Workplace Drug Testing: On-Site Screening Versus Laboratory Testing

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Sue Nolan
Director, DrugFree Sites
PO Box 3541, Shortland St
Auckland 1140
sue@drugfreesites.co.nz

(P36, Friday 28, Civic Room 1, 11.30)

Published in: Health & Medicine, Business
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Workplace Drug Testing: On-Site Screening Versus Laboratory Testing

  1. 1. Workplace Drug Testing On-Site Urine Screening versus Laboratory Testing Sue Nolan DrugFree Sites Ph: 021 877606 sue@drugfreesites.co.nz www@drugfreesites.co.nz
  2. 2. 2008 Standard ongoing queries & confusion ? ??
  3. 3. Introduction • Legal requirements • Overview of AS/NZS 4308:2008 – On Site – Laboratory • Cross reactions: screen test • Specimen integrity • Drug & alcohol policy flexibility • Pros & Cons
  4. 4. Drug Testing Is Lawful AirNZ Employment Court Judgement: April 04 • Random: Safety Sensitive Jobs • Post Incident/ForCause: All Staff • AS/NZS 4308: Latest Version: 2008 • Comprehensive programme adopted
  5. 5. AS/NZS 4308:2008 S1: scope & definition S2: collection, storage, handling, dispatch  NZQA US25458 S3: general laboratory requirements  IANZ accreditation S4: laboratory screening procedures  IANZ accreditation S5: laboratory confirmatory procedures  IANZ accreditation App.A: on-site screening procedures  NZQA (US25511) & IANZ accreditation (agency) App.B: verification of performance of on-site devices App.C (& S2.2.4): chain of custody forms
  6. 6. Collection & On-Site Screening Impact 1. NZQA qualifications 25458 : “Perform urine specimen collection in the workplace for drug testing” (level 3, credits 2) 25511: “Perform urine drug screening in the workplace” (level 4,credits 4) NZQA Courses run by 1. DrugFree Sites 2. ESR 3. InScience
  7. 7. Collection & On-Site Screening Impact 1. NZQA certification: US 25458 & 25511 2. Verified device
  8. 8. Collection & On-Site Screening Impact 1. NZQA certification: US 25458 & 25511 2. Verified device 3. Integrity testing: mandatory – Temperature (330 C & 380 C) – Visual – Creatinine • Recommended – Extended integrity – Smell
  9. 9. Ways to cheat ? • Drinking excessive fluid – Dilute specimen: creatinine test mandatory, S.G. • Adding fluid to specimen • Substitution Temperature mandatory • Dehydrated urine Smell • In vivo: diuretics, herbal: PH, creatinine • In vitro: bleach, detergents, nitrite • Collection: PH, nitrite, oxidant tests recommended • Artificial bladders
  10. 10. Artificial Bladders
  11. 11. Beating the cheats Suggestions
  12. 12. Collection Site Requirements • Allows for individual privacy • Only collector & donor in room where collection/ documentation/ screening is in process • No bags or coats taken into toilet • Empty pockets, remove boots, self frisk (optional) • No access to water in toilet • Remove cleaning agents & bins/ containers • Colouring in the toilet • Cistern and windows secured • Donor washes hand before urinating • Instruct not to flush toilet • Collector must accompany donor to the toilet area – stand and wait outside. Door can be ajar.
  13. 13. Company Policy: Responsibility Post Accident/ Incident, For Cause, Random From the time of notification, arrange for the employee to be accompanied at all times and escorted to the designated NZQA qualified collector and “on-site” screener and trained breath testing provider.
  14. 14. Collection & On-Site Screening Impact 1. NZQA certification: US 25458 & 25511 2. Verified device 3. Creatinine test mandatory 4. Other sample integrity screen recommended 5. Daily controls: +ve & -ve – Daily at testing site – After 25 tests (alternate) – Faint lines: negative ????
  15. 15. Collection & On-Site Screening Impact 1. NZQA certification: US 25458 & 25511 2. Verified device 3. Creatinine test mandatory 4. Other sample integrity screen recommended 5. Daily controls: +ve & -ve 6. Proficiency testing program – External: RCPA – Program with laboratory: 5% negatives 1. Agency has IANZ accreditation
  16. 16. Accreditation ISO 15189, AS/NZS 4308: 2008 (sect 2, app A & B) • IANZ: Shelli Turner programme manager • Recognised internationally 1.Application fee: $90 2.Advisory visit (optional): $1700 3.Document examples  IANZ for inspection 4.Initial assessment (IANZ & Tech Expert): $5000 5.Annual registration fee: $700 6.Annual surveillance visit 7.Every 4 years: full assessment
  17. 17. Chain of Custody Minimal Information (2.2.4) • Verification of donor’s ID (photo not essential) – Unequivocal and independent • Two unique identifiers (full name & date of birth) • Date & time of collection • Name & signature of collector • Requesting authority details • Results of specimen integrity checks • Declaration by collector: compliance with Standard – Specimen collected & Tested on-site (if applicable) • Signature from donor confirming – Their own specimen & correctly taken – NB: This is the last step • Medication & results of on-site screen not on employer copy
  18. 18. Language & Reporting • Screen result – Negative or “Not Negative” – Word “positive” prohibited • Screen “not negative” or specimen integrity ?? – Interim report may be issued to requesting authority that can only advise that the specimen requires further testing – No indication of which drug class • Why is this critical
  19. 19. Cross Reactions screen “not-negative” Medication •Pseudoephedrine  Methamphetamine •Codeine  Opiates •Orphenadrine Foodstuff •Poppy seeds  opiates Biogenic Amines (eg red wine)  Methamphetamine Multidrugs present
  20. 20. Laboratory Confirmation GCMS or LCMSMS Accredited Laboratories •CHL •ESR •LabPLUS
  21. 21. Excuses for Non Compliance
  22. 22. What Drug Classes & Substances? • Cannabis metabolites • Opiates: morphine, codeine, 6-acetyl morphine • Amphetamine type substances: – amphetamine, methylamphetamine (P), – methylenedioxymethylamphetamine (E) – methylenedioxyamphetamine (E) – pseudoephedrine, phentermine, ephedrine – benzylpiperazine (BZP): not “on site” screen • Cocaine metabolites • Benzodiazepines – diazepam, nordiazepam, oxazepam, temazepam – alprazolam, clonazepam, flunitrazepam, nitrazepam metabolites
  23. 23. Definition: Drugs Illicit, restricted and some currently legal drugs which have the potential to cause impairment, eg: •cannabis and hashish •opiates (such as heroin and morphine) •cocaine •amphetamine type substances (speed, “P”, ecstasy and party pills containing benzylpiperazine) •synthetic THC (Kronic, Puff, Amsterdam Cafe) •misuse of some prescription drugs (tranquillisers, sedatives) •other currently legal party highs •other “mind altering” substances can be added to the testing suite as they become available and are misused.
  24. 24. Other Drugs: S1.1 The detection & reporting of drugs other than those listed in Table 2 is not precluded – Synthetic THC (Kronic, Spice, Puff) – LSD – DMAA (dimethylamylamine) – Magic mushrooms (psilocybin) – Salvia Divinorum (tripping weed) – Oxycodone (on site cassettes available) – Cathinone derivatives: at least 20 variations • Make from Khat plant • Mephedrone, methylene dyoxypyrovalerone, methedrone
  25. 25. Laboratory Testing • Laboratory testing only • Screening by GCMS or LCMSMS • Mass spectrometry confirmation  detected • Laboratory determines cut-offs • No clinical trial data often to make decision on cut-offs • Synthetic THC • Metabolites of JWH- 018, 073, 122: tests available • Other derivatives: no tests yet • Cut-off 10ng/ml
  26. 26. Pros and Cons • Speed • Cost • Post Accident/ For Cause  only stand down “not- negatives” • Random  taking action immediately • Expense of compliance • Extended testing suite • Personal safety • Cross reactions  medications/ foodstuff Motto: Select the screening option(s) which is “fit for purpose” and complies with the Company policy. Always get laboratory confirmation after “not-negative” screen.
  27. 27. Goal is a Drug Free Playing Field

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