants and as such can suppress cognitive and psychomotor responses. While cognitive performance is reduced early in treatment (largely due to their sedative effects), neuroadaptation is rapidly established. This means that patients on a stable dose of an opioid may not have a higher risk of a crash. Working at night may be a problem due to the persistent miotic effects of these drugs, which reduce peripheral vision. Opioid use will be identified in a random drug test (urine or oral fluid test) and rail safety workers should be advised accordingly.

Medicinal cannabis products contain the cannabinoids cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), the latter being the psychoactive component and a ‘prescribed drug’ under section 128 of the RSNL as noted above. No products containing THC can be used legally by rail safety workers. THC consumption may be identified in a random drug test (urine or oral fluid test) and rail safety workers should be advised accordingly.

Psychedelics – currently the use of psychedelics for medicinal purposes is approved in Australia under very limited and strictly controlled circumstances. They remain ‘prescribed’ drugs under the RSNL.

Stimulants used to treat ADHD – the stimulant medications prescribed to treat ADHD (amphetamines) are unlikely to result in impairment unless there is abuse. They will however likely be detected in a random drug test and rail safety workers should be advised accordingly.

Feeling overwhelmed by drug and alcohol testing? We understand that navigating the complexities of workplace testing can be confusing and time-consuming. That’s why our qualified team is here to simplify the process for you. We offer expert advice, cutting-edge tools, and comprehensive training to help you develop robust policies, conduct testing and while ensuring compliance. Let us handle the intricacies of drug and alcohol testing, so you can focus on what really matters – running your business. Reach out to to our team by phone 1300 789 908 or register your details online and one of our team will get back to you.

Source National Transport Commission – revised standard available here.