INTRODUCING TESTING AS PART OF A WORKPLACE ALCOHOL AND DRUG POLICY

BARBARA BUTLER & ASSOCIATES INC.

Any decision on testing should be made with full understanding of what is involved and the role it can play. It requires careful assessment of whether alcohol and drug testing should or should not be included in your company policy - in other words, you should be able to explain how it contributes to the company’s overall safety objectives. There are many associated decisions that need to be made in light of overall objectives. Your policy and program should be clear on a number of fronts:

  • who is subject to testing?
  • under what circumstance?
  • for what substances (and cut-off levels at or above which the test would be positive)?
  • what technology will be used for sample collection and analysis?
  • what will the consequences be for a positive result or refusal to test (including tampering or adulteration)?

Once these decisions are made, you need to identify an internal Program Administrator to manage the program, and contract for appropriate and qualified services for external administration of your program. This would include:

  • trained and experienced collection services;
  • a laboratory certified by the U.S. Department of Health and Human Services (DHHS);
  • a certified Medical Review Officer (MRO) who is independent of the laboratory - an essential part of any workplace testing program; and
  • in the case of a positive test or other violation, the services of a trained Substance Abuse Professional (SAP) to assess whether the employee has a problem in need of accommodation.

As a result of recent trends and activities in Canada, an infrastructure has been established to support the introduction of testing programs, and companies exploring the option of including testing under their policy can be assured of reliable and accurate results - provided they use qualified and experienced service providers. When contracting for external services, companies/organizations should be extremely clear in identifying their program needs, so that they do not end up with products, or a long term service delivery contract, that does not meet those specific requirements or provide the necessary level of quality in the most cost-effective manner.

You can contract these services separately and fully manage the program internally, or contract with a Third Party Administrator (TPA) to manage all external parts of the program. In addition to organizing and coordinating the collection, laboratory analysis and medical review of test results, the TPA can also provide independent selection of unannounced testing dates for individuals on a follow-up program, manage the random selection program if required, and can provide advice on Substance Abuse Professional (SAP) services.

The series of questions and answers attached provides clarification of how the testing process works and the roles and responsibilities of the various service providers involved in the program.

QUESTIONS AND ANSWERS ON ALCOHOL AND DRUG TESTING

What is the role of a company Program Administrator? Every company that introduces a testing program needs to identify an internal Program Administrator (PA) who is the primary liaison point with the collector and Medical Review Officer (MRO) for the test results. The PA also receives the names for random or unannounced (follow-up) testing, usually selected by a Third Party Administrator, and then triggers the internal process to have the testing done. The PA is normally the key internal information resource for the company alcohol and drug policy, answering question of interpretation, maintaining all records, and ensuring appropriate communication with employees and contractors, and that training of supervisors takes place.

What is a Third Party Administrator? Many testing programs in Canada are managed by a Third Party Administrator (TPA) – an independently contracted service which ensures proper procedures are in place for a company’s testing program. The TPA contracts the lab and collection services, provides MRO services, provides random or unannounced selection for testing if the program requires it, and provides guidance and support in all parts of the testing process. The TPA is the primary contact for the company’s internal Program Administrator.

How does alcohol testing work? Employees required to undergo an alcohol test will be expected to provide a breath sample for analysis in an Evidential Breath Testing Device (these have been accredited by the U.S. National Highway Safety Administration for their accuracy). Samples will only be collected by someone who has been trained for proficiency in using the device (called a Breath Alcohol Technician or BAT). If the first test or “screen” is at or above the cut off level, the employee will wait at least 15 minutes but not more than 30 minutes to provide an additional breath sample (the confirmation test). The employee will immediately receive a printed copy of the result, and another copy will be forwarded to the company.

When a breath analyzer is not immediately available, the first step would be to use an alternative screening device – usually a saliva test. If it is negative, no further testing is done. If it is at or above the cut-off level, a breath sample must be collected within 30 minutes. In programs which are not subject to DOT regulation, and where a breath analyzer is not readily available, some companies require a second urine collection which will be forwarded to the laboratory for analysis. This is only recommended as an alternative measure if a breath sample is not available, as there are special collection and analysis procedures that must be followed to obtain a true result, and even then it is difficult to link a urine test result to a level of impairment as compared to breath testing.

What constitutes refusal to submit to an alcohol test? Under most company programs, refusal to an alcohol test would include refusal to be tested, failure to cooperate with the collection process, failure to complete and sign the certification on the breath alcohol testing form and failure to remain readily available for testing following an accident. Normally this would trigger disciplinary consequences under a company policy.

Individuals would also be determined to have refused to submit to a test if a licensed physician is unable to determine that a medical condition has, or with a high degree of probability could have, precluded the employee from providing an adequate amount of breath at the time of sample collection, and if they refuse to allow the results to be reported to the company Program Administrator.

Can errors occur in the breath testing?
Errors are eliminated in the breath testing process because:

  • the tests are performed on a calibrated and maintained breath testing device;
  • that two samples are taken at least 15 minutes apart (if the first sample tests at or above the cut-off level); and
  • that all tests are performed by a trained collector or Breath Alcohol Technician (BAT), or Screening Test Technician (STT).

How does drug testing work? The process follows a number of key steps to ensure accuracy:

  • urine samples are collected by trained collectors following stringent procedures set out in American regulations and replicated in Canadian programs;
  • a form (called a custody and control form or CCF) follows the sample through the process to document everyone who handled it, when, and why, to ensure there has been no possibility of tampering with or switching of specimens;
  • the samples are analyzed by laboratories accredited by the Department of Health and Human Services (DHHS) as meeting the highest standards of accuracy to determine if the drug is present;
  • a small portion of the sample is first analyzed by an immunoassay technique to distinguish samples that are potentially positive for drugs from those that are negative;
  • those that show positive on the screen, or indicate tampering, are then analyzed using another portion of the original sample and analyzed by a technique providing a greater level of confidence (gas chromatography/mass spectrometry or GC/MS); and
  • only those samples that are confirmed as positive for a drug or identified as tampered or adulterated after this second analytical procedure will be reported as such to the Medical Review Officer (MRO) for a discussion with the employee.

How does on site screening (‘quick test”) work? The process is almost identical to that noted above. The only difference is that the immunoassay screening step is part of the sample collection stage. If, in completing the process, the collector concludes that the sample is not negative (e.g. there are indications of drug presence, tampering or adulteration), the sample will be sealed and sent to the laboratory for analysis.

What constitutes refusal to submit to a drug test? Under most company programs, refusal to submit to a drug test would include refusal to be tested, failure to cooperate with the collection process, confirmed tampering with the sample, and failure to remain readily available for testing following an accident. Normally, this would trigger disciplinary consequences under the company policy.

Individuals would also be determined to have refused to submit to a test if a licensed physician determines that there is no medical reason to support a person’s alleged inability to provide a sufficient quantity of urine for a drug test, and if they refuse to allow the results to be reported to the company DER or Program Administrator. The MRO will report a refusal for any specimens verified as being adulterated or substituted.

What is the role of the Medical Review Officer (MRO)? The MRO makes the final decision on whether a non-negative laboratory drug test result will be reported as being positive, negative, cancelled, invalid, or a “refusal to test” to the company. He or she is a licensed physician responsible for receiving the laboratory results. The MRO must have knowledge of substance abuse disorders and appropriate medical training to interpret and evaluate a confirmed positive drug test or refusal.

The MRO will contact the employee and discuss any alternative medical reasons for the result before reporting to the employer whether it is a true (or verified) positive, a verified refusal (adulterated or substituted sample), invalid, cancelled, or a negative result. The MRO is always independent of the laboratory and is not an employee of the lab.

Can someone appeal the MRO’s decision? No.

Can someone appeal the Laboratory’s Results? Yes – they can have a further test done on their sample. When the sample is initially collected, it is split into two bottles (Sample A and Sample B) which are both sealed by the collector and initialed by the donor. If after discussion with the MRO if you disagree with the MRO’s conclusion that sample (A) was positive, you can request that Sample B be analyzed by a certified lab of their choice.

In the meantime, the MRO must advise the company that a second analysis is being undertaken and act on the results as per their company policy or the DOT regulations if applicable. However, if the second lab reports Sample B does not contain presence of the specified drug(s), and the appropriate testing is done to rule out the impact of adulterants, the MRO will report the result as cancelled to the company.

How do we know that the test results are accurate? Accuracy of the testing process is assured when companies use trained/ qualified collectors, use a DHHS certified laboratory that maintains its accreditation and is subject to ongoing unannounced blind or proficiency testing (a process to ensure the lab maintains its accuracy), the custody and control form is correctly filled out and properly follows the sample, and an experienced MRO reviews and confirms all positive results.

If someone is tested, who gets the results? In the case of an alcohol test, the collector will notify the company Program Administrator directly to advise of the test results. The MRO is not involved in the alcohol testing process except in limited cases of a urine alcohol test conducted by the laboratory.

The company’s Medical Review Officer will receive the drug test results directly from the laboratory on a confidential basis, and review non-negative results with the employee to determine whether the test is a refusal (adulterated or substituted), a true positive, invalid, cancelled, or a negative before anyone in the company is made aware of the result. If the MRO concludes that the test is positive, invalid, cancelled, or a refusal, he will notify the company DER or Program Administrator directly.

Can false positives occur in the urine drug screening?

A false positive situation would be found when a sample is reported to contain a drug that is not actually present in the sample. If all of the procedures listed below are followed, than a false positive can not occur:

  • all steps are taken to ensure integrity of the sample (including no breaks in the chain of custody);
  • all tests are performed by qualified personnel at a certified laboratory; or
  • all on site tests are performed by qualified collectors using accepted screening devices with adulterant checks, and any screening non-negative are forwarded to the laboratory for confirmation;
  • there is adherence to a stringent quality assurance/quality control program (as directed through the Department of Health and Human Services accreditation and certification procedures);
  • all positives on the first screen are confirmed by a different analytical method, which is gas chromatography/mass spectrometry;
  • all documents are checked by at least two qualified individuals to ensure there are no typographical errors;
  • all results are reviewed by a qualified supervising chemist before being forwarded to the Medical Review Officer; and
  • the MRO reviews the result with the employee to determine if there was a legitimate medical reason for the positive.

If someone gargles with mouthwash will they test positive for having alcohol? No. Proper use of mouthwash would not result in a positive breath test. However, if someone actually drank the mouthwash in sufficient amounts they may test positive for alcohol, and it will, indeed, impair their ability to perform. This would be the same for any medication containing alcohol.

Can passive inhalation of marijuana smoke lead to a positive test even if the employee did not smoke the joint? No. People will often claim that inadvertent exposure to marijuana smoke is the reason for their positive test result. Passive inhalation can result in detectable levels of THC metabolites (the primary pharmacological component of marijuana) in urine. However, clinical studies have found it is highly unlikely that a non-smoking individual could inhale sufficient smoke by passive inhalation to result in a high enough drug concentration to exceed the cut-off levels. The matter would be discussed with the MRO before a positive result is reported.

Will prescription medications result in a positive test result? The majority of day to day medications (like antibiotics, antihistamines, anti-depressants, aspirin, Tylenol, insulin) will not be detected by the test, because the laboratory is only directed to test for specific substances. These are, marijuana, cocaine, opiates (e.g. heroin) amphetamines (speed, some diet pills) and PCP (street drug).

Because some cough medications and strong painkillers contain opiates, they will be identified by the laboratory if they are present at or above the cut-off level. The employee will have an opportunity to discuss the test result with the Medical Review Officer; legitimate, authorized, and proper medication use will not be reported as a positive result to the company.

Will poppy seeds cause a positive test result? Poppy seeds contain opiates, and the lab is testing for presence of opiates to confirm recent use of codeine, morphine, and in some cases, heroin. With the higher opiate cut-off levels now established, it is less likely that the lab would find a positive opiate test result from poppy seeds. However, any time a sample contains a morphine concentration at or above the cut-off level, a special test is done to confirm heroin use (6-AM). If it is present, the MRO must declare the test is positive. If absent, but there is a level of morphine or codeine present at or exceeding 15,000 ng/ml, the employee must provide a legitimate medical explanation – food products including poppy seeds could not test positive at these levels. At lower levels reported above the cut-off of 2000 ng/ml the MRO must have clinical evidence of unauthorized use of opium, opiate or opium derivatives before a positive result can be declared. In other words, in these situations, food products or legitimate use of non-prescription medications would not be reported as positive.

Why is the alcohol cut-off level .04 BAC when the standard for driving is .08 BAC? The percentage of blood alcohol content (BAC) is a quantitative measure of the grams of alcohol present per millilitre of blood, in other words, the weight of alcohol with respect to volume of blood. The scientific community has concluded that even the lowest levels of blood alcohol content can result in a decline in the body’s ability to perform to its full potential.

For most adults, alcohol presence up to .04% BAC will result in a reduction in sensory and cognitive performance. In addition, at .04% BAC, virtually all individuals experience decreased cognitive abilities resulting in impacts on perception, visual field, tracking, information processing and performance of multiple tasks. At higher levels, cognitive skills can be seriously impaired, and coordination, balance and vision are visibly impaired for most individuals.

Although the current standard for impaired driving is .08% BAC at which point a charge under the Criminal Code is issued, drivers can be charged for impaired driving at lower levels, and will temporarily lose their license under provincial highway legislation if their breath test result is at .04% BAC or .05% BAC depending on the province.

A consistent practice in Canada has been to set .04 BAC as the level at or above which would be a policy violation, and this level has been upheld in court and arbitration decisions. However, under U.S. DOT regulations for motor carrier drivers, and in the case of some company programs with high risk positions, individuals with a test result of .02 to .039 BAC are removed from safety-sensitive duties for a specific period of time. In addition, in the situation of follow-up testing after treatment or a policy violation, the normal practice is to establish a cut-off level of .02 BAC. If an employer is going to undertake alcohol testing, their policy must be clear on what cut-off levels they are using, and what the consequences will be for a test result that exceeds the cut-off.

How long do drugs stay in the body? Opiates and amphetamines can stay in the body for one to two days; cocaine can stay in the body two to four days. Occasional use of phencyclidine (PCP) can be detected from one to eight days after use, and chronic use up to a month. Similarly, marijuana can be detected from one to two days up to seven days after occasional use and up to a month in a chronic user.

These are general guidelines only, as retention times differ among individuals according to a variety of factors. However, if the drug test is positive, it indicates the drug was used within a timeframe and at such levels that it exceeded the cut-off, and that the individual may have been under the influence of the substance at the time the sample was collected, but it can not necessarily confirm that the donor was impaired or the degree of impairment at the time of the test.

If someone has had a few drinks, how long will it take for their blood alcohol level to get back to zero? For comparative purposes, a standard drink is as follows:

12 oz beer X 30 mL/oz X 5% alcohol content = 18 mL alcohol
5 oz wine X 30 mL/oz X 12% alcohol content = 18 mL alcohol
1.5 oz spirits X 30 mL/oz X 40% content = 18 mL alcohol

Alcohol is absorbed in the blood and eventually travels to the liver where it is metabolized. No matter how much alcohol is consumed, or what blood level has been achieved, the liver metabolizes the alcohol at a constant rate of about 10 grams of ethanol per hour (slightly less than one standard drink which contains 13.5 grams).

The ethanol clearance rate is still a function of age, gender and drinking practices, but a recent study of driver characteristics and impairment at various BACs (NHTSA) found the elimination rate averaged for subjects in the study at about .015% per hour (slightly higher for female subjects, .0l85%). Because the situation someone is in may differ from the study (and the drinks may not be “standard” size), this is a guideline only; on average it would take at least an hour to metabolize one standard drink and bring the blood alcohol level back to zero.

Does the collector have the option of taking a blood sample to test for alcohol? No. Under Canadian workplace testing programs, the collector would never take a blood sample. People sometimes confuse employer testing programs with medical assessments. In the case of a medical assessment, the doctor may take a blood sample for medical reasons (for example as part of an annual physical), the sample is analyzed in a medical lab, and the results are sent to their doctor.

However, under employee testing programs currently in place in Canada, the only samples which can be taken for alcohol analysis are: a breath sample confirmed by a second breath sample, or a saliva sample confirmed by a breath sample. The results are sent by the collector to your Program Administrator. In limited circumstances when a breath analyzer is not readily available, the collector may collect a saliva sample and if the result is above the cut-off, would collect a second urine sample. The urine sample would be sent to a certified laboratory for analysis. The company policy should clarify if and when this third option would be triggered, and companies must sort out with their Third Party Administrator specific collection and analysis procedures which are unique to urine alcohol testing.