Dr. Melissa Snider-Adler, MD, CCFP(AM), MRO (MROCC), DABAM, FASAM
Addiction Medicine Physician | Medical Review Officer | Founder, FFD Learning Inc.

Employers train workers on equipment, procedures, hazards, harassment, cybersecurity, emergency response, and job-specific expectations. We train supervisors to recognize risk, follow process, document concerns, and respond to incidents.

Yet many organizations still overlook one critical safety topic: substance use education.

Most organizations with safety-sensitive positions have some form of alcohol and drug policy. Many have rules about fitness for duty, cannabis, medications, testing, disclosure, and accommodation. But a policy is not a substitute for substance use education. A policy may tell employees what the rule is. It does not necessarily help them understand why the rule exists, how substances affect safety, or how quickly personal choices can become workplace risks.

That gap needs to be addressed in all safety-sensitive workplaces.

Substance use can affect(1):

Judgment

Alertness
Perception
Motor coordination
emotional state
attention
concentration
productivity
absenteeism, and
safety-sensitive decision-making.

These are not side issues. They are the same human factors employers depend on every day to prevent incidents, injuries, errors, and near misses.

If a worker does not understand how alcohol, cannabis, medications, or other substances can affect reaction time, decision-making, coordination, attention, or risk perception, then the workplace has left a critical safety conversation unfinished.

Why Substance Use Education Should Be Treated Like Any Other Workplace Safety Training

In safety-sensitive and decision-critical workplaces, employers do not assume that workers will simply “figure out” how to manage risk. Workers are educated on lockout procedures, confined spaces, working at heights, fatigue, PPE, mobile equipment, site rules, and emergency response. Supervisors are trained to recognize hazards, intervene, detect signs of workplace impairment and follow procedures.

Yet substance use is often treated differently.

Instead of education, many workplaces rely on the assumption that employees already understand the risks. Or they assume that a signed policy is enough. Or they avoid the topic because it feels personal, legal, medical, or uncomfortable.

That approach no longer makes sense.

Substance use is part of the modern workplace safety landscape. Alcohol remains widely used and socially accepted. Cannabis is legal in Canada and in many U.S. states. Medical cannabis has added new questions for employers, supervisors, unions, occupational health professionals, and employees. At the same time, other substances including psilocybin, kratom, high-potency cannabis products, sedating medications, stimulants, and products marketed as “natural” or “wellness” supports, are increasingly discussed in everyday life.

Employees are hearing messages outside of work that many of these substances are safe, helpful, natural, therapeutic, or low risk. Some of those messages may contain partial truths. Some may be misleading. Some may apply only in a medical or controlled setting. Some may have nothing to do with workplace safety.

But if the workplace does not provide clear education, misinformation fills the gap.

Understanding Workplace Impairment

Workplace impairment occurs when an employee's ability to perform work safely is affected by alcohol, cannabis, medications, fatigue, illness, stress, or other factors. Workplace impairment can impact judgment, reaction time, attention, concentration, coordination, and decision-making, even when the individual does not believe they are impaired. In safety-sensitive workplaces, workplace impairment creates risks not only for the employee, but also for co-workers, the public, and the organization. This is why substance use education is so important. Employees need practical information that helps them understand what impairment is, how it can occur, how impairment may affect job performance, and why fitness-for-duty expectations exist.

Substance Use Education and the Reality of Workplace Impairment

One of the most important messages employees need to understand is also one of the simplest: legality does not equal fitness for duty.

Cannabis may be legal. Alcohol is legal. Many medications are legal and prescribed. Some products may be available without a prescription. None of that means an employee is safe to perform safety-sensitive work while affected by them.

This distinction is critical.

The changing legal status of cannabis has created confusion for many workplaces. Employees may believe that because cannabis is legal, it should be treated like any other lawful off-duty activity. In many contexts, that may be true. But in safety-sensitive work, the issue is not morality or legality. The issue is impairment risk, residual effects, timing of use, task demands, and whether the employee can perform the work safely.

NIOSH has recognized that rapidly changing cannabis laws and public attitudes raise important workplace safety and health questions(2). It has also noted that detecting cannabis impairment is more complex than detecting alcohol impairment, because impairment can vary by dose, route of use, THC concentration, tolerance, and timing(3).

That complexity is exactly why education matters.

Employees need to understand that cannabis can affect safety even when it is legal. They need to understand that medical authorization does not automatically mean fitness for duty. They need to understand that “I used it off duty” does not answer the safety question unless timing, effects, job demands, and workplace expectations are also understood.

Substance Use in the Workplace Has Become Normalized. Safety Education Has Not Kept Up.

The conversation about substance use in the workplace has changed quickly. Why? Because:

Cannabis is often discussed as a wellness product.
Psilocybin is increasingly discussed in relation to mental health research.
Kratom is marketed by some as natural or helpful for pain, energy, mood, or opioid withdrawal.
Alcohol remains normalized in social and professional life.
Medications for sleep, anxiety, pain, ADHD, and other conditions are common.
Employees may be managing stress, fatigue, pain, trauma, family pressures, or mental health symptoms while trying to remain productive and safe at work.

Employers cannot ignore this context.

Psilocybin-containing mushrooms can cause hallucinations, anxiety, fear, nausea, muscle twitches, increased heart rate and blood pressure, and in some cases “bad trips” or flashbacks(4).

The FDA has warned consumers not to use kratom because of serious adverse event risks, including liver toxicity, seizures, and substance use disorder, and notes that there are no FDA-approved kratom drug products or over-the-counter drugs legally on the U.S. market(5).

This does not mean employers need to educate employees on every emerging substance in detail. It means employers should teach the principles that help employees make safer decisions:

Substances can affect the brain and body in ways that impact the work they are doing and the safety for them, their co-workers and the public.
A substance can be legal, prescribed, natural, or socially accepted and still create safety risk.
Therapeutic potential in a research or medical setting does not mean unsupervised use is safe, predictable, or compatible with safety-sensitive work.
Fitness for duty is about function, safety, and risk. It is not about the legal status.

Why Substance Use Education Is More Effective Than Policy Alone

A workplace alcohol and drug policy is important. It sets expectations, outlines responsibilities, explains prohibited conduct, describes testing circumstances where applicable, and supports consistent decision-making.

But policy alone is limited.

The Canadian Centre on Substance Use and Addiction (CCSA) has noted that testing alone has limited efficacy as a deterrence measure and that comprehensive workplace approaches are needed(6).

SAMHSA recommends that employers educate staff and supervisors about the effects of substance use on health, job performance, and workplace safety as part of drug-free workplace programming(7).

This is the key point for employers: substance use education is not a soft add-on. It is part of prevention.

Substance use education helps employees understand expectations before there is a problem. It supports supervisors by creating a shared language. It reduces stigma by moving the conversation away from blame and toward risk, safety, support, and responsibility. It helps employees recognize when they may not be fit for duty. It may make it easier for someone to ask for help earlier. It also strengthens the credibility of the policy because employees are more likely to follow expectations they understand.

A policy says, “Do not report to work impaired.”

Substance use education explains what workplace impairment can look like, why timing matters, how residual effects can affect safety, why self-assessment is unreliable, what to do if there is a concern, and why the rule protects the worker, coworkers, the public, and the organization.

The Cost of Not Talking About It

Substance use is not only a health issue. It is also a workplace issue.

The workplace impact of substance use is not theoretical. In the United States, excessive alcohol use alone was estimated to cost $249 billion, including $179 billion in workplace productivity losses(8). In Canada, substance use was estimated to cost $49.1 billion in 2020(9), with lost productivity accounting for nearly half of the total.

Employers may not see those numbers listed as “substance use” on a balance sheet, but they often see the effects through absenteeism, presenteeism, disability, safety concerns, performance issues, and difficult fitness-for-duty decisions.

The question is not whether substance use affects workplaces. That answer is already clear. It does.

The question is whether employers are willing to address it proactively, practically, and consistently, before an incident forces the conversation.

There is a cost of being proactive, but it is a fraction of the cost of being reactive.

Key Elements of Effective Substance Use Education Programs

Effective workforce substance use education should not be fear-based. It should not shame employees. It should not turn supervisors into diagnosticians. It should not suggest that every person who uses a substance has a substance use disorder.

Good substance use education should be practical, respectful, and safety-focused. It should help employees understand:

how alcohol, cannabis, medications, and other substances can affect safety-sensitive functions;
why legality does not equal fitness for duty;
why “feeling fine” is not always a reliable safety measure;
how fatigue, stress, mental health, and substance use can interact;
what the workplace policy actually means in real situations;
when and how to disclose a safety concern;
how to seek help before there is a workplace incident; and
how substance-use stigma can prevent people from getting support.

For supervisors and managers, substance use education should also include how to recognize observable concerns, document objectively, respond without making assumptions, remove uncertainty from safety-sensitive work, and follow the organization’s process.

The Employer Question

Employers should ask themselves a few direct questions:

If substance use in the workplace can affect judgment, attention, coordination, reaction time, emotional state, and safety-sensitive decision-making, why would we not educate the workforce about it?
If we train workers on every other major hazard, why would this one be left to assumptions, misinformation, or a policy no one remembers reading?
And if cannabis, psychedelics, kratom, alcohol, medications, and other substances are becoming more normalized in society, why would we expect employees to automatically understand how those messages do, or do not, apply to safety-sensitive work?

Workforce substance use education is not about catching people. It is about protecting people.

It is about helping employees understand risk before they are standing at the edge of a bad decision. It is about giving supervisors the knowledge and confidence to respond appropriately. It is about building a culture where fitness for duty is understood as a shared safety responsibility.

Policies set the expectations.

Education changes the understanding.

And in workplace safety, understanding is often what changes behaviour.

Ready to implement workplace substance use education? Learn how FFD Learning's evidence-based training helps organizations reduce workplace impairment risks, strengthen fitness-for-duty awareness, and improve workplace safety.

About the Author

Dr. Melissa Snider-Adler, MD, CCFP(AM), MRO (MROCC), DABAM, FASAM

Addiction Medicine Physician | Medical Review Officer | Founder, FFD Learning Inc.

Dr. Melissa Snider-Adler is a board-certified Addiction Medicine physician, Medical Review Officer, and internationally recognized expert in workplace substance use, impairment, drug testing, cannabis, and fitness for duty. She serves as Chief Medical Review Officer at DriverCheck Inc., maintains an active addiction medicine practice in Oshawa, Ontario, and provides Independent Medical Evaluations and expert opinions.

With more than 20 years of experience in addiction medicine and workplace safety, Dr. Snider-Adler brings a unique combination of clinical expertise, regulatory knowledge, and practical workplace experience. She holds several respected designations, including Diplomate of the American Board of Addiction Medicine, Certificate of Added Competence in Addiction Medicine from the College of Family Physicians of Canada, Fellow of the American Society of Addiction Medicine, and current certification as a Medical Review Officer through the Medical Review Officer Certification Council.

Dr. Snider-Adler is widely regarded as a leading authority on substance use in safety-sensitive and decision-critical workplaces. She advises employers, unions, industry leaders, and legal teams on alcohol and drug policies, workplace testing programs, cannabis, medical cannabis, substance use disorders, accommodation, and fitness-for-duty decision-making. She has provided expert testimony and written opinions in numerous arbitration, tribunal, and court proceedings across sectors including railway, transportation, construction, mining, oil and gas, power and hydro, alcohol and gaming, and child services.

Her work has helped shape national and industry standards. She has served as a Technical Committee Member for CSA Z1008:21, the National Standard of Canada for Management of Impairment in the Workplace, and as a Subject Matter Expert for the Construction Owners Association of Alberta and Energy Safety Canada’s Canadian Model for Providing a Safe Workplace. She is also a Board Director with the Medical Review Officer Certification Council and a member of the National Safety Council Alcohol, Drugs and Impairment Division.

Dr. Snider-Adler is a published author and co-author on cannabis, impairment risk, medical cannabis, and opioid use disorder treatment, including the 2025 OEMAC Position Statement on the Implications of Cannabis Use for Safety-Sensitive and Decision-Critical Work.

In addition to her clinical and expert work, Dr. Snider-Adler is a dedicated educator and international speaker. Since 2005, she has presented at hundreds of conferences, agencies, and expert panels across Canada, the United States, and Europe. She is known for translating complex medical, legal, and workplace safety issues into clear, practical education that helps organizations make better decisions.

Her passion for workplace education led to the development of FFD Learning’s Alcohol and Substance Awareness Program, known as ASAP. Designed for safety-sensitive workplaces, ASAP provides practical, evidence-informed education on substance use, cannabis, alcohol, drug testing, impairment, and fitness for duty, helping organizations reduce stigma, improve safety, and move beyond policy awareness to practical understanding.

References

(1) Canadian Centre for Occupational Health and Safety. (n.d.). Substance use in the workplace.
https://www.ccohs.ca/oshanswers/psychosocial/substance.html

(2) National Institute for Occupational Safety and Health. (2024). Cannabis use and workers. Centers for Disease Control and Prevention. https://www.cdc.gov/niosh/substance-use/cannabis/index.html

(3) National Institute for Occupational Safety and Health. (2020). Cannabis and work: Implications, impairment, and the need for further research. Centers for Disease Control and Prevention. https://www.cdc.gov/niosh/bulletin/2020/cannabis-research.html

(4) Health Canada. (2025). Psilocybin and psilocin (magic mushrooms). Government of Canada.
https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/magic-mushrooms.html

(5) U.S. Food and Drug Administration. (2025). FDA and kratom. https://www.fda.gov/news-events/public-health-focus/fda-and-kratom

(6) Meister, S. R. (2018). A review of workplace substance use policies in Canada: Strengths, gaps and key considerations. Canadian Centre on Substance Use and Addiction.
https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Workplace-Substance-Use-Policies-Canada-Report-2018-en_0.pdf

(7) Substance Abuse and Mental Health Services Administration. (2024). Drug-free workplace toolkit. U.S. Department of Health and Human Services. https://www.samhsa.gov/substance-use/drug-free-workplace/employer-resources/toolkit

(8) Centers for Disease Control and Prevention. (n.d.). The CO$T of excessive alcohol use.
https://stacks.cdc.gov/view/cdc/35008

(9) Canadian Substance Use Costs and Harms Scientific Working Group. (2023). Canadian substance use costs and harms 2007–2020. Canadian Centre on Substance Use and Addiction. https://csuch.ca/assets/documents/reports/english/Canadian-Substance-Use-Costs-and-Harms-Report-2007-2020-en.pdf

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Why Substance Use Education Belongs in Every Workplace: Addressing Workplace Impairment Before Incidents Occur