datia 2019 concurrent session under the influence or...

DATIA 2019 Concurrent Session

Under the Influence or Impaired:What’s the Difference?

Testing Options to ConsiderBrian P. Feeley

Substance Abuse Testing Division

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OraSure TechnologiesIntercept Oral Fluid Drug Test

– Collect anytime, anywhere

– Recent use detection

– Lab-based results

– Difficult to cheat

– FDA cleared

www.chooseintercept.com or call: 800-ORASURE

Ranked as the #1 recognized

brand name in oral fluid testing

in the 2018 national drug

testing industry survey

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Agenda

• Under the Influence vs. Impairment

• The Marijuana Issue and more

• Testing Methodologies

• Addressing the issues

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UNDER THE INFLUENCE VS.IMPAIRMENT

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Under the Influence Versus Impairment

What’s the difference between being under the influence and being

impaired?

• If you have one drink, you are under the influence, but not necessarily impaired

• Impairment occurs when you can no longer function at a normal level because of the consumption of alcohol or drugs

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What does it mean to be "impaired"?

• The state of being diminished, weakened or damaged, especially mentally or physically

• Consider this: A person who is actually impaired by alcohol can be convicted of impaired driving, whether or not the person’s blood alcohol content was over the “legal limit”

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A DUI test is a helpful example

• DUI can be proven by:• A cutoff level test• Signs of impairment• Breath or blood test

• DUI can also be proven by signs of impairment, without a chemical test

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Under the Influence Versus ImpairmentIs there a drug level or value you can assign to impairment in your policy?

• Currently there is NO scientifically accepted, legally defensible level of a drug that defines impairment

• Employers need to define this in there policy using terminology tied to signs/symptoms/behaviors/fitness for duty/lack thereof

• Use testing methods best suited for your business & application

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The Marijuana Issue

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https://www.bls.gov/ces/home.htm

Over 75% of U.S. employees live in a state where marijuana is legal in some form

123 million FT Employees in the US

Recreational MJ States = 33 Million Med Marijuana States = 63 Million Illegal States = 27 Million

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The Marijuana Issue

• Drug tests can identify parent THC & metabolites, but cannot pin point impairment

• As marijuana is legalized, marijuana impairment in the workplace becomes more of a challenge

Determining marijuana impairment is difficult

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Marijuana potency is not going down*

• In the 60’s, THC content in pot was about 1 - 2%• In 2014, THC content was 6.1% (national average)

• In CO, the average THC content was over 18% • THC-rich hash oil averages 50% with some waxes and

other products exceeding 80% THC!!!

• 20% of young workers admit to using marijuana on the job• Are they fit for duty??

If they are driving or operating any equipment for your company, this should cause you great concern

*Marijuana and the Workplace – A Guide for Employers (Drug Free America Foundation, Inc. & National Drug-Free Workplace Alliance)

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Positive rates are on the rise*

• In oral fluid samples, THC positivity increased nearly 75% from 5.1% in 2013 to 8.9% in 2017

• Among the federally-mandated, SAFETY-SENSITIVE WORKFORCE, THC positivity increased nearly 10% from 2015 to 2016, the largest increase in 5 years

• Marijuana users have 85% more injuries at work, 78% increase in absenteeism, 64% more disciplinary problems & 55% more industrial accidents compared to non-users


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Driving and Marijuana*

• “Driving under the influence of marijuana is dangerous, adversely affects concentration, coordination & perception, all important driving skills”

• Columbia University study concluded…drivers that are positive for marijuana were more than 2X as likely to be involved in a collision

• And…3-7X more likely to have caused the crash

• National Highway Traffic Safety Admin. reported a total economic cost of a vehicle fatality at ~$1.4 million (property damage, medical, insurance, productivity, etc.

• Marijuana can be impairing for 24 hours after a single use


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Not just about Marijuana…

• Remember, the condition of being “under the influence” or “impaired” is not just about marijuana

• Use of many prescription drugs can do this

• Combinations of drugs and alcohol

• Combinations of drug, alcohol & sleep deprevation

• Know the common signs and test for the drugs that tie to the behavior / signs being observed

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Common Signs of Under the Influence/ Impairment

Physical• Watery / red eyes

• Fatigue

• Slurred speech

• Sleepiness

• Constricted/dilated pupils

• Abnormal sweating

• Shakiness/tremors/unsteady

• Frequent accidents/incidents

• Smell of alcohol/drugs

• Poor job performance

Mental/Emotional• Poor concentration

• Big mood swings

• Outbursts of anger/argumentative

• Defensive

• Hyper/hypo activity

• Denial

• Poor judgement

• Lying

• Stealing

• Cheating

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2 Amtrak Worker’s Killed

Amtrak Accident, Chester, PA – April 3, 2016

30Million

Estimated damagestrain and tracks

Additional injury lawsuitspending!

• A 106mph train collided with a backhoe doing work on the tracks: • 2 Amtrak workers killed• 341 passengers were on

board• Cause of accident:

miscommunication • Tested positive for drugs:

• Engineer – marijuana• Worker #1 – cocaine• Worker #2 – opiates

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• BMW shut an assembly line down for 40 minutes on March 3, 2017, reportedly costing the company more than $1 million—after two drugged-out employees got high and collapsed while working

• The workers, who were assigned to the exhaust assembly area in the Munich factory, both reportedly smoked a joint in the locker room before attempting to work on the factory's evening shift. One of the employees also had a high amount of alcohol in his system, and the other was also under the influence of amphetamines, the report said.

• After collapsing, one of the workers had to be taken to an off-site medical facility

*Bild report March 20, 2017

Another example: Stoned Assembly Line Workers Cost BMW $1 Million in One Day, Report Claims*

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Workplace Incidents Related To Opioid Usage - NSCThree Quarters Of Employers Have Experienced The Effects Of Opioid Usage

37%

37%

30%

30%

22%

18%

18%

18%

17%

14%

8%

25%

Positive drug test results for illicit opioid use

Legal employee use of opioid pain relievers at work

Family member of employee affected

Absenteeism or missed work

Impaired or decreased job performance

Arrest (on/off job)

Illicit employee use of opioids at work

Complaints to HR or negative impact on morale

‘Near miss’ or injury

Borrowing or selling opioids at work

Opioid overdose

None of the above

Incidents Experienced Due To Opioid Usage …

75%… have been affected in some way

by employee use of opioids

38%… have experienced

absenteeism or impaired worker

performance

31%… have experienced a near-

miss/injury, overdose or arrest

Facts about the impact of opioids on US

Employers

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TESTING METHODOLOGIES

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Testing options…reasonable & fair??

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Drug Testing in the Workplace Today

• Urine – laboratory and instant/on-site tests

• Hair – laboratory• Oral fluid – laboratory and instant/on-site tests

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Testing Methods

Why Do You Test?

• Do you want to capture recent drug use, or long term lifestyle

• Do you want immediate results or to send specimens to a lab?

• Do you want to focus only on the bottom line?

• Are you required to and, if so, by whom?

Pre-employment

Random

For Cause

Post Accident

Return to Duty

Follow up

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Testing Methods

Not One Size Fits All AND It Is Not All Or None!

§ Different testing methodologies can be used for different situations – Historical, Recent and Immediate use

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What Method is Best for Your Application(s)?

Urine Hair Oral Fluid/Saliva

Ease of collection No No Yes

Invasive Yes Yes No

Accurate Yes Yes Yes

Subject to Tampering & Shy Bladder

Yes No No

Subject to Dilution Yes No No

Detects Recent Use No No Yes

Window of Detection Days/Week Months Immediate to Days

Legal/Defensible Yes Yes Yes

Allowed for Fed/DOT Yes Not yet Not yet

Instant test option Yes No Yes

Cost considerations Expensive to collect Expensive to collect Improved ROI in many cases

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Overall positivity in oral fluid: general US workforce

4.1% 4.2% 4.2% 4.4% 4.3%

5.5%

6.7%

7.7%

9.1%

10.5% 10.4%

0%

2%

4%

6%

8%

10%

12%

Overall positivity climbing in the past 10 years

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Source: Quest Diagnostics Drug Testing Index Full Year 2017

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Data source: Quest Diagnostic Drug Testing Index, Fall 2017

Oral Fluid vs. Urine Drug Testing & ROI implications

Positivity rates – general workforce samples (non-regulated)*

Overall Positivity Drug Test Urine Analysis (%)

Oral Fluid Analysis (%)

Marijuana 2.5 8.9

Cocaine 0.28 0.63

Amphetamine 1.2 0.66

Opiates 0.47 0.71

6-AM 0.037 n/a

Oxycodones 0.69 n/a

PCP 0.01 0.05

Methamphetamine n/a 0.42

Accuracy and performance like this has convinced HHS to add laboratory-based oral fluid testing to the SAMHSA federal guidelines

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Verified Positive Rates Highest with Oral Fluid

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1

2

3

4

5

6

7

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2015 2016 2017 2018

MRO Verified Positive Rates*

Urine Oral Fluid Hair

Averages: Urine 2.03% Oral Fluid 6.03% Hair 5.08%

*Data courtesy of Dr. Simo, HireRight

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ROI Considerations

• Fixed / Hard CostsØ Collection fees - ALL…in network and outØ Screening fees - ALL…instant test, device, lab fees…Ø Confirmation fee if not bundledØ MRO fees

• Direct / Indirect CostsØ Time away from work for collections / testingØ Fringe rates for employee, supervisorØ Other costs related to being out of work

Based on # of tests/year, positive rate

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Laboratory Based Oral Fluid - Legal Overview

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Situation:

An employee comes into work with red eyes, euphoric and speaking very slowly. He/she looks stoned!

What do I use?

Oral Fluid – detects very recent use - urine and hair may miss this reasonable suspicion/cause situation

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Situation:

A random test is due for an employee that falls under REGULATED testing requirements

What do I use?

Lab based Urine test – must comply with federal/DOT mandating testing until alternative testing methods are approved and implemented

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Situation:

An accident occurs in the warehouse with a fork lift driver running into a pallet of goods; he begin yelling at everyone, blaming others, and his speech is slurred.

What do I use?

Oral Fluid – detects very recent use - urine and hair may miss in this post-accident situation (alcohol testing seems in line as well)

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Situation:

You are hiring a senior financial analyst who will manage money and highly confidential information about your clients. Long term life style is important to you.

What do I use?

Hair Testing – detects long term use ideal for this situation

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Situation:

I have an employee who has been chronically late for work over the last 2 months and now recently has been looking very sleepy, shows a lack of concentration on tasks and today they ran their car into our loading dock after lunch.

What do I use?

This may be a good opportunity to combine Oral Fluid & Hair testing to detect very recent use and what this individual may be using over time.

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ADDRESSING UNDER THE INFLUENCE / IMPAIRMENT

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What Does an Employer Do?

Review your workplace drug testing policy…does it:

• Define a prescription?

• Define legal and illegal use?

• Address impairment and use on the job?

• Address marijuana?

• Allow for drug disclosure?

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Workplace & Marijuana

• States will continue to change policies,

adopt rules & face ongoing issues

• Rules will change

• Courts will have case rulings

• Stay educated

• Stay aware

• Be prepared to be flexible

• Always put safety first

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Preparing for the Future

A successful program includes:

• Policy

• Training

• Testing

• Discipline

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Key Take-Aways…

• Under the influence, impairment, unfit for duty – none should be tolerated, all should be managed in your policy

• It’s not just about Marijuana but any potentially impairing substance

• We have viable options to tests for very recent use

• Stay educated, legally advised and revisit your policy often

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Q&A

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For More Information

www.chooseintercept.com Phone: 800-ORASURE

[email protected]

datia 2019 concurrent session under the influence or...

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