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Drugs in the Workplace

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Drugs in the workplace, drug testing.

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Drugs in the Workplace

  1. 1. © Aurora HHeeaalltthh CCaarree,, IInncc.. DRUGS IN THE WORKPLACE Mary Jo Capodice, DO, MPH, MRO Medical Director Aurora Occupational Health Aurora Health Care
  2. 2. © Aurora Health Care, Inc. Define “Drugs in the Workplace” What Are We Talking About?
  3. 3. • To understand the spectrum of drug and alcohol use and associated costs in the workplace • To identify and manage those individuals exhibiting substance use behavior • To create a safer workplace, save your companies money and improve productivity © Aurora Health Care, Inc. Objectives
  4. 4. © Aurora Health Care, Inc. Impact of Substance Abuse on Productivity • 8 X Absenteeism • 3 X Sick Benefits • 8 X Hospital Days • 5 X Workers Compensation Costs • 3.6 X Workplace Accidents • Performance 67% of Norm Source: NIH data from NIAAA Studies
  5. 5. © Aurora Health Care, Inc. Costs to Industry • Costs of Alcohol and Drug Abuse in the United States per year: $484,000,000,000 Source: Office of Natl. Drug Control Policy, Centers for Disease Control & Prevention, Harwood, H. 2000
  6. 6. Workplace Indicators of Substance Abuse • Substandard Performance • Increased Production Costs • Increased Accident Rates • Increased Theft & Property Damage • Increased Medical Benefit Utilization • Increased Absenteeism • Workers Comp. Claims UP • Increased Recruitment • Training Costs © Aurora Health Care, Inc.
  7. 7. © Aurora Health Care, Inc. Behavioral Indicators of Substance Abuse. • Abrupt Changes (attendance, quality, quantity, etc.) • Attitude Changes • Withdrawal • Deterioration of Appearance • Impaired Performance
  8. 8. © Aurora Health Care, Inc. Behavioral Indicators (continued) • Sunglasses (inappropriate) • Long Sleeves (inappropriate) • Guilt by Association • Stealing • Secretive Behavior • Frequent Trips to Restroom or Vehicle
  9. 9. © Aurora Health Care, Inc. Reasonable suspicion checklist
  10. 10. Wisconsin-#1 Overall Ranking in Alcohol Abuse! Binge and heavy drinking 1 Underage drinking 2 Lowest beer tax rate 2 Alcohol-related healthcare costs 3 Gallons of alcohol sold per capita 4 Arrest rates-alcohol related crimes 4 Liquor licenses per capita 4 Alcohol dependence and abuse 5 Needing but not getting treatment 5 Drunk driving fatalities 11 © Aurora Health Care, Inc.
  11. 11. © Aurora Health Care, Inc. Wisconsin-”We’re #1”
  12. 12. So What If Your Employee Got Drunk Last Night?! © Aurora Health Care, Inc. 2:00am Went to bed .250 3:00am Sleeping .235 4:00am Sleeping .220 5:00am Sleeping .205 6:00am Got up for work .190 7:00am Can’t find car .175 8:00am Make it to work .160 9:00am Spilled coffee .145 10:00am Grunt at co-worker .130 11:00am Stumble and trip .115 12:00noon Still legally drunk (US) .100 1:00pm Feeling groggy .085 2:00pm Just under limit (WI) .070 3:00pm Still tipsy .055 4:00pm DOT cutoff. (SAP ref) .040 5:00pm DOT cutoff (24 hours) .025 6:00pm Finally ok to drive .010 Alcohol
  13. 13. Effects on Performance – The mental impairments resulting from the use of alcohol produce reactions that can lead to unsafe Workplace practices. – Distorted visual perceptions, impaired signal detection and altered reality can make operating equipment very dangerous. © Aurora Health Care, Inc. Alcohol
  14. 14. Signs and Symptoms • Flushed Face Constricted Pupils • Slowed Speech Impaired Coordination • Unsteady Gait Repeating Oneself • Smell of Alcohol Altered Perception • Poor Memory Poor Concentration • Altered Reality Aggressive Behavior • Slow Response Sleep Disturbance • Impaired Visual Tracking • Impaired Signal Detection • Erratic Cognitive Functioning • Difficulty Following Directions • Impaired Distance or Time Judgment © Aurora Health Care, Inc. DOCUMENT!!! Alcohol
  15. 15. 5+ panel test (10/01/10) • Phencyclidine (PCP) • Marijuana • Cocaine • Amphetamine/Methamphetamine (+ MDMA, MDA, MDEA) • Opiates (Heroin, Codeine, Morphine, 6-AM) © Aurora Health Care, Inc. Drugs- DOT/Safety sensitive panel
  16. 16. PCP: 2.1% lifetime 12TH Grade Marijuana: 42% lifetime age 12 or older. 12th grade 32% year, 24% month, 6% daily. Cocaine: 8% 12th graders cocaine, 3.2% crack cocaine. Amphetamines: 11% lifetime. 6.9% Age 18-25 Ecstasy, 3% H.S. Seniors meth, 3.4% crystal meth Opiates: 9% H.S. Seniors have used illegal opiate in past 12 months. Alcohol: 72% 12th grade, 62% 10th, 39% 8th – Sources: NHSDA (National Household Survey on Drug Abuse) and MTF (Measuring the Future 2008) survey of NIDA (National Institute on Drug Abuse) © Aurora Health Care, Inc. Drugs: Prevalence of Use
  17. 17. © Aurora Health Care, Inc. Drugs Workplace Prevalence Drugs: A Workplace Problem •73% of all drug users are employed •7.4 million workers used drugs last month •52% of all workers who test positive for drugs are daily users •35% of workers have seen or heard of on-the-job drug use by co-workers Source: Institute for a Drug-Free Workplace
  18. 18. © Aurora Health Care, Inc. Drugs/Alcohol Detection Detectability PCP 8-30 days Marijuana 7-30 days Cocaine 1-3 days Amphetamine 1-3 days Opiates 1-3 days Alcohol 12-24 hrs Ecstasy 1-3 days
  19. 19. Screening/Confirmatory (ng/ml) PCP 25/25 Marijuana (THC) 50/15 Cocaine 150/100 Amphetamine/Meth. 500/250 Opiate(codeine-morphine) 2000/2000 Heroin(6-acetylmorphine) 10/10 MDMA (ecstasy) 500/250 October 1, 2010 © Aurora Health Care, Inc. Drugs Test Cutoffs
  20. 20. • CNS Depressant/Hallucinogen • Appearance : Green or brownish dried leaves and flowers, or solid brown or black chunks • Street Names: Over 200, including pot, herb, weed, gangster, chronic, ganja, doobie, blunts, hash, oil, etc. • How Ingested: Smoked in pipes, “vaped”, joints, blunts or bongs or eaten in brownies, etc. Can also be made into tea © Aurora Health Care, Inc. Drugs: Marijuana (THC)
  21. 21. Signs and Symptoms • Reddened Eyes Stained Fingertips • Chronic Fatigue Persistent Cough • Slowed Speech Chronic Sore throat • Altered Reality Altered Perception • Panic Reactions Impaired Tracking • Grandiosity Poor Concentration • Impaired Short-Term Memory • Impaired Signal Detection • Distorted Visual Distance Measurement • Erratic Cognitive Functioning • “I Don’t Care” Attitude © Aurora Health Care, Inc. Drugs: Marijuana (THC)
  22. 22. Effects on Worker Performance • The mental impairments resulting from the use of marijuana produce reactions that can lead to unsafe and erratic behavior. • Distorted visual perceptions, impaired signal detection and distorted visual distance measurement can make working very dangerous. © Aurora Health Care, Inc. Drugs: Marijuana (THC)
  23. 23. • CNS Stimulant • Appearance: White, crystalline powder or small chips or chunks (rocks) in the case of crack cocaine • Street Names: (Powdered Cocaine) Coke, Blow, Nose Candy, Toot, Flake (Crack Cocaine) Crack, Rock • How Ingested: Snorted, Smoked or Injected © Aurora Health Care, Inc. Drugs: Cocaine
  24. 24. Effects on Worker Performance • Cocaine use results in an artificial sense of power and control that leads to a feeling of invincibility. • It can bring on lapses in attention and ignorance of warning signals, which greatly increase the potential for accidents. • Paranoia, hallucinations, and extreme mood swings make for erratic and unpredictable reactions. © Aurora Health Care, Inc. Drugs: Cocaine
  25. 25. Signs and Symptoms • Dilated Pupils Profuse Sweating • Irritated Nose Loss of Appetite • Tremors Over-excitability • Restlessness Talkativeness • Depression Increased Activity • Isolating Secretive Behavior • Defensiveness Wide Mood Swings • Paranoia Hallucinations • Overreaction to Stimulus • Lapses in Attention, Forgetfulness • False Sense of Power and Control © Aurora Health Care, Inc. Drugs: Cocaine
  26. 26. • CNS Stimulant • Appearance: (Amphetamines) pill, tablet, capsule. (Methamphetamine) white powder, pills, crystal “rock” • Street Names: (AMPH.) Speed, Uppers, Bennies, Black Beauties, Pep Pills, (Meth.) Crystal, Crank, Chalk, Meth, Ice, Glass, (MDMA) Molly, X, or Ecstasy • How Ingested: Swallowed, Injected, Inhaled or Smoked © Aurora Health Care, Inc. Drugs: Amphetamines
  27. 27. Signs and Symptoms • Dilated Pupils Decreased Appetite • Sweating Dizziness • Dry Mouth Blurred Vision • Headaches Talkativeness • Confusion Hallucinations • Panic Restlessness • Anxiety Moodiness • False Sense of Confidence • False Sense of Power • False Sense of Alertness • Fatigue (When Coming Down) © Aurora Health Care, Inc. Drugs: Amphetamines
  28. 28. • CNS Sedative, Analgesic • Appearance: (Heroin)White to brown powder, (Morphine) white crystals, liquid or tablets, (Codeine) dark liquid, capsules • Street Names: (Heroin)Smack, horse, junk, H, Black Tar. (Morphine) Mud, M, Dope, (Codeine) Schoolboy, Cooties • How Ingested: (Heroin) injected, snorted, smoked (Morphine) injected, swallowed, (Codeine) swallowed © Aurora Health Care, Inc. Drugs: Opiates (Street)
  29. 29. © Aurora Health Care, Inc. Prescription Drug Epidemic Prescription painkillers now kill more people in the US than heroin and cocaine combined Source: Director of the CDC In 2010, there were more ED visits from misuse of pharmaceuticals than from all illicit drugs combined. Source: The DAWN (Drug Abuse Warning Network) Report, July 2012 and Pew Health Group 2012
  30. 30. Effects on Worker Performance • Amphetamines, while causing a false sense of alertness and power along with potential hallucinations, result in risky behavior and increased accidents. • Workers who fail to get sufficient rest may use the drugs to increase alertness. Low doses may cause a short-term improvement, greater use impairs functioning. • Hangover effect is marked by fatigue and depression. © Aurora Health Care, Inc. Drugs: Amphetamines
  31. 31. © Aurora Health Care, Inc. Americans love Opioids! Americans consumed 99% of the 39 tons of hydrocodone sold worldwide in 2009 Americans consumed 81% of the 77 tons of oxycodone sold worldwide in 2009 Source: Milwaukee Journal-Sentinel “FDA to weigh tighter rules on Vicodin” Jan. 23, 2013
  32. 32. Signs and Symptoms •Constricted Pupils Sweating •Nausea Vomiting •Diarrhea Slurred Speech •Loss of Appetite Slowed Reflexes •Drowsiness Fatigue •Mood Swings Depression •Apathy Euphoria •Stupor Fatigue •Impaired Coordination •“I Don’t Care” Attitude •Underestimation of Injuries © Aurora Health Care, Inc. Drugs: Opiates
  33. 33. Effects on Performance • The apathy caused by opiates can translate into an unconcerned attitude about performance. • The physical effects as well as the depression, fatigue, slowed reflexes and disregard for consequences impede a driver’s reaction time, raising the potential for accidents. © Aurora Health Care, Inc. Drugs: Opiates
  34. 34. © Aurora Health Care, Inc. Additional drugs/synthetic substances of abuse (beyond the 5 panel) • Barbiturates • Benzodiazepines (valium, etc.) • Methadone • Methaqualone (Quaalude) • Propoxyphene (Darvon, etc.) • Synthetic marijuana • Bath Salts-(K2/Spice)
  35. 35. © Aurora Health Care, Inc. Synthetic Drugs K2, Spice, Bliss, Blaze, etc. These are synthetic cannabinoids sprayed on herbs or dried leaves and sold as incense. Not for human consumption, unregulated production, unknown ingredients, appeal to young kids-(Ages 12-19 yrs)
  36. 36. © Aurora Health Care, Inc. Synthetic Drugs (cont.) Bath Salts This is not “Calgon calling”. these are substituted cathinones, a synthetic concentrated version of the active ingredient in khat, a psychoactive stimulant used in Africa and the Mideast Methylenedioxypyrovalerone (MDPV) is a psychoactive drug with stimulant properties which acts as a norepinephrine-dopamine reuptake inhibitor (NDRI) Products labeled as bath salts containing MDPV were previously sold as recreational drugs in gas stations and convenience stores in the United States, similar to the marketing for Spice and K2 as incense.
  37. 37. © Aurora Health Care, Inc. What about “Legal” Marijuana? Medical Marijuana is legal in many states Two states recently made recreational use of marijuana legal Federal law trumps state law. Marijuana is still illegal, e.g. for a DOT covered driver with a CDL
  38. 38. © Aurora Health Care, Inc. What Can Employers Do? • Human Resources • Supervisors/Managers • Employees
  39. 39. © Aurora Health Care, Inc. Employer Programs • Strong HR policies • Prehire testing • Post Accident testing • Supervisor training • EAP
  40. 40. © Aurora Health Care, Inc. Drug Testing • Type of drug testing • When to test • Designated Employer Representative (DER) • Medical Review Officer choice and relationship
  41. 41. © Aurora Health Care, Inc. Types of Testing • Pre-Employment • Reasonable Suspicion • Random • Post Accident • Return to Duty • Follow-up
  42. 42. © Aurora Health Care, Inc. Post Accident vs. Incident Post Accident. Injury to employee or someone else Post Incident. Damage to equipment, altercation, etc. *Must have a foolproof company policy!!
  43. 43. Reasonable Suspicion Guidelines • Alcohol or Drugs. Must be: – Specific – Contemporaneous – Articulable • Observations, concerning: – Appearance – Behavior – Speech – Body Odors © Aurora Health Care, Inc. Reasonable Suspicion Testing
  44. 44. © Aurora Health Care, Inc. Checklist Reasonable Suspicion Checklist Using a checklist facilitates the documentation of reasonable suspicion. (see sample)
  45. 45. © Aurora Health Care, Inc. Reasonable suspicion steps to take • Supervisor to meet with employee – Hold the conversation in private • Advise employee of your request that they be tested and reasons – Review completed reasonable suspicion checklist • Request employee to sign consent to test form • Arrange transportation of employee to and from testing site • Call police if employee attempts to drive themselves home
  46. 46. © Aurora Health Care, Inc. Reasonable suspicion-don’ts • Lose your temper • Moralize or preach • Attempt to diagnose or treat • Let employee “evade” the subject • Ignore poor performance by employee in the future • Place yourself in physical harm
  47. 47. © Aurora Health Care, Inc. Reasonable suspicion-do’s • Know your company policy • Document & keep records • Limit discussion to objective performance facts • Discuss consequences – Inform employee that they will be immediately suspended without pay until test results are confirmed & received by company – If negative, employee will receive back-pay • Keep confidential
  48. 48. © Aurora Health Care, Inc. What if the employee refuses the test? • Inform employee refusal to test will constitute insubordination and be considered a “positive” drug test • Discipline up to and including discharge • Arrange for employee’s transportation home • If employee demands to leave and drive him/herself, contact the police • Do not try to restrain employee yourself
  49. 49. Overview of EAP Process • Worker suspended from safety sensitive duties • EAP Counselor assesses worker • EAP recommends treatment or education • EAP monitors compliance or lack thereof • EAP recommends return to work test • EAP recommends follow up random testing © Aurora Health Care, Inc. EAP/SAP Process
  50. 50. © Aurora Health Care, Inc. Questions?

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