French employers break taboo on tackling mood-altering drugs

Terry Brisco reports on the measures being taken by French employers to eliminate drug use by employees.

On this page:
Proscribed drugs
Daily dopers
No more denial
Addiction to prescription medicines
Case studies

European employers have often turned a blind eye towards drug use among their employees, for fear of appearing to meddle in their private lives. Yet in France, the taboo appears to be fading, as employers seek to tackle the knock-on effects of the increasing use of legal and illegal drugs among the population at large. French employers are reported to be increasingly addressing the problem of employee use of mood-altering drugs both through the provision of support for individuals and collective screening procedures.

The use of “psychotropic” substances at work, whether stimulants or other mood-enhancing drugs, was the focus of a number of articles in the November 2007 edition of Travail et Sécurité1, the magazine of INRS, the French national institute for occupational health and safety. Issues addressed included changing managers’ attitudes to the problem, the worrying increase in employees who take drugs to improve their job performance and the thorny issue of addiction to prescription drugs.

Available statistics on drug use in France are unreliable, the authors note, but according to, OFDT (France’s monitoring centre for drugs and drug addiction), 3.8 million Frenchmen and women regularly take psychotropic drugs.

The increasing popularity of cannabis with young people – there are 850,000 cannabis users in the country – is a particular concern for employers and their human resources managers, the French authors state, and also for works councils and health and safety committees. This is not just because of the legal issues, but also because various active substances in cannabis, as well as in other drugs, may affect employees’ vigilance and perception. As with all psychotropic substances, if cannabis is used by those doing safety-critical tasks (controlling machines or overseeing a production line), health and safety regulations will require that the employer acts to remove the risk.

Proscribed drugs

French legislation introduced in 1970 made it illegal to use cannabis, heroin and ecstasy (amphetamines). But the legislation excludes psychotropic drugs prescribed by a physician and makes no mention of alcohol or tobacco. Neither are there any French occupational health regulations concerned with alcohol or tobacco. This largely explains why employers in France have tended to ignore the subject of drug use and addiction among employees. French employers wishing to screen their workforce for drug use have had to rely on the general requirements of health and safety regulations in order to justify any internal rules or disciplinary procedures.

A French government directive of July 1990 (90/13) on testing for illegal drug use stipulates that systematic testing is only justified for safety-critical jobs. Any such tests, it says, may only be carried out at the time an employee is hired or as part of routine medical checks.

Only in the transport sector are stricter procedures mandated, to control the use of psychotropic drugs by passenger vehicle drivers.

To break the taboo surrounding screening for drugs, the French government recently commissioned a report on addictive behaviour and the workplace from an inter-ministerial mission on drugs and drug addiction (the Mildt commission). The report has recommended that, as part of France’s 2004–08 governmental plan on illegal drugs, tobacco and alcohol, there should be a change in attitudes among staff and management in all organisations. Above all, the idea is to encourage companies to stop denying they have a problem with addictive behaviour.

The Mildt report’s authors promote an “integrated approach”, which takes account of the health, safety and legal aspects of drugs in the workplace and the need to ensure fair treatment of employees who may need support and counselling.

One strategy advocated by an INRS work group is for a carefully thought-through approach to be adopted (see box). This should start with the setting up of a works council for all staff and end with the definition of the steps to take when an individual is recognised to have a problem with drug addiction. The final step may involve removing the person from their job or providing medical and psychological help.

Tackling drug use in the workplace effectively, says the Mildt report, means involving all actors and potentially changing a company’s culture. Any action taken will only be reinforced if it is followed up by information and awareness-raising campaigns.

Daily dopers

Figures, although hard to come by, indicate that more and more French workers are using drugs and psychotropic substances. This should come as no surprise, says Dr Michel Hautefeuille, a Paris hospital psychiatrist, since employers cannot shield themselves from developments in society as a whole. He notes that high levels of addiction among working people is not a new phenomenon. What is new, Hautefeuille says, is the worrying trend of “daily doping”: the use of certain drugs to increase performance at work.

These drugs range from high-dose caffeine tablets to amphetamines. While they may improve people’s work performance in the short term, over time they are likely to be harmful. According to Hautefeuille, “daily dopers” are not drug addicts “in the usual sense”, since the products they take are a tool rather than an end in themselves. “They are simply trying to be more competitive at work and do not take the drugs for pleasure,” Hautefeuille says.

The model approach, according to Hautefeuille, is for such employees to be offered free and confidential advice and support. Doctors first assess which drugs are being taken and proceed to implement a variety of measures, including complete elimination of some types of dug use (eg cocaine) while allowing use of other, legal substances to be continued (eg anti-depressants). With anti-depressants, for example, the goal is to ensure that doses are “effective and reasonable, in line with a prescription rather than self-prescription”.

The next stage is tackling the employee’s original problems, such as stress and work conditions. This may involve the employees approaching their managers in the hope that they will respond positively.

Support by the employer may last from four to six months. Until recently, companies did not intervene at all, except in cases where employees’ addiction problems clearly affected their work. Hautefeuille likens companies’ attitude in the past to that of sporting federations: “Provided the user remains productive, adapted and respectful, they turn a blind eye.”

Hautefeuille distinguishes between daily dopers and “drug addicts who work”. He says the occupational health department’s approach to the latter group has to be different. Nevertheless, when such patients seek consultations at Hautefeuille’s clinic of their own accord they will receive free and anonymous appointments. In comparison to the treatment for daily dopers, theirs is more traditional, lasts longer and is more likely to be based on psychotherapy, weaning them off drugs.

No more denial

Hautefeuille detects a change in contemporary attitudes, noting that more than half of participants at a recent conference on drug addiction at work were human resources managers. This may be because these managers increasingly realise that daily dopers will eventually “crack”. In which case, companies stand to lose staff in whom they may have invested a great deal. This is especially true for small and large firms, but less so for medium-sized ones, where “jobs and staff are interchangeable”.

Daily doping is no longer restricted to top-level managers, says Hautefeuille, since the problem now affects people at all levels, including women.

Addiction to prescription medicines

One in five employees in the Midi-Pyrenees region of France has an addiction to prescribed drugs, according to a 2006 study by the Toulouse Faculty of Medicine and the city’s inter-enterprise medical department. The study looked at the consumption of psychotropic substances, their patterns of use as well as the underlying social and professional factors behind their use.

The report says that these employees are hard to identify and treat. It also concludes that their doping behaviour (20% of employees in companies of every type dope themselves) is encouraged by the current way in which work is organised.

If the consumption of medicines is for a limited time only, the consequences are usually not serious. But if it continues for more than a year, some employees become addicted.

According to Dr Maryse Lapeyre-Mestre, a university lecturer and hospital doctor, almost one in three people over the age of 65 regularly consume one or more medicines from the benzodiazepine class of drugs. She says research suggests that many of these people started taking these tranquillisers during their work career. Young women, in particular, use psychotropic substances, often because they have more access to prescribers. Nevertheless, it is very difficult to identify such users because there is little questioning of systematic prescriptions in France, according to Lapeyre-Mestre. She says few prescribers of medicines refuse to give prescriptions to patients who know which drug they want – even though it is common knowledge that benzodiazepines are only effective for a few weeks and should not be prescribed for long courses of treatment.

The secondary effects of psychotropic substances are well known. They include reduced vigilance, longer reaction times and poorer memory. All of these effects can result in accidents at work or on the journey to or from the workplace. Lapeyre-Mestre notes that there is significant research done on these effects in older people, but not among young people – research for this category focuses on consumption of alcohol or illegal drugs.

The Midi-Pyrenees study also highlighted workers’ increasing use of cannabis, which is sometimes taken with an anxiolytic drug. Of the 2,500 employees surveyed – with an average age of 37 – 15% were cannabis users. Similar studies conducted in 1986 and 1996 did not reveal any such cases.

The study also identified the kinds of employee most likely to be addicted to drugs. They include those who feel their job is not rewarding and, at the other extreme, those who feel pressurised in their work. Also encountered, although to a lesser extent, were employees who took drugs because they felt they had little room for manoeuvre or expression in their job. Both sexes were affected almost equally, although men tended to use alcohol (which is more socially acceptable) more than other drugs. This is also true of women at management level.

Although consultations are common for employees addicted to illegal drugs, the treatment for those with an addiction to medicines is very complex. “It is easy to start prescribing a drug, but nobody is able to stop it,” says Lapeyre-Mestre. She adds that this is a real problem, especially since occupational health professionals in France are not allowed to start or stop prescriptions; and the doctors that can do so are ill-equipped to wean patients off them.

Case studies

In a case study reported in Travail et Sécurité, a recently retired manager from the Paris transport system (RATP) describes the in-depth medical examinations that drivers must undergo, including screening for cardiovascular disease, diabetes, back and sleep problems. They are also tested for consumption of alcohol, medicines and cannabis in particular. In the past, the company’s employees often baulked at the idea of campaigns aimed at raising awareness of the occupational risks of taking such substances. Today, that mentality has changed, the article says, since employees have become accustomed to prevention campaigns on many different issues. The workers elect their own representatives for committees to work alongside human resources managers.

Among other case studies reported, the awareness campaigns run by the construction company Groupe Vinci are described. These follow the death in 2004 of an employee in one of its subsidiaries, owing to cannabis consumption. Another Groupe Vinci subsidiary company works with the Alcool Assistance organisation to help make employees aware of the risks of alcohol addiction. It offers five-day training courses to members of the alcohol reflection group (GRAL), which includes occupational health specialists, one-day courses for managers and half-day courses for employees.

1. This article is a summary of the feature “Drogues et travail: un très mauvais ménage”, in the November 2007 issue (no.678) of Travail et Sécurité. This magazine is available for download, in French only (external website).