Alcohol & Drugs Testing - Why Should We

Alcohol & Drugs – Why should we test? - Richard Evers
Richard Evers
Laboratory Manager
Synergy Health Laboratory Services
Alcohol & Drugs –
Why should we test?

Contents
+ Understand why drug testing is justified
+ Know what regulations apply
+ Understand the process of testing
+ Know the rights of the employee
+ Have confidence in the results

Understand Why Drug
Testing is Justified

Drink Driving
+ Level of impairment linked to dose
+ Drink drive limit 80mg/100mL blood
+ Blood / Breath alcohol linked to dose
+ 3 Units alcohol ~ Drink drive limit
+ Accidents statistically linked to Drink Driving

Accident rate
+ Little firm evidence that drugs lead to accidents and
absenteeism
+ 5 Studies associate drug use with accidents
+ 7 studies find little or no evidence (HSE 2002)
+ Prevalence of Drug use lower than alcohol
+ British Crime Survey
+ Not all accidents lead to drug tests
+ Hangovers also lead to accidents

How Common is Drug Use?
+ British Crime Survey 2009-2010
+ Working Age Adults in England and Wales
+ 8.6% used drugs in the last 12 months
+ 3.1% used a Class A drug
+ 6.6% used Cannabis
+ Young Adults (16-24)
+ 20% used drugs in the last 12 months
+ 10.7% used a Class A drug
+ 16.1% used Cannabis

Incidences of Positive Tests
Synergy Health Laboratory Services Figures
+ Includes prescribed and over the counter medications
+ UK Energy Industry 2010
+ 6.5% positive
+ UK Leisure Industry 2010
+ 7.9% positive
+ UK Light Industry
+ 4.1% positive

Right to respect for private and family life: -
1.Everyone has the right to respect for his private and
family life, his home and his correspondence
Article 8
European Convention on Human Rights

Acute Effects of Cannabis Use
+ 1976 study of 7 professional
and 3 private pilots
+ Flight simulator performance
30 minutes after smoking 6mg
+ Deviation from desired height
of 2600ft
+ Placebo gave deviation of
680ft

How long do the effects of Cannabis
last?
+ 1985 study of 10 private
pilots
+ 19mg THC (3 x 1976 dose)
+ How close to the runway
midline can they land in a
simulator?

Cannabis effects last all week

Impairment due to drugs
+ Detection times unrelated to impairment
+ Cannabis in urine detected for up to 1 month
+ Cannabis in saliva detected for <24 hours
+ Urine results do NOT link to impairment
+ Tests show use, not impairment
+ Not everybody reacts the same
+ May Cause drowsiness
+ Addiction
+ Withdrawal

Right to respect for private and family life: -
1.Everyone has the right to respect for his private and family life, his home and his
correspondence
2.There shall be no interference by a public authority with the exercise of this right
except such as is in accordance with the law and is necessary in a democratic
society, in the interest of national security, public safety or the economic well-
being of a country, for the prevention of disorder or crime, for the protection of
health or morals or for the protection of the rights and freedom of others.
Article 8
European Convention on Human Rights

So when is testing justified?
+ Safety Critical Industries
+ Airline pilots
+ Train drivers
+ Trackside workers
+ Steel workers
+ HGV drivers
+ Fork Lift operators
+ Healthcare

Integrity critical
+ Police
+ Prison staff
+ Drug testing staff
+ Customs & Excise

Know What
Regulations Apply

+ Misuse of Drugs Act 1971
+ Offence to allow drug use, or fail to act if drug use is known to employers
+ Health and Safety at Work Act 1974
+ Health, Safety and Wellbeing of Employees
+ Reasonable care to protect Health and Safety of people affected by work
+ Management of Health and Safety at Work Regulations 1992
+ Assess the Health and Safety to employees and the public
Criminal Liability

Civil Liability
+ Plaintiff often works for the company
+ Damages
+ No Win, No Fee – Blame Culture
Competent Staff
+ “Your employer must ensure, to the best of their ability, that the people the that
he employs around you are competent in their jobs and do not put others at risk
by their actions. So if an employee injures another through a failure to use
equipment properly, a drink or drugs problem or simply by messing around then
the employer is potentially liable for those actions”
www.lawontheweb.co.uk/personal_injury/work_injury 08/03/2011

+ Original Regulations on which others are based
+ US Federal employees
+ Strictly defined criteria
+ Only covers 5 drugs
+ UK Laboratory Guidelines for Legally Defensible Workplace
Drug Testing
+ Cover urine drugs only
+ Technology change
+ Cover range of drugs
+ European Laboratory Guidelines for Legally Defensible
Workplace Drug Testing
+ More up to date
+ Saliva and Hair testing guidelines
SAMHSA Guidelines

Informed consent
+ Is the employer justified in testing?
+ Safety critical or integrity driven?
+ Staff participation essential
+ Consultation prior to implementation
+ Staff information sessions
+ Junior Manager / foreman buy-in
+ Discrimination MUST be avoided
+ External randomisation
+ For Cause guidelines defined
+ All staff on all shifts

Understand the
Process of Testing

+ For-Cause
+ Testing may be carried out if an accident/incident occurs and there
are reasonable grounds to suspect the accident was a result of
substance misuse
+ Pre-Employment
+ Employers may request prospective employees to undertake
substance misuse test before employment commences
+ Random
+ Employers may wish to randomly test a selection of their workforce to
discourage substance misuse
Reasons for Testing

+ Urine Testing
+ The mainstay of drugs of abuse testing as the sample is easy to collect
and analyse
+ The process is well controlled and is legally defensible
+ Retention time of drugs in urine is mostly between 2 and 4 days
+ Saliva Testing
+ Newer technology
+ Smaller sample size
+ Less invasive
+ Hair Testing
+ Very small sample size
+ Difficult to test
+ 3 month drug history
+ Shows Abuse levels only, not use
Methods of Testing

+ Privacy required
+ Toilet facility
+ Interview room
+ Translator present if required
+ Company representative
+ Identify Donor
+ Decide on actions
Testing process

+ Donor must :
+ Understand the process
+ Understand why they have been picked
+ Know that confidentiality is maintained
+ Have sufficient opportunity to ask questions
+ Know how to appeal against a test
Informed consent

Sample
+ Freshly voided urine
+ Toilet not flushed
+ Temperature measured
+ Split between ‘A’ and ‘B’ bottles
+ Tamper evident seals applied
+ Initialled by donor and collector
+ Sealed in Tamper evident bag with CoC form
+ Posted by Royal Mail or courier

Laboratory Analysis
+ Primary Screen
+ Chain of Custody Checks
+ Adulteration checks
+ Negative or Non-negative
+ Quickly eliminate negative results
+ Negative samples discarded
+ On site testing
+ Primary Screen may be done on site
+ Provides instant negative
+ Allows donor to return to work

LCMS Analysis
+ Sensitive
+ Can identify very low levels of drug
+ Specific
+ Does not cause false positive results
+ Can identify illicit and legal drugs
+ Compares against defined threshold
+ Report as Positive or Negative
+ Medication
+ Consistent with medication declared
+ Further information required
+ Not consistent with medication declared

Understand the Rights
of the Employee

Privacy
+ Anonymous collections
+ Synergy Health Staff not conspicuous
+ Staff ID number not names if required
+ Collection process
+ Private room
+ Informed Consent
+ Observed collections NOT routine
+ Collection completed and sealed before next collection starts

Confidentiality
+ Drug History on CoC form
+ Only recent medicine use requested
+ Reasons for medication not asked
+ Medications withheld from company
+ Medical Review Officer
+ Company doctor or external reviewer
+ Doctors confidentiality of results
+ Can change positive results to negative

Informed Consent
+ Cannot give informed consent for mandatory procedures
+ Staff consultation
+ Union consent
+ Consequences of positive results
+ Drug & Alcohol policy
+ Communicated to all staff
+ Universal in operation
+ Amnesty period

Have Confidence in
the Results

Chain of Custody
+ Ensures protection of donor & company
+ Prevents allegations of interference
+ Provides legally defensible results
+ Follows sample through laboratory processes
+ Ensures the reported results come from the donor
named on the form

Laboratory Quality
+ Quality Control sample with every batch
+ Known sample must produce results within a specified range
+ Validated methods
+ Tested for interferences, reproducibility and accuracy
+ Authorised, Trained and Qualified Staff
+ External Proficiency tests
+ Test whole laboratory performance
+ Results of unknown samples compared with other laboratories

ISO 17025:2005
+ UK Accreditation Service (UKAS)
+ Independent of Laboratories
+ Annual assessment of quality systems
+ Audit of methods to ensure “fit for purpose”

Challenges
+ ‘B’ sample challenge
+ ‘B’ sample stored as ‘A’ sample
+ Analysed by independent laboratory
+ Chain of Custody checked
+ Cost of challenge met by donor
+ Test costs around £150-£200
+ Reduces timewasting
+ Often leads to admission of drug use

Summary
+ Drug testing may be justified where safety or integrity are paramount
+ Drug testing is covered by a number of regulations, and the
justification will depend on the risk
+ The process is designed to ensure accurate results that are
traceable to the donor and to international standard materials
+ The employee has the right to privacy as far as it does not
compromise safety or integrity
+ Quality is an integral part of the drug testing process, and
laboratories spend a significant amount on maintaining quality

Thank you for listening
Does anybody have any questions?

Alcohol & Drugs Testing - Why Should We

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