1. The complete picture of health The complete picture of health

2. Some Statistics 40% of the working population have used illegal drugs. 25% of those seeking help with drug problems are employed 1 in 25 of people are alcohol dependent – most employed Absenteeism is 60% higher in drug users Recruitment and training costs increase at the rate of job loss in those with alcohol or drug problems, can be up to 50% higher. Abermed find around 3% of all drug tests are confirmed positive (and rising rapidly) Cocaine overtaking cannabis

3. Employment Eye Drug Testing Cases

4. Case Number 1 Male – age 27 – scaffolder Seen for OGUK medical, nil PMH Admitted to benylin, lemsip for sore throat Dipstick – positive for cocaine Confirmation - cocaine

5. Case 2 Male – age 52 Dip stick positive for benzodiazepines Admitted to taking benzos that were his mother’s (allegedly), 6 days ago, as a one off Confirmed by lab, GP confirms mother’s prescription Question – he has taken benzos not prescribed for him – what view do we take?

6. 33 year old man, on drilling rig, RTW medical Off with wrist surgery Admits to taking sleeping tablets, tranquillisers, and major painkillers – about to stop them Dipstick test confirms use of these drugs Case 3

7. Immediate doubts – tranquillisers and sleeping tablets not usual in these circumstances. Confirmation showed he was positive for all these but also showed the specific marker for heroin. GP says he is being treated with these drugs for PTSD – but certainly not heroin Patient is drug addict

8. Case 4 33 year old mud engineer, for Norwegian Medical Dip Stick positive for cocaine but sample not sent for confirmation because of abnormalities in test sample.

9. Noted to be a long time in the toilet, noise of paper ripping “like a sachet being opened” Small sample, foaming at top and of a very clear colour Temperature of sample 33  C – too cold to have been freshly passed and unadulterated Strange smell “like bleach” Obviously an attempt at using one of the “drug neutralisers” that can be found on internet. None has been found to work to date.

10. How do we Ensure Sample is Genuine? Patient has to take off all outdoor clothes and empty pockets. Lavatory has “saloon” doors so privacy limited. Test for temperature of urine – difficult to keep a doctored sample within body heat. High index of suspicion. If patient cannot pass urine Remains under observation Given small frequent drinks of water After 4 hours, considered a refusal to provide a sample.

11. Alcohol Stays in the system for a much shorter time than most drugs so timing of testing is crucial Cannot easily “work back” to calculate what the likely level would have been some hours ago Depends on over what period alcohol was taken and the particular metabolism of the person in question. Prompt testing is vital.

12. Metabolism Affected by 1. Liver enzymes – natural genetic variation between people 2. Regular heavy drinking induces enzymes initially so body metabolises alcohol more quickly 3. Sex, height, weight 4. Race 5. Food intake – slows absorption

14. Well Worn Explanations Of cannabis –”I was at a party where everyone was smoking –it must be from passive smoking” Cannabis level has actually been set to ensure that it is well above anything possible from passive smoking. Of everything except cannabis and opiates-“It must be a false positive from nasal sprays/ cough medicines etc “ Whilst this may be the case (but only very rarely) with the Dipstick testing, it is never true with the lab confirmation. Of opiates – it was Nurafen Plus, honest! The lab can tell exactly which opiate was taken as well as estimating the dose.