1. Tackling Drugs in the Workplace
New Challenges
Tackling Drugs in the Workplace

2. New decade … new challenges
Medical Marijuana
Prescription Drug Issues
Specimen Validity

3. Medical Marijuana - the wonder drug?

4. A few Marijuana facts
Marijuana (grass, pot, weed) is the common name for a drug made from the plant Cannabis saliva.
The main mind-altering (psychoactive) ingredient in marijuana is THC (tetrahydrocannabinol), but more than 400 other chemicals also are in the plant.
When smoked, the effects start within minutes and peak in minutes. Usually the high is over in about 3 hours.
When ingested, such as eating a brownie laced with marijuana, the effects are slower to peak and last for a longer period of time.
Numerous studies have shown that marijuana has no medical value that can’t be met more effectively by legal drugs
The Institute of Medicine conducted comprehensive studies on the potential health benefits of marijuana.
Advocates has promoted the use of marjuana to treat medical conditions such as glacome. However this is a good example of more effective medicines already available.
Mayo clinic also conducted a study in which it found THC was less effective than standard treatments in helping cancer patients regain lost appetites.
Marinol has been available since 1985 for use as a treatment for nausea and vomiting assiciated with chemotherapy

5. Marijuana and Driving
Driving experiments show that marijuana affects a wide range of skills needed for safe driving -- thinking and reflexes are slowed, making it hard for drivers to respond to sudden, unexpected events.
A driver's ability to "track" (stay in lane) through curves, to brake quickly, and to maintain speed and the proper distance between cars is affected. Research shows that these skills may be impaired for at least 4-6 hours after smoking a single marijuana cigarette, long after the "high" is gone.
If a person drinks alcohol, along with using marijuana, the risk of an accident greatly increases.

6. Replacing the noontime martini…

7. Arizona’s Medical Marijuana Law
Arizona became the 15th state to approve marijuana to be used by individuals who have a debilitating medical condition such as cancer, glaucoma, HIV, hepatitus C, Crohn’s disease, severe and chronic pain.
Arizona is the 1st state with specific employer language regarding discrimination against medical marijuana users.
Proposition 203 only prohibits discrimination against “registered qualifying patients”.

8. Arizona’s Medical Marijuana Law
An employer may not discriminate against an employee who is a medical marijuana cardholder unless:
The employee used, possessed or was impaired by marijuana on the premises of the place of employment or during the hours of employment.
Employers may take action against medical marijuana users if the failure to do so “would cause an employer to lose a monetary or licensing benefit under Federal Law or Regulation”
Department of Transportation (DOT) Regulation does not authorize “medical marijuana” under a state law to be a valid medical explanation.
Proposition 203 only prohibits discrimination against “registered qualifying patients”.
A positive drug test alone may not authorize an employer to terminate or choose not to hire an individual.
Walmart case in Detroit – 02/2011

9. Medical Marijuana & Drug Free Workplace Programs
Carefully review and revise if needed your drug and alcohol policies. Determine with legal counsel whether the federal exemption will apply.
Note – most contracts that are funded with federal funds usually have an agreement to comply with the Federal Drug-Free Workplace Act.
Train supervisors to recognize impairment and document appropriately. Use the drug test as confirmation
Coordinate testing policies with your MRO and testing laboratory

10. Medical Marijuana Impairment
Train Supervisors to know the signs
Performance indicators
Excessive absenteeism or tardiness
Impaired ability to concentrate and retain information
Increased minor accidents, mistakes, reports of theft
Physical indicators
Bloodshot eyes
Dry mouth
Smell like marijuana
Observe and document behaviors. Don’t’ diagnose!
Use a drug test to confirm.
Consider saliva testing – when THC is found in saliva, this means the drug is in the blood stream and affecting the brain, thus affecting motor skills.

11. Synthetic Marijuana
Was marketing under various names – Spice , K2, Smoke, Black Mamba
Usually smoked, but can be mixed in food or drink

12. Synthetic Marijuana
Spice/K2 is a substance which has been marketed as incense since The incense is sprayed with JWH-018 or similar synthetic THC.
Produces a high similar to marijuana – often more quickly / more intense - with longer effect
DEA enacted temporary ban of 5 of the chemicals used to create Spice.
In Arizona, Governor Brewer signed law which classifies 10 chemicals that can be sprayed on the herb as dangerous drugs under state law and therefore banned.

13. Bath Salts
Products may contain synthetic stimulants called MDPV, CFT, and mephedrone.
Effects are similar to cocaine or MDMA
Side effects from ingesting bath salts include seizures and paranoia
Although the package is marked “not for human consumption”
There is a lot of information that shows how harmful these things are, but people continue to use them.

14. Changing Patterns of Drug Misuse
From 1997 to 2006, retail sales of opioid pain medications increased dramatically
Americans are 4% of the world’s population, but consume 80% of the world’s opioids
Between 1998 and 2009, hydrocodone moved from 13th to 1st most commonly prescribed medication in the US

15. Prescription Drug Issues
"What many people forget is that prescription drugs have the potential to be just as harmful as street drugs, and that most of today's illegal drugs were once marketed and sold as pharmaceuticals." -- Gary W. Smith, Executive Director of Narconon Arrowhead.

16. Prescription Drug Issues
The rate of employees testing positive for prescription opiates rose by more than 40% from
In Arizona:
Marijuana positives are No. 1 of drug positives
Opioids are No. 2
Benzodiazepines are No. 3
All opioids are capable of producing tolerance and withdrawal.
Heroin, morphine, codeine, dihydrocodeine, hydrocodone, hydromorphone, oxycodone, oxymorphone
Other opiiods – buprenorphine, methadone, propoxyphene, fentanyl, meperidine and tramadol

17. Prescription Drug Issues
Testing for prescription drugs identifies a lot of use that is unapproved, but not necessarily illicit:
Your employee had a root canal and her roomate gave her a Vicodin.
Your employee test positive for oxycodone. He has a 3-year old prescription.
Your employee just returned from a trip to Cancun. He said the clinic gave him codeine when he burst his ear drum while scuba diving.
Your employee uses on-line pharmacies without a prescription because it is less expensive.

18. Prescription Drug Issues
Workplace testing for prescription drugs as well as illicit drugs should be done for reasons of safety, security, and job performance.
Check your testing panel to be sure that it includes hydrocodone and oxycodone (not just the standard “5 Panel”).
Work closely with your MRO

19. Specimen Validity
A recent Google search on “Beat the Drug Test” gave 820,000 results in 0.14 seconds

20. Specimen Validity
“Suspicious result” There are four basic terms we use to report unusual specimens:
Dilute
Substituted
Adulterated
Invalid

21. Specimen Validity
Dilution involve ingestion of large volumes of water immediately prior to providing a urine specimen.  A number of products, all which accomplish essentially the same thing, are available in most health food stores and on the Internet.  Dilution is easily determined by initial screening for creatinine and followed up with a specific gravity test.
Specimens are reported as “Substituted” have creatinine and specific gravity values that are so diminished that they are not consistent with normal human urine.  
Urine is an aqueous solution. Its major constituents are primarily electrolytes, metabolic excretory products and other substances eliminated through the kidneys.
Creatinine is metabolic excretory product formed from creatine in muscle – used clinically to access renal function.
Specific gravity accesses urine concentration, or the amount of substances dissolved In urine.

22. Specimen Validity
An Adulterated specimen is one that contains a substance that is not expected to be present in human urine, or contains a substance expected to be present but is at a concentration so high that it is not consistent with human urine.   Adulterated is the term used for a specimen that has been altered by the donor in an attempt to defeat the drug test.   Many substances can be used to adulterate a urine specimen in vitro, including common household products, commercial chemicals and products developed specifically for that purpose.
An Invalid result is when a specimen appears to be adulterated with an unknown oxidant or when it is overly dilute but does not meet the federal definition of substituted.

23. Signs and Symptoms Alcohol : Benzodiazepines Odor on breath
Difficulty focusing / eyes glazed over
Gradual decline in appearance / hygiene
Increased absenteeism
Benzodiazepines
Behaviors like alcohol with no odor

24. Signs and Symptoms Cocaine Cannabinoids Extremely dilated pupils
Excessive activity, difficult to sit still
Irritable / Nervous
Talkative, but conversation lacks continuity
Cannabinoids
Forgetfulness in conversation
Bloodshot eyes
Dry mouth
Brown residue on fingers
Cannabinoids:
Increased appetite
Difficulties in thinking, comprehending, and remembering
Easily distracted

25. Signs and Symptoms Opioids Lethargy, drowsiness Constricted pupils
Frequent doctors visits for pain

26. Benefits of Drug-Free Workplace
Employees depend upon the benefits of drug-free workplace policies. They know that these policies create safer working conditions and establish clear standards for performance.
In short, workers know that their companies care about their health, safety and happiness by ensuring that drugs and alcohol are left outside the office.

27. Southwest Laboratories
Contact information
Sonja Hoppe
Vice President
Southwest Laboratories
4625 E Cotton Center Blvd
Phoenix, AZ
, ext 111