Drug & Alcohol Testing in the Workplace Training for Supervisors

1. Drug & Alcohol Testing in the WorkplaceTraining for Supervisors Presented by VickiL Hanson Occupational Medicine Drug Testing Coordinator Essentia Health Clinic West Fargo

2. A new Surgeon General’s Report on Drugs & Alcohol Alcohol and drug misuse and severe substance disorders, commonly called addiction, is one of America’s most pressing public health concerns Nearly 21 million Americans – more than the number of people who have all cancers combined, suffer from substance use disorders

3. DOT Required Training DOT requires 60 minutes of training on drugs, and 60 minutes of training on alcohol, before an employer/supervisor may request an employee to take a reasonable suspicion drug and/or alcohol test Training is for: Supervisors Management Lead people Anyone who is in the position to observe staff performing safety sensitive job functions

4. Reasonable Suspicion Best tool to deter drug and alcohol use in the workplace When employees know they can be tested for drugs and/or alcohol, they may abstain from using substances that will cause impairment Saves lives, prevents injuries Reduces employer liability because you are exhibiting “good faith effort” do have a drug-free workplace Allows employees to easily say “NO” to illegal drug use

5. Why is a drug and alcohol testing program important? • Safety of employees • Increases productivity • Reduces turnover rate • Company reputation

6. Benefits of Testing Be proactive rather than reactive Company reputation is important Possible Workers Comp discounts DOT - It’s the law

7. Promote aDrug-Free Workplace Ask all employees to share the responsibility of promoting a Drug-Free Workplace

8. Designated Employer Representative (DER) Employee/employees who are responsible for your company’s drug and alcohol testing program

9. Substance Abuse in the Workplace Workplace theft Destruction of equipment Workplace violence Higher absenteeism Lower productivity Higher turnover Performance problems Higher medical costs Higher worker’s compensation costs Good employees may leave if nothing is done

10. According to the U.S. Department of Labor, the following signs & symptoms may indicate possible substance abuse: Performance Inconsistent work quality; Poor concentration; Lowered productivity; Increased absenteeism; Unexplained disappearances from the jobsite; Carelessness, mistakes; Errors in judgment; Needless risk taking; Disregard for safety; and Extended lunch periods and early departures. Source: United States Department of Labor. Available at: http://www.dol.gov/asp/programs/drugs/workingpartners/materials/symptoms.asp

11. Behavior • Frequent financial problems; • Avoidance of friends and colleagues; • Blaming others for own problems and shortcomings; • Complaints about problems at home; • Deterioration in personal appearance; and • Complaints and excuses of vaguely defined illnesses. • Source: United States Department of Labor. Available at: http://www.dol.gov/asp/programs/drugs/workingpartners/materials/symptoms.asp

12. Testing Terminology • Government Certified Laboratory • Screening test (initial screening) • Confirmation test (2nd test on same sample) • Split specimen re-confirmation test

13. Medical Review Officer(MRO) • Licensed Physician • Reviews Laboratory Results • Evaluates Medical Explanations

14. Direct Observation Same Gender Observer Required • Temperature out of range • Specimen appears adulterated • Donor behaves suspiciously or displays items to adulterate or substitute sample • Previously tested positive • Instructed by MRO

15. Shy Bladder Procedure • Unable to provide 45 mL sample • Must remain at collection site up to 3 hours or until 45 mL sample provided • May be allowed to drink up to 40 ounces of water • Leaving before 3 hours without providing sample is the same as refusing to test

16. Refusal, Adulterated, Substituted or Positive • All are treated as positive results • Must be removed from safety-sensitive position • Must see Substance Abuse Professional (SAP) and have a negative RTD result before returning to safety-sensitive functions

17. Substance Abuse Professional (SAP) • Special educational requirements to meet DOT regulations • Performs evaluation following positive or refusal test result • Determines RTD & FUP test schedules • Cannot provide treatment 49 CFR Part 40 Subpart O

18. Types of Tests Pre-employment Post-accident/Injury Random Reasonable Suspicion Return-to-Duty (must be observed) Follow-up/unannounced (must be observed)

19. Drugs That Are Tested/Detection Times Alcohol - dissipates at a rate of 1 oz. per hour and a half Marijuana - up to 30 days Cocaine – up to 4 days Amphetamine, Methamphetamine, MDMA-Ecstasy – 24-48 hours Opiates, (Opium, Codeine, Morphine & Heroin – 2 days Phencyclidine – up to 8 days

20. 10-Panel Drug Test MedTox Test #88797 for Non-Regulated Employees Only • Amphetamines • Barbiturates • Benzodiazepines • Cocaine • Opiates • Oxycodone • Phencyclidine • Marijuana • Methadone • Methaqualone • Propoxyphene

21. Medical Review Officer A licensed physician with knowledge of substance abuse disorders Knowledgeable about issues relating to adulterated, substituted specimens and invalid test results Knowledgeable about DOT agency regulations

22. Alcohol Test Many over-the-counter medications contain alcohol When to test: Just prior to, during or immediately after performing safety sensitive duties Breath alcohol testing is more accurate than urine alcohol testing at determining current levels of alcohol in system Breath alcohol values are approximate to blood results

23. Alcohol Test (DOT Approved Methods) Breath/EBT device (Screening and Confirmation) Operator of Evidential Breath Testing (EBT) device must meet strict DOT training requirements Saliva Swabs - Screening test only Swabs must be DOT approved Positive results must be confirmed by Breath

24. DOT Breath Alcohol Test Results • 0.020 – 0.039 Employee is removed from safety-sensitive duties for 24 hours • 0.040 or > Employee immediately removed from safety-sensitive duties

25. Consequences of a Positive Test Immediately removed from safety sensitive duties A referral must be made to a Substance Abuse Professional (SAP) Employee cannot return until recommended by SAP Return-to-Duty test must be negative Employee subject to unannounced, follow-up testing determined by the SAP

26. Refusals to Test Fail to appear for any test within a reasonable time Fail to remain at the testing site until testing is completed Fail to provide a urine or breath sample Failure to provide a sufficient amount of urine or breath sample Failure to permit observation or monitoring of the specimen collection if required

27. Consequences of a Refusal Immediately removed from safety sensitive duties A referral must be made to a SAP (Substance Abuse Professional) Employee cannot return until recommended by SAP Return-to Duty test is negative Followed by unannounced, follow-up testing

28. Supervisor Responsibilities Definition of Reasonable Suspicion Drug and Alcohol Testing Policy Role in supporting and enforcing the policy

29. Supervisor Responsibilities Definition of Reasonable Suspicion Drug and Alcohol Testing Policy Role in supporting and enforcing the policy

30. Reasonable Suspicion DOT - Reasonable Suspicion determination must be made on specific, contemporaneous, articulable observations based on employees conduct, behavior, appearance, speech and odors.

31. Reasonable Suspicion One or more supervisors must be trained before they can to make a Reasonable Suspicion determination when they believe or suspect that the individual is under the influence of drugs and/or alcohol. Supervisors should be in direct contact with employees so they are aware of usual and unusual behaviors Decisions to test must be made on direct observations, not based on a hunch or guess

32. Supervisor Responsibilities “A referral for Reasonable Suspicion testing is not an accusation”

33. Short Term –Physical Indicators Bloodshot or watery eyes Flushed or very pale complexion Profuse sweating, clammy skin Sleepy, stuperous Difficult to arouse or wake up

34. Short Term –Physical Indicators Hard time focusing Unkempt grooming Runny, irritated nose Unstable walking, lack of coordination Possible puncture marks Sensation of “bugs crawling on skin” – crank sores

35. Short Term –Physical Indicators Hand tremors, shaking Irritating cough, chronic sore throat Facial itching Mouth and gum problems – “Meth mouth” Increased heart rate, rapid respiration Jerky eye movements Muscle rigidity

36. Short Term –Behavioral Indicators Slowed reaction rate Depressed, withdrawn Lackadaisical attitude Diminished concentration, confusion Delayed decision making, dulled mental processes Loss of inhibitions, impaired judgment

37. Short Term –Behavioral Indicators Hyper-excitability, restlessness Anxiety, agitation Mood changes, unpredictable behavior, panic Combative, argumentative Paranoid, suspicious Hallucinations

38. Short Term –Speech Indicators Slurred or slowed speech Loud, boisterous Incoherent, nonsensical, repetitious, rambling Cursing, inappropriate speech Rapid, pressured Excessive talkativeness and enunciation

39. Short Term Indicators – Body Odors Odor of alcoholic beverage on breath or clothes Distinct pungent aroma on clothing or person Strong chemical odor

40. Long Term Indicators Long term indicators - most reliable group of indicators Long term indicators – changes observed over days, weeks or months Long term indicators - may not be used to make a reasonable suspicion referral Always use short term indicators in making the Reasonable Suspicion determination

41. Long Term Indicators Work performance problems (quality and quantity) Personality changes: aggressiveness, moodiness, depression, anxiety, fearfulness Personal hygiene and physical appearance Social withdrawal: isolation, lack of eye contact Overreaction to criticism

42. Long Term Indicators Chronic problems Tardiness Absenteeism (Mondays, after holidays, andpaydays) Leaves work without notice Accidents Poor judgment Difficulty in concentrating Gives improbable excuses for absences

43. Alcohol

44. Which is More Intoxicating? Beer – 12 oz x 5% Alcohol = 0.6 oz ethanol Wine – 5 oz x 12% Alcohol = 0.6 oz ethanol Spirits - 1.5 oz x 40% Alcohol = 0.6 oz ethanol Same amount of ethanol (0.6 oz)

45. Effects and Skills Impaired by a Hangover Headache Nausea Dizziness Fatigue Thirst Eye ache Shaking Reflexes Coordination Professionalism Perception Judgment Comprehension

46. Marijuana

47. Marijuana

48. What is Marijuana? Dry, shredded green/brown mix of leaves, flowers, stems and seeds Hemp plant – Cannabis sativa Hashish – more concentrated, resinous form THC – delta-9-tetrahydrocannabinol (mind-altering) chemical Pungent and distinctive, usually sweet and sour odor

49. How is Marijuana used? Smoked in hand-rolled cigarettes (joints) Smoked in pipes or water pipes (bongs) Smoked in blunts – cigars that have been emptied of tobacco and refilled with a mixture of marijuana and tobacco Can also be mixed in food sold as candy or brewed as tea

50. Marijuana Usage Facts The amount of marijuana required to generate a high depends on: THC content of the marijuana Individual’s weight, height, and body type Skills are impaired for 4 to 6 hours after smoking one joint, but some people show effects for up to 24 hours. THC may stay in a person’s system for up to 30 days or longer