1. Employee Drug-Free Workplace Education Provided by the Office of the Assistant Secretary for Policy U.S. Department of Labor and Sheridan Memorial Hospital Employee Health

2. 2 Employee Education Outline Objectives of training Overview of a Drug-Free Workplace Policy Impact of substance abuse in the workplace Ways that people use alcohol and other drugs Understanding addiction Signs and symptoms of substance abuse Family and coworker impact Assistance Confidentiality Specific drugs of abuse

3. 3 Objectives of Training The requirements of the policy The prevalence of alcohol and drug abuse and its impact on the workplace How to recognize the link between poor performance and alcohol and/or drug abuse The progression of the disease of addiction What types of assistance may be available Employees should be familiar with the Drug-Free Workplace Policy and aware of the dangers of alcohol and drug abuse. Employees should understand:

4. 4 Overview of Drug-Free Workplace Policy Sends a clear message that alcohol and drug use in the workplace is prohibited Encourages employees who have problems with alcohol and other drugs to voluntarily seek help The Drug-Free Workplace Policy accomplishes two major things:

5. 5 The Drug-Free Workplace Policy exists to: Protect the health and safety of all employees, patients, physicians, volunteers and the public. Safeguard employer assets from theft and destruction. Maintain SMH integrity and reputation. Comply with the Drug-Free Workplace Act of 1988 or any other applicable laws.

6. 6 The Drug-Free Workplace Policy answers the following questions: What is the purpose of the policy and program? Who is covered by the policy? When does the policy apply? What behavior is prohibited? Are employees required to notify supervisors of drug-related convictions?

7. 7 Does the program include drug testing? What are the consequences for violating the policy? Are there Return-to-Work Agreements? What type of assistance is available to employees needing help? How is employee confidentiality protected? Who is responsible for enforcing the policy? How is the policy communicated to employees?

8. 8 Impact of Substance Abuse in the Workplace Employee health People who abuse alcohol or other drugs tend to neglect nutrition, sleep and other basic health needs. Substance abuse depresses the immune system. Its impact on the workplace includes higher use of health benefits; increased use of sick time and higher absenteeism and tardiness.

9. 9 Productivity Employees who are substance abusers can be physically and mentally impaired while on the job. Substance abuse interferes with job satisfaction and the motivation to do a good job. It’s impact on the workplace includes reduced output; increased errors; lower quality of work and reduced patient satisfaction. Decision Making Individuals who abuse alcohol and/or other drugs often make poor decisions and have a distorted perception of their ability. Here, substance abuse’s impact on the workplace includes reduced innovation; reduced creativity; less competitiveness; and poor decisions, both daily and strategic.

10. 10 Safety Common effects of substance abuse include impaired vision, hearing and muscle coordination and low levels of attention, alertness and mental acuity. Its impact on the workplace includes increased accidents; and more workers’ compensation claims. Employee Morale The presence of an employee with drug and/or alcohol problems creates a strain on relationships between coworkers. Organizations that appear to condone substance abuse create the impression that they don’t care. Impact on the workplace includes higher turnover; lower quality; and reduced team effort.

11. 11 Security Employees with drug and/or alcohol problems often have financial difficulties, and employees who use illegal drugs may be engaging in illegal activities in the workplace. In this area, substance abuse’s impact on the workplace can include theft and law enforcement involvement.

12. 12 And Finally: Substance abuse impacts Organizational Image and Community Relations – Accidents, lawsuits and other incidents stemming from employee substance abuse problems may receive media attention and hurt an organization’s reputation in the community. The impact on the workplace includes reduced trust and confidence; and reduced ability to attract high-quality employees.

13. 13 Ways People Use Alcohol and Other Drugs There are various ways that people use alcohol and other drugs. The first is “use,” where alcohol and other drugs may be used in a socially accepted or medically authorized manner to modify or control mood or state of mind. Examples include having a drink with friends or taking an anti-anxiety agent as prescribed by a physician. The following slides lists different ways that people use alcohol and other drugs without necessarily becoming addicted.

14. 14 Use: Experimentation Out of curiosity and/or at the urging of peers, individuals may try drinking or using drugs illegally. If the illegal drug use is not repeated, or discontinues after a short time, such experimentation may not be problematic. Likewise, deciding to drink alcoholic beverages after early experimentation is not problematic for most adults.

15. 15 Social/Recreational Drinking alcoholic beverages is permitted in American society, and some excessive use may even be condoned. If use doesn’t cause problems for the user, or those around him/her, most people would consider such use to be social or recreational. Some use marijuana in a similar manner – only in certain social or recreational situations and without immediate adverse consequences. However, marijuana use is illegal, except in a few states.

16. 16 As a stress reliever Many people use alcohol or other drugs to help them cope with pressure or stress. If this type of use is infrequent and doesn’t create more stress or difficulties for the user, or those around him/her, it may not lead to addiction, but alcoholism and drug addiction often begin with relief drinking.

17. 17 Another form is Abuse: Abuse is using a substance to modify or control mood or state of mind in a manner that is illegal or harmful to oneself or others. Potential consequences of abuse include: Accidents or injuries Blackouts Legal problems Poor job performance Family problems Sexual behavior that increases the risk of HIV infection

18. 18 Finally, there is “Addiction: “ The irresistible compulsion to use alcohol and other drugs despite adverse consequences. It is characterized by repeated failures to control use, increased tolerance and increased disruption in the family.

19. 19 Understanding Addiction For one in ten people, abuse leads to addiction. Addiction to alcohol and other drugs is: Chronic Once you have developed an addiction, you will always have to deal with it. You may manage to stop using alcohol or other drugs for significant periods of time, but for most, the disease doesn’t disappear but rather goes into remission. Should you attempt to resume ‘normal’ use, you will rapidly return to addictive, out of control use and abuse.

20. 20 Progressive Addiction gets worse over time. With some drugs, the decline is rapid; with others, like alcohol, it can be more gradual, but it does get worse. Alcohol and other drugs cause a biochemical change in the nervous system that can persist even after the substance leaves the blood. Repeated use causes progressive damage. Primary Addiction is not just a symptom of some underlying psychological problem, a developmental stage or a reaction to stress. Once your use of alcohol or drugs has become an addiction, the addiction itself needs to be medically treated as a primary illness.

21. 21 Terminal Addiction to alcohol and/or other drugs often leads to disease and possibly death. Characterized by denial One of the most disturbing and confusing aspects of addiction is that it is characterized by denial. The user denies that his/her use is out of control or that it is causing any problems at home or work. The user often seems to be the last to know that his/her life is out of control. There are effective strategies employed by professionals for helping to break through this denial, which must be overcome before treatment can take place.

22. 22 It’s important to know that addiction is a family disease: Some people with a history of substance abuse in their family are more susceptible to developing problems with addiction. Children of alcoholics or addicts are three times as likely to develop problems. If both parents are addicts or alcoholics, the risk increases to five times as great. This is due to heredity as well as learned behavior. It is important for parents to realize that children learn much more from watching their behavior than listening to their advice.

23. 23 Risk of addiction: Addiction is a family disease Many people use alcohol or other drugs to help them cope with pressure or stress. If this type of use is infrequent and doesn’t create more stress or difficulties for the user, or those around him/her, it may not lead to addiction, but alcoholism and drug addiction often begin with relief drinking.

24. 24 Prior abuse of alcohol and other drugs has a great impact on developing future problems: A pattern of abuse develops and can lead to addiction and psychological reliance on drugs and/or alcohol. This can be a slow progression for some and a rapid decline for others. Research demonstrates that the later in life an individual first drinks alcohol or uses other drugs, the less likely he or she will be to progress to problem use.

25. 25 Other contributing factors: Some people abuse alcohol and drugs as part of a self-destructive lifestyle. Other people start to use substances to seek relief from depression or crisis in their lives. Although some fortunate individuals never develop serious problems and use diminishes or ceases once the precipitating events change, others develop a serious problem before they even realize it.

26. 26 Signs and Symptoms of Substance Abuse Emotionally Behaviorally Physically Abuse of alcohol and other drugs affects people:

27. 27 Emotional effects of substance abuse: Aggression Burnout Anxiety Depression Paranoia Denial

28. 28 Behavioral effects of substance abuse: Slow reaction time Impaired coordination Slowed or slurred speech Irritability Excessive talking Inability to sit still Limited attention span Poor motivation or lack of energy

29. 29 Physical effects of substance abuse: Weight loss Sweating Chills Smell of alcohol

30. 30 Family and Coworker Impact Families and coworkers can have a significant impact on substance use and abuse. One way is through enabling: An action that someone takes to protect the person with the problem from the consequences of his or her actions. Unfortunately, enabling actually helps the person to NOT deal with his or her problem.

31. 31 Examples of enabling: Covering Up Providing alibis, making excuses or even doing an impaired worker’s work rather than confronting the issue that he/she is not meeting his/her expectations. Rationalizing Developing reasons why the person’s continued substance abuse or behavior is understandable or acceptable.

32. 32 Withdrawing/Avoiding Avoiding contact with the person with the problem. Blaming Blaming yourself for the person’s continued substance abuse or getting angry at the individual for not trying hard enough to control his/her use or to get help. Controlling Trying to take responsibility for the person by throwing out his/her drugs, cutting off the supply or trying to minimize the impact by moving him/her to a less important job; and

33. 33 Threatening Saying that you will take action (ceasing to cover up, taking formal disciplinary action) if the employee doesn’t control his/her use, but not following through.

34. 34 Examples of traps family members and coworkers may fall into: Sympathy Trying to get you involved in his/her personal problems. Excuses Having increasingly improbable explanations for everything that happens. Apology Being very sorry and promising to change. (“It won’t happen again.”) Diversions Trying to get you to talk about other issues in life or in the workplace.

35. 35 Innocence Claiming he/she is not the cause of the problems you observe, but rather the victim. (“It isn’t true.” “I didn’t know.” “Everyone is against me.”) Anger Showing physically intimidating behavior, and blaming others. (“It’s your fault.”) Pity Using emotional blackmail to elicit your sympathy and guilt. (“You know what I’m going through. How can you do this to me now?”); and Tears Falling apart and expressing remorse upon confrontation.

36. 36 Assistance Things to remember: Difficulty performing on the job can sometimes be caused by unrecognized personal problems - including addiction to alcohol and other drugs Help is available Although a supervisor may suspect that an employee’s performance is poor because of personal problems, it is up to the employee to decide whether or not that is the case

37. 37 It is an employee’s responsibility to decide whether or not to seek help Addiction is treatable and reversible An employee’s decision to seek help is a private one and will not be made public

38. 38 SMH has EAP services that are available: An EAP can help employees decide what to do if they have a problem with alcohol or other drugs. An EAP also can help an employee decide what to do if someone in his/her family or workgroup has a problem. Conversations with an EAP are confidential.

39. 39 Other services that are available: Community hotlines Self-help groups such as Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, etc. Community mental health centers Private therapists or counselors Addiction treatment centers

40. 40 Confidentiality Problems will not be made public Conversations with an EAP professional - or other referral agent - are private and will be protected All information related to performance issues will be maintained in his/her personnel file Information about referral to treatment, however, will be kept separately

41. 41 Information about treatment for addiction or mental illness is not a matter of public record and cannot be shared without a signed release from the employee If an employee chooses to tell coworkers about his/her private concerns, that is his/her decision When an employee tells his/her supervisor something in confidence, supervisors are obligated to protect that disclosure

42. 42 Employees can also be assured that: EAP records are separate from personnel records and can be accessed only with a signed release from the employee EAP professionals are bound by a code of ethics to protect the confidentiality of the employees and family members that they serve There are clear limits on when and what information an EAP professional can share and with whom

43. 43 However, there are some limits on confidentiality that may require: Disclosure of child abuse, elder abuse and serious threats of homicide or suicide as dictated by state law Reporting participation in an EAP to the referring supervisor Reporting the results of assessment and evaluation following a positive drug test Verifying medical information to authorize release time or satisfy fitness-for-duty concerns as specified in company policy Revealing medical information to the insurance company in order to qualify for coverage under a benefits plan

44. 44 Specific Drugs of Abuse Alcohol Marijuana Inhalants Cocaine Stimulants Depressants Hallucinogens Narcotics Designer Drugs

45. 45 Alcohol In American society, alcohol is a legal drug. Nonetheless, it is a depressant and is the leading drug of abuse. Use of alcohol affects judgment and decision-making abilities, slows down the central nervous system and brain function, and reduces coordination and reflex actions.

46. 46 Signs and Symptoms of Abuse Dulled mental processes Lack of coordination Slowed reaction time Poor judgment Reduced inhibitions

47. 47 Alcohol consumption causes a number of marked changes in behavior. Even small amounts of alcohol can significantly impair the judgment, reaction time and coordination needed to safely operate equipment or drive a car.

48. 48 A 12 oz. can of beer, a 5 oz. glass of wine and a 1.5 oz shot of hard liquor all contain the same amount of alcohol. Coffee, cold showers and exercise do not speed up the body’s ability to metabolize alcohol. Each half ounce of alcohol takes the average body about one hour to process and eliminate. Only the passage of time will free the body from the effects of alcohol.

49. 49 Low to moderate doses of alcohol increase the incidence of a variety of aggressive acts, including physical altercations, threats, and spousal and child abuse. Moderate to high doses of alcohol cause marked impairments in higher mental functions, severely altering a person’s ability to learn and remember information. Very high doses cause respiratory depression and death. If combined with drugs, much lower doses of alcohol can multiply the problems.

50. 50 Health Effects Decreased sexual functioning Liver disease Increased cancers of the mouth, tongue, pharynx, esophagus, rectum, breast and skin Kidney disease Ulcers, spontaneous abortion Birth defects—leading cause of preventable retardation

51. 51 Repeated use of alcohol can lead to dependence. For a regular drinker, the need to suddenly stop drinking is likely to produce withdrawal symptoms, including severe anxiety, tremors, hallucinations and convulsions. Long- term consumption of large quantities of alcohol, particularly when combined with poor nutrition, can also lead to permanent damage to vital organs such as the brain and the liver.

52. 52 Mothers who drink alcohol during pregnancy may give birth to infants with fetal alcohol syndrome. These infants have irreversible physical abnormalities, and alcohol consumption is the leading cause of preventable mental retardation. In addition, research indicates that children of alcoholic parents are at greater risk than other youngsters of becoming alcoholics themselves.

53. 53 Workplace Issues Many employers now test for the presence of alcohol along with other drug testing. Consuming alcohol increases the likelihood that a driver or equipment operator will be involved in an accident. Low doses of alcohol reduce inhibitions and affect decision making. People who would not ordinarily behave in inappropriate ways can be persuaded to change their behavior when they are drinking.

54. 54 Often employees are under the influence of alcohol when they make the decision to use drugs.

55. 55 SMH allows an employee to have the presence of alcohol in the urine of up to 0.02 gm%. Why? If an employee went out the evening before he/she worked and celebrated an event and had a drink, the alcohol may still be present in the urine the next day, - and- The body itself also produces small amounts of alcohol.

56. 56 Marijuana Marijuana is a derivative of the cannabis sativa plant and is illegally used for its intoxicating effects and dreamy state of relaxation and euphoria. All forms of marijuana have negative physical and mental effects. The active ingredient in marijuana is Delta-9- Tetrahydrocannabinol, or THC.

57. 57 SIGNS AND SYMPTOMS OF USE Several regularly observed physical effects of marijuana include: Substantial increase in heart rate Bloodshot eyes Dry mouth and throat Increased appetite Chronic sore throat

58. 58 Use of marijuana also has mental effects that may include: Impaired or reduced short-term memory and comprehension Altered sense of time Changed sensory perception--sight, smell, hearing, touch Reduced ability to perform tasks requiring concentration and coordination, such as driving a car

59. 59 Research also shows that people do not retain knowledge when they are “high”. Motivation and cognition may be altered, making the acquisition of new information difficult. Marijuana also can produce paranoia and psychosis.

60. 60 HEALTH EFFECTS Emphysema-like symptoms Respiratory track and sinus infections Lowered immune system response

61. 61 Because users often inhale the unfiltered smoke deeply and then hold it in their lungs as long as possible, marijuana is damaging to the lungs and pulmonary system. Marijuana smoke contains more cancer-causing agents than tobacco smoke. Long-term users of marijuana may develop tolerance levels requiring more and more marijuana to achieve the same “high”. Prolonged use leads to dependence, and the drug can become the center of users’ lives.

62. 62 THC also is contained in a prescription medication called Marinol that is prescribed for cancer patients who are suffering from severe nausea and loss of appetite. Some states have passed propositions to consider marijuana a medication that can be used with a physician’s recommendation.

63. 63 WORKPLACE ISSUES Employees who fall under federal guidelines such as the Department of Transportation’s testing regulations are prohibited from using marijuana in any form. THC is stored in the body fat and is slowly released over time. Since it is retained in the fat, an employee can test positive many days after use. Many employers also have work rules requiring the employee to disclose if he or she is taking any sedating medications that could impact his or her ability to work safely. This rule would apply even in states that have approved the medicinal use of marijuana. The use of marijuana definitely would cause fitness- for-duty concerns.

64. 64 Inhalants Inhalants are mood-altering substances that are voluntarily inhaled. Most substances used are commercial and household products, such as solvents and aerosols, which are easily obtained and are not harmful, if used for the purpose intended and as directed. Because they are common products, inhalants often are a young person’s first attempt at “getting high.”

65. 65 SIGNS AND SYMPTOMS OF USE Inhaling solvents allows the substance to reach the bloodstream very quickly. The immediate negative effects of inhalants include: Nausea Sneezing Coughing Nosebleeds Fatigue Poor coordination Loss of appetite

66. 66 Solvents and aerosol sprays also may decrease heart and respiratory rates. Amyl and Butyl Nitrite cause rapid pulse, headaches and involuntary passing of urine and feces. Inhalants can severely impair judgment and driving ability. They also cause severe disorientation, visual distortion and confusion.

67. 67 HEALTH EFFECTS Hepatitis Brain damage Debilitating effects on the central nervous system Weight loss Fatigue Electrolyte imbalance Muscle fatigue Permanent damage to the nervous system

68. 68 There is evidence that tolerance to the effects of inhalants develops with continued use so, users need to increase use to obtain the same high. Studies have shown that dependence on inhalants continues even when the user goes on to use other drugs. Deeply inhaling the vapors, or using large amounts over a short time, may result in disorientation, violent behavior, unconsciousness or death. High concentrations of inhalants can cause suffocation by displacing the oxygen in the lungs or depressing the central nervous system to the point that breathing stops.

69. 69 Inhalants include: Nitrous Oxide, laughing gas, propellant aerosol cans, Amyl Nitrite, poppers, snappers in ampules, Butyl Nitrite, rush, bullet, climax, aerosol sprays, aerosol paint cans, containers of cleaning fluid, gasoline, glue and paint thinner.

70. 70 Inhalants include: Nitrous Oxide, laughing gas, propellant aerosol cans, Amyl Nitrite, poppers, snappers in ampules, Butyl Nitrite, rush, bullet, climax, aerosol sprays, aerosol paint cans, containers of cleaning fluid, gasoline, glue and paint thinner.

71. 71 WORKPLACE ISSUES Inhalants can severely impair judgment and driving ability. They also cause severe disorientation, visual distortion and confusion. Some such products may be available in the workplace.

72. 72 Cocaine Cocaine is the most potent stimulant of organic origin and the most widely used of the stimulants. Although cocaine has been used in the past as a topical anesthetic, its therapeutic uses have almost been eliminated due to the development of safer anesthetics. Cocaine is a powerfully addictive drug leading to physical and psychological dependence.

73. 73 SIGNS AND SYMPTOMS OF USE Dilated pupils Increased pulse rate Elevated blood pressure Insomnia Loss of appetite Tactile hallucinations Paranoia Seizures Anxiety, agitation Periods of increased activity followed by fatigue and depression Wide mood swings Difficulty in concentration

74. 74 HEALTH EFFECTS Cocaine stimulates the central nervous system. Its immediate effects include dilated pupils and elevated blood pressure, heart rate, respiratory rate and body temperature. In addition, cocaine use can lead to death by cardiac arrest or respiratory failure.

75. 75 Cocaine powder is sniffed or snorted. The euphoric high tends to last for approximately 30 minutes. Occasional use can cause a stuffy or runny nose, while chronic use can ulcerate the mucous membrane of the nose. Cocaine powder can also be injected into the bloodstream when it is mixed with water. Using contaminated equipment to inject cocaine, or any other substance, can transmit HIV and cause HIV/AIDS, hepatitis and other diseases. Preparation of freebase, which involves the use of volatile solvents, can result in death or injury from fire or explosion. Inhalation of cocaine fumes from freebasing produces effects that are very fast in onset, very intense and momentary in duration.

76. 76 Crack is cocaine that is processed into tiny chips having the appearance of slivers of soap. Crack has become a very popular form of cocaine, since it is inexpensive and relatively easy to use. It is smoked in a pipe or rolled with tobacco in a cigarette. Cocaine can produce psychological and physical dependency, a feeling that the user cannot function without the drug. Many users become extremely depressed when not using the drug, and the craving for the drug is intense. In addition, tolerance develops rapidly.

77. 77 WORKPLACE ISSUES Employees who fall under federal guidelines such as the Department of Transportation’s testing regulations are prohibited from using cocaine in any form. The addictive nature and cost can lead to workplace theft and/or dealing. Work performance is erratic with periods of high performance and periods characterized by forgetfulness, absenteeism and missed assignments.

78. 78 Other Stimulants Stimulants are drugs that stimulate the central nervous system and excite bodily activity. Methamphetamine or crank is one of the fastest growing drugs of abuse. These drugs create less intense and less expensive cocaine-like effects in the body.

79. 79 SIGNS AND SYMPTOMS OF USE Mood changes Impaired concentration Impaired mental functioning Swings between apathy and alertness

80. 80 In addition to the physical effects, users report feeling restless, anxious and moody. Higher doses intensify the effects. Persons who use large amounts of amphetamines over a long period of time can develop an amphetamine psychosis that includes hallucinations, delusions and paranoia. These symptoms usually disappear when drug use ceases.

81. 81 HEALTH EFFECTS Increased heart and respiratory rates Elevated blood pressure Sweating Headaches Blurred vision Dizziness Sleeplessness and anxiety Rapid or irregular heartbeat Tremors Poor coordination Physical collapse

82. 82 Physical exertion while using stimulants can be dangerous because of the drugs’ effects on the body’s temperature-regulating and cardiovascular systems and can cause deaths in otherwise healthy young athletes. Amphetamines can be swallowed in pills or capsules, smoked as crank and ice or injected. An amphetamine injection creates a sudden increase in blood pressure that can result in stroke, very high fever or heart failure. Also, injection using contaminated needles may result in needle-related diseases such as AIDS and hepatitis.

83. 83 WORKPLACE ISSUES Employees who fall under federal guidelines such as the Department of Transportation’s testing regulations are prohibited from using amphetamines without a current prescription. The addictive nature and cost can lead to workplace theft and/or dealing. Work performance is erratic with periods of high performance and periods characterized by forgetfulness, absenteeism and missed assignments.

84. 84 Depressants A depressant is a drug that depresses the central nervous system, resulting in sedation and a decrease in bodily activity. Depressants, taken as prescribed by physicians, can be beneficial for the relief of anxiety, irritability, stress and tension.

85. 85 SIGNS AND SYMPTOMS OF USE The effects of depressants are in many ways similar to the effects of alcohol. Small amounts can produce calmness and relaxed muscles, but somewhat larger doses can cause:

86. 86 Slurred speech Staggered walk Altered perception Respiratory depression Coma and death The combination of depressants and alcohol can multiply the effects of the drugs, thereby multiplying the risks.

87. 87 HEALTH EFFECTS The use of depressants can cause both physical and psychological dependence. Regular use over time may result in a tolerance to the drug, leading the user to increase the quantity consumed. The main classes of medical depressants are barbiturates and benzodiazepines. When regular users suddenly stop taking large doses, they can develop withdrawal symptoms ranging from restlessness, insomnia and anxiety to convulsions and death.

88. 88 Babies born to mothers who abuse depressants during pregnancy may be physically dependent on the drugs and show withdrawal symptoms shortly after they are born. Birth defects and behavioral problems also may result. Depressants are known as: barbiturates, downers and tranquilizers, such as Valium, Librium, Equanil, Serax, Tranxene and Zanax.

89. 89 WORKPLACE ISSUES Mental clouding and drowsiness pose a fitness-for-duty concern. Many employers also have work rules requiring the employee to disclose if they are taking any sedating medications that could impact their ability to work safely.

90. 90 Hallucinogens Hallucinogenic drugs distort the senses and often produce hallucinations--experiences that depart from reality. Phencyclidine (PCP) interrupts the function of the neurocortex, the section of the brain that controls the intellect and keeps instincts in check, because the drug blocks pain receptors. Violent PCP episodes may result in self-inflicted injuries.

91. 91 SIGNS AND SYMPTOMS OF USE Impaired concentration Confusion and agitation Muscle rigidity Profuse sweating

92. 92 The effects of PCP vary, but users frequently report a sense of distance and estrangement. Time and body movement is slowed down, muscular coordination worsens and senses are dulled. Also, speech is blocked and incoherent.

93. 93 HEALTH EFFECTS Chronic users of PCP report persistent memory problems and speech difficulties. Some of these effects may last six months to a year following prolonged daily use. Mood disorders, such as depression, anxiety and violent behavior, also occur. In later stages of chronic use, users often exhibit paranoid and violent behavior and experience hallucinations. Large doses may produce convulsions and coma, as well as heart and lung failure.

94. 94 Lysergic acid (LSD), mescaline and psilocybin also are hallucinogens that cause illusions and hallucinations. The physical effects may include dilated pupils, elevated body temperature, increased heart rate and blood pressure, loss of appetite, sleeplessness and tremors. Sensations and feelings may change rapidly. It is common to have a bad psychological reaction to LSD, mescaline and psilocybin. The user may experience panic, confusion, suspicion, anxiety and loss of control. Delayed effects or flashbacks can occur even after use has ceased.

95. 95 WORKPLACE ISSUES Use causes severe disorientation.

96. 96 Narcotics Narcotic analgesics are the most effective compounds used for pain relief. Narcotic analgesics include Opium, Opiates (morphine, codeine, percodan, heroin and dilaudid) and Opioids (synthetic substitutes such as vicodin, darvon, demerol and methadone).

97. 97 SIGNS AND SYMPTOMS OF USE Narcotics initially produce a feeling of euphoria that is often followed by: Drowsiness Nausea and vomiting Constricted pupils Watery eyes and itching Low and shallow breathing Clammy skin Impaired respiration Convulsions Coma Possible death

98. 98 Narcotics can be: Smoked or eaten, such as opium Injected, taken orally or smoked, such as morphine Inhaled, injected or smoked, such as heroin

99. 99 HEALTH EFFECTS Tolerance to narcotics develops rapidly and addiction is likely. The use of contaminated syringes may result in diseases such as HIV/AIDS, endocarditis and hepatitis. Addiction in pregnant women can lead to premature, stillborn or addicted infants who experience severe withdrawal symptoms. Opiates also are known as: heroin, smack, horse, brown sugar and black tar.

100. 100 WORKPLACE ISSUES Employees who fall under federal guidelines such as the Department of Transportation’s testing regulations are prohibited from using opiates without a current medical prescription. Many employers also have work rules requiring the employee to disclose if they are taking any sedating medications that could impact their ability to work safely. The addictive nature and cost can lead to workplace theft and/or dealing. Mental clouding and drowsiness pose a fitness-for- duty concern.

101. 101 Designer Drugs Illegal drugs are defined in terms of their chemical formulas, but underground chemists can modify the molecular structure of certain illegal drugs to produce analogs known as designer drugs, which do not meet these definitions. These drugs can be several hundred times stronger than the drugs they are designed to imitate.

102. 102 Many of the so-called designer drugs are related to amphetamines and have mild stimulant properties but are mostly euphoriants. They can produce severe neurochemical damage to the brain. The narcotic analogs can cause symptoms such as those seen in Parkinson’s disease, including uncontrollable tremors, drooling, impaired speech, paralysis and irreversible brain damage. Analogs of amphetamines and methamphetamines cause nausea, blurred vision, chills or sweating and faintness.

103. 103 Psychological effects include anxiety, depression and paranoia. As little as one dose can cause brain damage, and the designer drugs still cause illusions, hallucinations and impaired perception. Some designer drugs are: Synthetic Heroin White, MPTP (New Heroin), analogs of MDMA (Ecstasy, XTC, Essence), hallucinogens (STP, PMA, EVE) and analogs of PCP.

104. 104 Statistics Speak Businesses that do not have a program in place are more likely to be the employer of choice for illicit drug users. Individuals who can’t adhere to drug-free workplace policies seek employment at establishments that don’t have one. An estimated 14.8 million Americans are current illicit drug users with approximately 9.4 million of these individuals employed

105. 105 Statistics Speak Workers’ Compensation Impact 38-50% of all Workers’ Compensation claims are related to substance abuse in the workplace. Substance abusers are 3-4 times more likely to be involved in an accident and 5 times more likely to file a Workers’ Compensation claim.

106. 106 Statistics Speak Medical costs for substance abusers are 300% higher than average Workers’ Compensation clients. Substance abusers are 2.5 times more likely to be absent eight or more days per year. Substance abusers are more likely to be late. Substance abusers are 33 to 50% less productive. They are responsible for 50-80% of all employee thefts.

107. 107 Statistics Speak: General Workplace Impact Annually substance abuse drains more than $100 Billion from American Businesses.

108. 108 Remember…… In our facility, the problems of substance abusers become your problems. They increase the risk of accidents, lower productivity, raise insurance costs, and reduce profits, not to mention the risk of patient safety. They are your friend, they are my friend, we are here to help them.

109. 109 So, where are we now? Our facility does provide assistance to help make it possible for employees to remain on or return to the job. It is sometimes necessary for workers to take time off for treatment. In these cases, successful completion of a rehabilitation program generally brings the former substance abuser back to our workplace.

110. 110 A Safer, Drug-Free Workplace To conclude, we hope this presentation has shed some light on: Recognizing the impact of alcohol and drug abuse on our workplace Understanding and following our Drug-Free Workplace Policy and Remember the types of assistance that are available

111. 111 Drug-Free Workplace Policy and Testing Procedures Following is our Drug-Free Workplace Policy and Testing Procedures, please read the policy. Please print off the quiz, complete and return to Dee Neavill. This is mandatory, it must be completed by December 11 th.

112. 112 Resources: 1.Partnership for a Drug-Free America 2.www.wyomingrecovery.comwww.wyomingrecovery.com 3.U.S. Department of Labor 4.Larry Hammond 5.I Have a Dream Ministry