10/23/2013
Employer Drug Testing Employer Drug Testing Responsibilities
U.S. Drug and Alcohol Testing History The Designated Employer Representative Thwarting a Drug Test State and Federal Attempts to Legalize Marijuana Prescription Medical Review Issues The DER
Jeff P. Sims, C‐SAPA, C‐SI, President A’ TEST Consultants, Inc.
I Beat My Test
Public Safety
Pot, Inc.
Rx Abuse
Early regulations associated with drug and alcohol abuse • 1875 – First anti‐opium smoking law ‐ San Francisco • 1904 ‐ Pure Food & Drug Act ‐ Label drugs • 1914 ‐ Harrison Narcotics Act ‐ Prohibited narcotics
‐ The Anti‐Drug Abuse Act of 1986 (directed The U.S. Secretary of Labor to initiate efforts to address the issue)
• 1920 1920 ‐ Volstead Act ‐Prohibited sale of alcohol Volstead Act Prohibited sale of alcohol • 1935 ‐ Alcoholics Anonymous ‐ Organized • 1971 ‐ Vietnam drug use‐ led to “Operation Golden Flow” drug testing • 1982 ‐ USS Nimitz ‐ First Navy drug test program
‐ Drug‐Free Workplace Act of 1988 (required federal contractors and grantees to have drug‐free workplaces)
Most aggressive actions occurred since the late 1980’s:
‐ President Reagan’s Executive Order 12564, Drug‐Free Federal Workplace (made it a condition of employment to refrain from using p ( p y g illegal drugs)
‐ Drug‐Free Workplace Act of 1998 (establish grant programs that assist small businesses in developing drug‐free workplaces) ‐ Omnibus Employee Transportation Act of 1991 (required transportation industry employers to conduct alcohol and drug testing for employees in “safety sensitive” positions) It created a model for non‐regulated employers to now follow. Creation of 49 CFR Part 40.
Past Month Illicit Drug Use Among Persons Aged 12 or Older, 2010 and 2011 In 2011, an estimated 22.5 million (up from 20.4 million in 2006) Americans were current illicit drug users, which is a rate of 8.7% of the population aged hi h i f 8 7% f h l i d 12 or older.
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In 2011, of the 19.9 million current illicit drug users age 18 and over, 13.1 million or 65.7 percent were employed either full or part time.
Substance abusers are: 3.6 times more likely to be involved in a workplace accident 5 times more likely to file a workers’ compensation claim As many as 50% of all workers’ compensation claims compensation claims As many as 50% of all workers involve substance abuse
80% of those injured in “serious” drug‐related accidents at work are not the drug abusing employees… are not the drug abusing employees… but innocent co‐workers and others.
The responsibilities of the employer, not the provider
The DER
The DER is your key employee for many drug and alcohol functions The DER must be a company employee DERs cannot be contractors or service agents (exception is when C/TPAs function as DERs for owner‐operator truck drivers)
More likely to be involved in an accident and file a workers’ compensation claim More likely to quit or get fired More likely to steal from workplace More likely to miss work More likely to be in a confrontation Less productive
Key components of the job Understand the rules or laws governing the organization Identify those employees that will be subject to testing Manage and implement the employers drug and alcohol program policy Assigning responsibilities and contracting with service agents
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There are three general options when managing a drug and alcohol testing program: Option 1: Administer the program internally. You would have on your own staff Urine Specimen would have on your own staff Urine Specimen Collectors and Screening Test Technicians (STTs) / BATs, MROs, and Substance Abuse Professionals (SAPs) and support staff to run the program. The testing laboratory would be the only part of your program outside your own organization.
A service agent is any person outside your company that you use to help you implement the DOT regulations. These might include a urine collector, a BAT, an STT, a laboratory, an MRO, a SAP, or a C/TPA in charge of coordinating your testing services. Are your service agents qualified? When was the last time you checked their training records and the quality of work they do? Should I enter into a contract with a service agent?
Type of Service Agent
Responsibilities
Where can I find their qualifications?
Substance Abuse Professional (SAP)
Evaluate employees who have violated DOT drug and alcohol 49 CFR Part 40, Section regulations and make recommendations concerning education, 40.281 treatment, follow‐up testing, and aftercare. The SAP determines if the employee demonstrates successful compliance with the recommended education and treatment
Consortium / Third Party Administrator (C/TPA)
A service agent who coordinates a variety of drug and alcohol testing 49 CFR Part 40, Subpart Q services for employers. These services can include random selections, preparation, of annual Management Information System (MIS) Reports, and coordinating urine collections, laboratory testing, MRO services, alcohol testing, and SAP evaluations. A C/TPA must ensure the services it provides comply with DOT regulations and that its service agents are qualified.
Option 2: Outsource some of the program functions to service agents. For example, you could have your own MRO and SAP, but contract with Urine Specimen Collectors and STTs / BATs to perform the collections, while keeping a support staff to run the program. Option 3: Outsource all of the program’s functions to a vendor, called a “consortium” or a “third‐party administrator” (C/TPA), with only a DER and the DER’s support staff, if any, remaining in‐house.
Type of Service Agent
Responsibilities
Where can I find their qualifications?
Urine Collector
Collect urine specimens using Part 40 procedures, ship the specimens to 49 CFR Part 40, Section Department of Health and Human Services (HHS) certified laboratories for 40.33 analysis, and distribute copies of the CCF to the laboratory, MRO, employer, and employee in a timely and confidential manner. The collector is required to maintain collection site security and integrity.
Laboratory
Receive, analyze, and report laboratory confirmed results only to MRO’s. 49 CFR Part 40, Section The laboratoryy must be certified byy HHS. 40.81
Medical Review Officer (MRO)
Receive laboratory confirmed urine drug test results, determine whether 49 CFR Part 40, Section there is a legitimate medical explanation for a laboratory‐confirmed 40.121 positive, adulterated, or substituted result, and review and report a verified result to the employer in a timely and confidential manner.
Screening Test Technician (STT)
Conduct an alcohol screening test (i.e., the first test given to an employee). 49 CFR Part 40, Section It can be either a breath or saliva test. The STT documents the test results 40.213 on an ATF and transmits the results to the employer in a timely and confidential manner.
Breath Alcohol Technician (BAT)
Conduct alcohol screening and confirmation tests (i.e., the second test 49 CFR Part 40, Section given to an employee whose screening test result is .02 or above) by 40.213 collection and analyzing breath specimens using an approved screening device and an evidential breath testing (EBT) device, document the results of the test on a DOT ATF, and transmit the results to the employer in a timely and confidential manner.
What educational materials do I need to give to my employees? The name and contact information of persons assigned to answer questions about the program. The employee duties who are subject to the req irement requirement. Employee conduct that is prohibited by the regulations. The requirement that employees must be tested for drugs and alcohol. When and under what circumstances employees will be tested. The testing procedures that will be used. An explanation of what constitutes a refusal to test.
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An explanation of the consequences of refusing a test. The consequences of violating the DOT rules. Information on the effects of drugs and alcohol on a person’s health, work, and personal life. The signs and symptoms of drug use and alcohol misuse. The name and contact information of an individual or organization that can provide counseling and access to treatment programs.
What specimens are collected for DOT drug and alcohol tests? DOT drug tests are conducted only using urine specimens specimens. DOT alcohol screening tests are conducted using either breath or saliva. DOT alcohol confirmation tests must be conducted using Evidential Breath Testing Devices (EBTs) that only analyze breath.
Pre Employment Random Post Accident Reasonable S spicion/Ca se Reasonable Suspicion/Cause Return to Duty Follow Up
Type of Training
Duration
Documentation of Training Required?
Recurring Training Required?
Indicators of Probable Drug Use
1 Hour
Yes
Recommended as Best Practice
Yes
Recommended as Best Practice
Indicators of 1 Hours Probable Alcohol Use
Where must I have DOT urine specimens analyzed? DOT urine specimens can only be tested at drug testing laboratories certified by the HHS. There are no “point of contact” or “instant” tests permitted by the DOT. All specimens must be urine.
For what drugs does DOT require me to test? Marijuana metabolites / THC Cocaine metabolites Phencyclidine (PCP) Opiates (6 Am) Amphetamines, Methamphetamine, and Methylenedioxymethamphetamine (MDMA)
Immediately remove the employee from a safety sensitive function, AND Give the employee a list of qualified SAPs. This list must have a SAP’s or a SAP Network name and phone number who is suitable to you and readily available to the employee.
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• A face‐to‐face clinical assessment Recommendation of treatment and/or education Review of successful completion Review of successful completion A second face‐to‐face clinical assessment Formal letter of follow up plan to employer
•
Before you hire or transfer someone into a safety‐ sensitive position, you must check the person’s DOT drug and alcohol testing history. You need to check with any DOT‐regulated company that employed the person during the past two years – unless you are regulated by: l l t db
FMCSA requires a three‐year records check for drivers FAA requires a five‐year records check for pilots FRA requires a five‐year records check for locomotive engineers
What is considered a refusal, and who determines it? Event
You must get the person’s written consent to seek the information from other employers/ release information to future employers. Watch for individual state laws! Arkansas has a repository of drug and alcohol violators with a commercial drivers license.
Event
Decision Maker
DOT’s Instruction
Fails or declines to take an additional drug test the employer or collector has directed
Employer / DER after reviewing the collector documentation
If the employer or collector directs the employee to take an additional test, as required or permitted by the DOT, and the employee does not, it is a refusal.
Fail to undergo a medical examination or evaluation the MRO or employer has directed
MRO
If the employee does not go in for a medical evaluation or does not permit it to occur, it is a refusal.
FFails to cooperate il with any ih part of the urine collection process
E l Employer / DER / DER after reviewing the collector documentation
SSome examples of failure to cooperate are l f f il when the employee: 1. Refuses to empty pockets when directed; 2. Behaves in a confrontational manner that disrupts the collection process; 3. Refuses to remove hat, coat, gloves, coveralls when directed; or 4. Fails to wash hands when directed.
For an observed collection, fail to follow the instructions to raise and lower clothing and turn around
Employer / DER after reviewing the collector documentation
If the employee does not follow these instructions so that the observer can check for prosthetic or other devices that could be used to interfere with the collection process, it is a refusal.
Decision Maker
DOT’s Instruction
Fail to appear at a urine Employer / DER after If the employee did not get to the site or collection site when reviewing the collector spent too much time getting there, it is a directed to report documentation refusal. Fail to remain at the urine collection site
Employer / DER after If the collector reports that the employee reviewing the collector left the collection site before the testing documentation process was complete, it is a refusal.
Fail to provide a urine Fail to provide a urine specimen
Employer / DER after Employer / DER after If the collector reports that the employee If the collector reports that the employee reviewing the collector left the collection site before providing a documentation required specimen, it is a refusal.
Fail to permit a monitored or observed urine collection
Employer / DER after If the employer ordered an observed reviewing the collector collection or if the collector required the documentation collection to be monitored or observed, it is a refusal if the employee does not permit it to occur.
Fail to provide a sufficient amount of urine
MRO
Event
Decision Maker
If the MRO finds that there was no medical reason for the employee to provide an insufficient amount of urine, it is a refusal.
DOT’s Instruction
Employer / DER after Possess or wear a reviewing the collector prosthetic or other device that could be documentation used to interfere with the collection process
If the employee is found to have or wear a prosthetic or other device designed to carry clean urine or a urine substitute, it is a refusal.
Admit to the collector to having adulterated or substituted the specimen
Employer / DER after reviewing the collector documentation
If the employee, during the collection process, admits to having tampered with his or her specimen, it is a refusal. p ,
Adulterate or substitute a urine specimen
MRO
If the laboratory reports a confirmed adulterated or substituted specimen to the MRO and the MRO determines there is no medical reason for the result, it is a refusal.
Admit to the MRO to MRO having adulterated or substituted the specimen
If the employee, during the medical review, admits to having tampered with his or her specimen, it is a refusal.
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Event
Decision Maker
DOT’s Instruction
Fail to appear for an alcohol test when directed to report
Employer / DER after reviewing the STT or BAT documentation
If the employee did not get to the alcohol test site or spent too much time getting there, it is a refusal.
Fail to remain at the alcohol test site
Employer / DER after reviewing the STT or BAT documentation
If the STT or BAT reports that the employee left the collection site before the testing process was complete, it is a refusal.
Fail to provide an adequate Fail to provide an adequate amount of saliva or breath
Employer / DER Employer / DER after reviewing the STT or BAT documentation
If the STT of BAT reports that the If the STT of BAT reports that the employee left the alcohol testing site before providing a required amount of saliva or breath, it is a refusal.
Fail to provide a sufficient breath specimen
Evaluating Physician
If the evaluating physician finds that there was no medical reason for the employee to provide an insufficient amount of breath, it is a refusal.
Fail to undergo a medical examination as employer has directed as part of the insufficient breath procedures
Employer/DER
If the employee does not go in for a medical evaluation or does not permit it to occur, it is a refusal.
What drug and alcohol records do I keep and for how long?
Should receive twice a year from laboratory It’s primarily used as a monitoring tool Remember these statistics can be different from what is reported by the MRO Will not receive if under 5 test performed in a year
Event
Decision Maker
DOT’s Instruction
Fails to sign the certification statement at step 2 of the ATF
Employer / DER after reviewing the STT or BAT documentation
If the employee does not agree to have a test accomplished by signing Step 2 of the ATF, it is a refusal.
Fails to cooperate with any part of the alcohol testing process p
Employer / DER after reviewing the STT or BAT documentation
One example of failing to cooperate is when the employee behaves in a confrontational manner that disrupts the alcohol testing process. gp
An MRO’s refusal is final and not subject to review An evaluating physicians refusal is final and not subject to review
1. Alcohol test result greater than 0.02. 2. Positive drug test results. 3. Refusals 4. Annual MIS Reports 5. SAP reports, and follow‐up tests and schedules (Aviation employers must keep commercial pilot positives, negative, and refusals for 5 years because of the Pilot Record Improvement Act and must keep employee dispute records.)
1. Information obtained from previous employers under 40.25 concerning drug and alcohol test results of employees. (Pipeline operators must keep supervisor and employee drug training records, and records related to the drug collection process).
1. Records of impaction, maintenance, and calibration of EBT’s, and records related to the alcohol and drug collection process. (random selections, reasonable suspicion and post accident determinations, medical evaluations associated with shy lung/bladder, and supervisor/employee training records.
1. Records of negative and cancelled drug test results and alcohol test results with a concentration of l h less than 0.02 (Railroads must keep these records for two years).
2. Motor carriers must keep supervisor, employee, BAT and STT training records for two years after ceasing the function.
You are responsible for compliance, not the service agent What can happen to service agents who don’t pp g comply with the DOT rules? (PIE) How do I report a service agent who is not complying with Part 40.
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Just go to your favorite search engine or YouTube
• Can you beat the test by: 1 D i ki 1. Drinking a bunch of fluids? b h f fl id ? 2. Substituting urine? 3. Using a detox drink or additive? 4. Not allowing a direct observation?
I Beat M My Test My Test
Thwarting a Drug Test
Several states, including Arkansas, have adulteration laws. Drafted legislation in Congress exist (The Drug Congress exist (The Drug Testing Integrity Act), but has been waiting to be voted on. The industry is pushing for the Federal Trade Commission to act. Convictions have been upheld (Mr. Whizzinator).
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1. Can the ingestion of certain foods cause me to fail my test? 2 Does having a prescription always make it right? 2. Does having a prescription always make it right? 3. How do I interview the employee when they may have a disconnected phone, in the hospital, in jail, etc.? 4. “I have a medical condition that ………..?” 5. “It’s legal in that state, and my doctor recommended me to use it.” 6. The donor works in the heat all day, drink water to prevent dehydration, that’s why it’s diluted and looks like trying to beat the test.
Pot, Inc.
State and Federal Attempts to Legalize Marijuana Legalize Marijuana
California became 1st state to pass a medical marijuana law. Now 20 states and the District of Columbia have medical marijuana laws. All these laws vary: Acceptable amounts to possess Acceptable amounts to grow Routes to obtain Dispensaries Licensing Registration of patients & caregivers Penalties Most states do not require an employer to “accommodate” an employee who is on medical marijuana
Table 4.38.2011 Number of marijuana plants eradicated and seized, arrests made, weapons seized, and value of assets seized Under the Drug Enforcement Administration’s Domestic Cannabis Eradication/Suppression Program, by State, 2011a
State
Total cultivated plants eradicated
Outdoor Operations
Indoor Operations
Plots eradicated
Cultivated plants eradicatedb
Grows seized
Cultivated plants eradicated
Total
6,735,519
10,547
6,226,288
3,801
California
3,987,538
1,326
3,756,400
752
Note: These data were collected by the Drug Enforcement Administration (DEA) in conjunction with the Domestic Cannabis Eradication/Suppression Program. This program is a joint Federal and State effort in which the DEA contributes funding, training, equipment, investigate, and aircraft resources to the participating States in the effort to eradicate domestically cultivated marijuana.
Bulk processed marijuana (pounds)
Number of arrests
Number of weapons seized
Value of assets seized
509,231
113,167
8,501
5,181
$42,113,650
231,138
74,949
1,985
1,150
11,051,858
aDetail may not add to total because of rounding. bMay include tended ditchweed, a type of marijuana that
grows wild. Source: Table adapted by SOURCEBOOK staff from table provided by the U.S. Department of Justice, Drug Enforcement Administration.
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Arizona & Delaware prohibit an employer or school from taking adverse action against an employee on medical marijuana unless: The employer would lose federal funds, grants or other federal business The user is impaired by marijuana at work Th The user is in possession of marijuana on the work site i i i f ij th k it
“Pot entrepreneurs have high expectations for a future market in legalized marijuana.”
Employers in these states, when caught between opposing federal and state laws usually opt not to accept medical marijuana as a legitimate medical explanation. The courts have thus far consistently ruled that the states cannot force an employer to knowingly violate the federal drug laws.
http://www.usatoday.com/story/money/business/2013/ 04/07/medical‐marijuana‐industry‐growing‐billion‐ dollar‐business/2018759/
So far, no case law on Arizona’s prohibition on employer adverse action on medical marijuana users.
• Hemp, Inc. is a publicly traded company (Stock Symbol HEMP) that is working to expand its infrastructure while investing in profitable, legal, and diversified ventures, bringing reward and value to its shareholders • Marijuana, Inc., a division of Hemp, Inc., is working toward a green future with HEMP and is working to expand it’s infrastructure in preparation for possible legalization of marijuana and hemp.
•
Cheeba Chews, chocolate taffy infused with the active substance in marijuana, that were found on a Kansas State student on spring break in Gulf Shores on March 23, 2013, has raised concerns with drug education advocates.
• Marijuana, Inc. foresees and recognizes the possible benefits that may be derived from the many uses for industrial hemp and recognizing the profits that could be made.
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Marijuana Dispensaries in Los Angeles, CA
Local communities and counties that don’t agree with their state’s medical marijuana laws are passing local ordinances banning medical marijuana dispensaries within their borders. In California: Riverside banned them – banned them closed 15 dispensaries closed 15 dispensaries Riverside – Upland – ban Lake Forest – ban Long Beach – considering a ban Los Angeles – closed 180 dispensaries within the city limits
February 5, 2013: California Supreme Court heard the issue: Do local municipalities have the right to ban medical marijuana dispensaries within their city limits when state law permits them?
As of November 2011:
168 cities and 17 counties in the (then) 16 medical marijuana states which have prohibited medical marijuana dispensaries 80 cities and 10 counties have a moratorium on marijuana dispensaries Increasing D.E.A. pressure on landlords of buildings housing dispensaries
California Letters Currently in violation of federal laws 45 days to evict dispensaries Monetary fines Imprisonment Possible forfeiture of premises to the U.S. Government
Local laws are in disarray and lack consistency within several states. Courts are issuing conflicting rulings on the local bans. California Supreme Court will rule on legality of bans. Previously threw out argument that federal law preempts state law. Long Beach then replaced that ban and simply banned all medical marij ana dispensaries itho t comment medical marijuana dispensaries without comment. Nov. 6, 2012: Washington & Colorado legalize recreational use of THC •
What will Feds do? •
If nothing: watch medical THC industry die in Washington & Colorado
•
Watch THC become cheaper – cartels lose revenue
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Gonzales v. Raich 545 U.S. 1 (2005) Roe v. Teletech Customer Care Management, 060607 WAWDC, C07‐5149 RBL (W.D. Wash. 2007) Ross v. Ragingwire Telecommunications, Inc., 42 Cal. 4th 920, S138130 (Sup Ct. Cal 2008) Johnson v. Columbia Falls Aluminum Co., LLC, 033109 MTSC, DA 08‐0358 (MT Sup Ct 2009) Emerald Steel Fabricators, Inc. v. Bureau of Labor and Industries, 348 Or. 159 (Or. 2010) Beinor v. Industrial Claim Appeals Office of Colorado (Ct of Appeals of CO, 7th Div.) (CO. 2011) Casias v. Wal‐Mart Stores, Inc., 764 F. Supp. @d 914 (W.D. Mich. 2011) Coats v. Dish Network LLC, (CO Ct Appeals April 25, 2013)
DOT Statements “Medical Marijuana” § 40.151 What are MROs prohibited from doing as part of the verification process? – As an MRO, you are prohibited from doing the following as part of the verification process: following as part of the verification process: – (e) You must not verify a test negative based on information that a physician recommended that the employee use a drug listed in Schedule I of the Controlled Substances Act. (e.g., under a state law that purports to authorize such recommendations, such as the “medical marijuana” laws that some states have adopted.)
DOT Statements “Medical Marijuana” • “It remains unacceptable for any safety‐sensitive safety sensitive employee subject to drug employee subject to drug testing under the Department of Transportation’s drug testing regulations to use marijuana.” October 2009 ODAPC Medical Marijuana Notice
DOT Statement “Medical Marijuana” See the ODAPC statement issued by Jim Swart in October 2009: The Department of Transportation’s Drug and Alcohol Testing Regulation – 49 CFR § 40.151(e) – does not authorize “medical marijuana” under a state law to be a valid medical explanation for a transportation employee’s positive drug test result.
DOT Statements “Medical Marijuana” • Therefore, Medical Review Officers will not verify a drug test as negative based upon information that a physician recommended information that a physician recommended that the employee use “medical marijuana.” • Marijuana remains a drug listed in Schedule I of the Controlled Substances Act.
1990: John W. Huffman – Professor of Organic Chemistry at Clemson University Began synthesizing new analogs and metabolites of Δ9 THC To discover new pharmaceuticals To discover the exact nature & location of cannabis receptors in humans Over the next 21 years: S th i d 450 substances which will bind to the cannabis receptors Synthesized > 450 b t hi h ill bi d t th bi t and reproduce the effects of marijuana in humans Highly variable group of molecules, but all have the ability to bind to the receptor sites Vary in potency from very mild to many times more powerful than Δ9 THC itself Dr. Huffman published his work in legitimate scientific journals Clandestine labs use the publications as cookbooks to make these drugs and sell them to get around the marijuana laws in effect These drugs will not test positive for THC
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Began appearing in Europe, 2000 Became a problem in U.S. 2009 – several states banned them Marketed as: Bath Salts Bath Salts K2 Spice Ivory Wave I.V. Labeled: “Do Not Smoke” – which means: “Smoke This”
March 1, 2011: DEA invokes emergency authority to prohibit the commonest appearing “designer drugs” as Schedule I substances
Congress Passes the Synthetic Drug Abuse Prevention Act of 2012 Included 15 of Professor Huffman’s “designer drugs” Included 11 designer amphetamines Included provisions to add other drugs to Schedule I as needed
An ever changing market As current drugs are detected by labs and g y banned, the Clandestine labs start making new ones from their book of over 450 possibilities Constant demand by users for new, undetectable and unregulated drugs
Rx Ab buse buse
Prescription Drug Abuse
• Include clear information about the Employer’s position on Medical Marijuana in its Drug and Alcohol Testing Policy. j g g y • In your employee awareness session, go through the workplace related impairing effects of Marijuana. • Make it all about safety. • Watch the state laws carefully and do not take adverse action or impose disciplinary consequences against an employee or applicant that makes a Medical Marijuana claim without consulting knowledgeable legal counsel. • Treat medical and recreational Marijuana like any other impairing effect prescription medication or substance.
ER visits involving misuse or abuse of pharmaceuticals increased from 2004 (626,470 visits) through 2011 (1,428,145 visits) Most commonly involved drugs were anti‐anxiety and insomnia medications and narcotic pain relievers (160.9 and 134.8 visits per 100,000 population, respectively)
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Substances Pharmaceuticals Anti-anxiety and Insomnia Medications Alprazolam Clonazepam p Lorazepam Zolpidem Narcotic Pain Relievers Oxycodone Products Hydrocodone Products Methadone Morphine Products Antidepressants Antipsychotics Cardiovascular Medications Anticonvulsants Muscle Relaxants Respiratory Medications Central Nervous System Stimulants
Number of ED Visits in 2011* 1,428,145 501,207
Rate of ED Visits per 100,000 Population in 2011 458.3 160.9
154,016 76,557 50,399 37,225 420,040 175,229 97,183 75,693 38,416 108,388 76,197 55,543
49.4 24.6 16.2 11.9 134.8 56.2 31.2 24.3 12.3 34.8 24.5 17.8
155% 122% 127% 152% 153% 220% 96% 74% 144% NC 71% 63%
NC NC NC NC NC NC NC NC NC NC NC NC
53,142 52,830 46,819 45,158
17.1 17.0 15.0 14.5
51% 71% 76% 292%
NC NC NC 78%
Percent Change, 2004 to 2011** 114% 124%
Percent Change, 2009 to 2011** 13% 14%
Chain of events: 1. The donor arrived with supervisor for a FAA reasonable cause drug test 2 He mumbled, staggered, couldn’t stay awake 2. He mumbled staggered couldn’t stay awake and even washed his hands again in the urinal 3. He passed his drug and breath alcohol test 4. What does the employer do now?
1. Write a policy, or handbook statement and don’t forget about it. W k ith ATA t t i i Work with ATA to get an opinion. 2. Communicate with your medical review officer to determine the best course of action. 3. Special accommodations might be needed for certain employees. 4. Don’t rush without all the facts, seek advice when you are uncertain. 5. Let common sense prevail!
Thanks ATA! Jeff P. Sims, C‐SAPA, C‐SI
[email protected] 800.testN‐4u
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