Workplace drug testing: Evidence and issues

Workplace drug testing:Evidence and issues Ken Pidd National Centre for Education & Training on Addiction (NCETA)

Alcohol, drugs & the workplace: putting it into a safety context • Workplace drug testing as a response to safety risk

Workforce & workplace use • Workforce use • Overall use • Impact on workplace safety indirect & dependent on other factors (fatigue, hangover, health outcomes, addiction) • Workplace use • Use at work/work under the influence • Impact on workplace safety directly associated with use (intoxication/impairment)

Alcohol, drugs & the workplace: putting it into a safety context

Workforce alcohol use by industry % drinking weekly (or more often) at risk levels

Workforce drug use by industry % of workers using drugs (last 12 months)

Construction workforce use in context YES YES Drug use Risky alcohol use

Construction workforce use in context Risky alcohol use Drug use

Workplace use Alcohol use at work

Workplace use Drug use at work

Construction workplace use in context Work under the influence

Alcohol & drug related accidents • Up to 15% of all workplace injuries/accidents may be related to alcohol or drug use • At least 85% of injuries are not • Other factors associated with workplace injuries • Unsafe work conditions • Fatigue • Unsafe equipment • Poor/no training

2. Workplace drug testing as a response to safety risk

Types of workplace tests • Breath analysis (use increasing) • Urinalysis (most common) • Saliva (growing popularity & potential)

Breath Testing • Advantages • Onsite test that can reliably indicate alcohol intoxication/impairment • Non-intrusive • Wide acceptance • Disadvantages • Can only detect alcohol use • Requires constant calibration (can be affected by paint & solvents) • Cannot detect “hangover” effects

Urinalysis • Advantages • In-expensive (test) • Fully developed methodology • Fewer sample storage issues • Disadvantages • Collection can be expensive & time consuming • Cannot detect impairment/intoxication • Cannot detect hangover effects • Long window of detection (cannabis)ay miss

Saliva testing • Advantages • Relatively non-intrusive • Can detect recent use • Difficult to adulterate sample • Disadvantages • Can be difficult to collect sufficient fluid • Low reliability (cannabis) • Cannot detect intoxication/impairment • Cannot detect “hangover” effects • Sample can deteriorate at room temp

Methods of testing • On-site screen (initial test) • Laboratory analysis (confirmation of positives)

On-site drug screening • Advantages: • Relatively inexpensive (compared to lab testing) • Quick cost effective initial screen • Easy to administer • Disadvantages • Cannot distinguish between prescribed drug use & illicit drug use • On-site tests have a much lower level of accuracy & reliability than lab testing • Subject to user error

Laboratory drug analysis • Advantages: • Much more reliable & accurate than on-site tests • Can detect a much wider range of drugs • Can detect both the level of drug/drug metabolite present • but test itself cannot determine intoxication/impairment, amount use or pattern of use

Laboratory drug analysis • Disadvantages: • Can be expensive & time consuming • Cannot distinguish between legitimate prescription drug use and illegitimate use without donor’s medical background • As with on-site tests, some prescribed drugs/food stuffs can produce false positives • As with on-site tests, subject to human error

Testing programs Pre-employment Post accident/incident Random For cause

Pre-employment • Advantages • Cost effective method of screening out drug users • Disadvantages • Can deter skilled & capable workers from applying • Can screen in some drug users & screen out some non-drug users • Limited efficacy • Rationale based on false assumptions

Post accident/incident • Advantages • Allows collection of statistics on potential drug-related incidents • Disadvantages • Limited evidence of causal role • May lead to under reporting of minor accidents & near misses • May lead to delay in treatment seeking • Potential to jeopardise ‘no fault’ workers compensation schemes (accident/near miss)

Random • Advantages • Possibly most effective method of deterring use • Disadvantages • Receives least support from employees • Most open to employer abuse • Fosters culture of mistrust

For cause • Advantages • Only applied to individuals ‘suspected’ of drug use/impairment • Disadvantages • Can be used to victimise employee • Subjective application

The efficacy of testing • Deterrence effect? • Reduces prevalence of injuries/accidents? • Improves safety? • Cost effective?

Main problems with workplace testing • A test can only determine past drug use • It cannot determine: • the degree of impairment/intoxication • except alcohol breath analysis • the amount used or the time of use • how it was administered • If the person is a chronic/casual user or an addict • If the drug was prescribed

Testing may mask the true extent of risk • Underreporting of accidents & near misses • Avoidance • Change in pattern of use, masking agents, sample substitution • Testing may contribute to the risk • Displacement to more dangerous - but less detectable - drug use (ice/speed, synthetics)

Australian standards • AS 4760 – 2006 • Procedures for specimen collection & the detection & quantitation of drugs in oral fluid • AS/NZS 4308 – 2001 • Procedures for the collection, detection & quantitation of drugs of abuse in urine • Problems: • Voluntary • Mainly apply to laboratory, not on-site testing

Other issues • Lack of industry regulation • Lack of relevant legislation • Limited understanding of testing • May divert resources away from more effective strategies • Focus on individual worker • Employer control/intrusion

Thank you

Consultancy & Advice on: • Workplace AOD policies • Workplace AOD intervention strategies • Tailored employee awareness & education sessions • Tailored supervisor & OHS staff training programs • Evaluation of education, training & intervention strategies www.nceta.flinders.edu.au

Workplace drug testing: Evidence and issues