Workplace drug testing:Evidence and issues

Ken Pidd

National Centre for Education & Training on Addiction (NCETA)

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

2. 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)

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

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

% of workers using drugs (last 12 months)

Workforce drug use by industry

Construction workforce use in context

Risky alcohol use

YESYES

Drug 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

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

• Breath analysis (use increasing)

• Urinalysis (most common)

• Saliva (growing popularity & potential)

Types of workplace tests

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

Breath Testing

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

Urinalysis

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

Saliva testing

Methods of testing

• On-site screen (initial test)

• Laboratory analysis (confirmation of positives)

• 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

On-site drug screening

• 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

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

• 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

Pre-employment

(accident/near miss)• 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

Post accident/incident

• Advantages– Possibly most effective method of deterring use

• Disadvantages– Receives least support from employees– Most open to employer abuse– Fosters culture of mistrust

Random

For cause• Advantages

– Only applied to individuals ‘suspected’ of drug use/impairment

• Disadvantages– Can be used to victimise employee– Subjective application

•Deterrence effect?

•Reduces prevalence of injuries/accidents?

•Improves safety?

•Cost effective?

The efficacy of 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

Main problems with workplace testing

• 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)

• 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

Australian standards

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

www.nceta.flinders.edu.au

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