Drug Use Prevention in the Workplace

Any drug treatment or rehabilitation program must take into consideration the biological, psychological, and societal causes and consequences of drug abuse. A policy begins with the employer's recognition of the problem, which may be triggered by government requirements, an insurance company's or subcontractor's contractual requirements, by an injury or accident, by discovery of drugs or drug use on the work premises by law enforcement, or by the confrontation of a drug- or alcohol-intoxicated employee (Table 10.7).

Table 10.7. Industrial Drug Program.

Employer's recognition for a need of a drug program triggered by: Government requirement Insurance company requirement Injury or accidents Discovery of drugs or drug use Confrontation with an intoxicated employee Decision for action:

Recognize the costs and consequences Select consultants Creation of a company policy: Use attorneys and consultants

Decide which modes of testing will be conducted: preemployment, for-cause, random, postaccident, return-to-duty, follow-up Short and easily understandable policy transmitted to the employees in writing Must be fair and applicable to all employees

Selection of collection company, testing lab, medical review officer (MRO), and counselors; have this arranged ahead of time Education: Employees: About drugs

About the company policy Supervisors: About drugs

About the company policy

Recognition of drug syndromes and what to do when noticed Testing process (variations of this process may be used from company to company and situation to situation):

Employee (or applicant) is informed of the need for a test; a written request form is issued. Collection point:

Chain-of-custody and identification forms completed

The employee is positively identified through a driver's license, passport or other form Specimen is provided by the employee: Witnessed if there is reason to believe the individual is trying to fake a test Bottle is sealed and marked in the presence of the donor Specimen is stored in a secure location and chain-of-custody forms completed Transportation:

By secure courier and using chain-of-custody forms Testing:

Secure, reliable laboratory Maintain chain-of-custody

Confirmation of positive results with a second, alternative method Written reports Medical review officer (MRO): Reviews all positives in regulated testing May be asked to review all positives in nonregulated testing Provides written report to employer Employer:

Action according to stated company policy: Do nothing

Remove the employee from duty until rehabilitation is completed Keep the employee on duty until rehabilitation is completed Terminate employment

Once the problem is recognized, the supervisors and managers of the company must be willing to engage in a detection and prevention program. Through research, education, or consultation with a specialist, the company management makes a decision for action, knowing there will be an expense for testing and that employees may have to be terminated from employment. Management must be prepared to litigate if challenged and take their policy as far in the courts as is needed to protect their program.

When the company management has demonstrated willingness to proceed, a short, understandable, and blunt policy is formulated in lay language. Consultants or attorneys will usually have input in the policy that lays out the forbidden conditions or actions and resultant discipline. The policy needs to be communicated to the employees with documentation. In 2000 in the United States 76% of full-time workers aged 18 to 49 (more than 66 million workers) were aware of written policies on substance use at their workplace. Awareness was greatest in administrative support personnel and smallest in precision production crafts and repair. Government employees were more aware of alcohol- and drug-use policies than any other industry. While not specifically studied, agriculture, which has a mix of workers in different categories, seems to be in the middle (19).

Utilizing consultants, the company will typically conduct an education program on drug abuse for employees and an additional class on the recognition of drug use behavior for supervisors. Once the policy is in place, the company can begin testing, typically using a third party such as a physician, laboratory, clinic or collection company.

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