Announcement: 2017 – 4th of July Holiday Hours

Our office will be closed Monday, July 3rd, 2017 at 5pm through the 4th of the July Holiday. We will return on Wednesday at our normal operating hours.

Happy 4th of July!

Are You Developing a Drug Free Workplace Policy?

Some states have specific regulations regarding drug testing. It is imperative that you consult with an attorney before administering a “new” Drug Free Workplace Policy. Here is a link to State by State regulations:

State by State Drug Testing Regulations

The US Department of Labor has also created a Free Drug-Free Workplace Policy Builder tool:

Drug-Free Workplace Advisor Program Builder

By utilizing the services of a knowledgeable, experienced Third party Administrator employers are able to reduce the stress and financial burden of attempting to build something new. Nationwide Medical Review can provide a list of qualified Third Party Administrators to assist any employer with their drug-free workplace policy creating and maintenance.

THE FEATURES OF A GOOD POLICY:

  1. Must be in writing! …. thorough but easy to understand.
  2. Must be confidential
    • Absolutely no court or law-enforcement involvement!
    • No public punishment! The thrust should be to deter people, not to shame them!
  3. A copy must be given to each person in the system…. and it’s good to get a signed statement of understanding from each person in the testing pool.

KEY ITEMS TO BE INCLUDED: (discussion of each item follows)

  1. Define what (if any) agencies and regulations your program is governed by
    • Locate and master the regulations of whomever governs you
    • Know who may “inspect” your program and what they might be looking for.
  2. Even if not regulated by federal or state rules, it is a good idea to refer to them because:
    • Much thought and expertise has gone into developing them.
    • They have stood the test of time.
  3. Define who is included in the testing pool
  4. Define philosophy of the program: Deterrence or Enforcement
  5. Decide upon the frequency of testingTHE FOLLOWING CHART PROVIDES GUIDANCE FOR ITEMS 3, 4, AND 5.

    What is the basic approach and philosophy of your drug program?

    DETERRENCE?   or   DETECTION? – MOST PROGRAMS ARE A “COMBINATION.”Here’s how the two approaches differ:

    DETERRENT PROGRAM DETECTION PROGRAM
    WHOM TO INCLUDE: Whomever you wish to deter
    (Everyone)
    Persons at high risk or those requiring scrutiny
    MEASURE OF SUCCESS Negative Tests Positive Tests
    NUMBER OF SUBSTANCES: Select few Maximum affordable
    (Unannounced & Randomized)
    FREQUENCY OF SUBSTANCES: May randomize
    (different “panel” each time)
    Maximal!
    (every test every time)
    FREQUENCY OF TESTING: Can be infrequent / unannounced As often as possible
    WHAT DRUGS TO TEST FOR: Select randomized few As many as suspected
    Here’s how the two approaches are the same:
    RANDOM TESTING Necessary Necessary
    SCHEDULED OR ANNOUNCED TESTS Useless Useless
    (Abusers can “clean up” for a scheduled test)
    ENFORCEMENT OF CONSEQUENCES: Prompt and Consistent! Prompt and Consistent

    OTHER KEY ITEMS ARE:

  6. Define who will manage the random testing… and how — Both donors and test panels may be randomized.
  7. Define who will (and who may) do the specimen collections— In-house collections are the most cost effective and give the most confidence.
  8. Define the parameters of any “for cause” testing.
  9. Define who will do the reviews. (“outside” MRO is optimal but more expensive)
    • Monitor for false negatives.
    • Monitor and interview for false positives.
    • Know the “tricks of the trade” used by savvy abusers.
    • An adulteration protocol should be defined.
  10. Define the consequences of a positive test!
    • One person should be in charge and only that person should receive positive results.
  11. Define list (or criteria) of approved counselors and/or treatment options required for those persons who test positive.
    • Also define clearly who is responsible for cost of counseling.
  12. Schools may consider a course (for credit) covering Substance Abuse and explaining how the school’s program works.
  13. Selection of a laboratory: [All the following may affect the choice of a lab.]
    • Define your documentation and chain of custody system.
      • Best to use a recognized system rather than inventing your own.
      • D.O.T. 7-part form is the “gold standard.”
    • Define whether collections will be single or “split” specimens
      • Split specimens give added confidence and protection against litigation.
      • Define which substances will be tested for. [See the discussion at the end of the page.]

    DEFINITIONS AND DISCUSSION OF THE KEY ITEMS:Items 3 -5 are covered in the chart above… The rest of the items follow:

  14. RANDOM MEANS:
    • EVERY PERSON IN THE SYSTEM HAS AN EQUAL CHANCE OF BEING SELECTED EVERY TIME A DRAWING OCCURS!
    • Cannot be “a certain group” (unless randomized in groups)
    • Randomization may be by location, class, alphabet, or any set of parameters as long as the categories include everyone (and no one is duplicated.)
    • Policy must define exactly which person or persons are in charge of random program.
  15. SPECIMEN COLLECTIONS:
    IN HOUSE COLLECTION IS HIGHLY RECOMMENDED — even though collection services abound!

    • No certification or degree is required for collectors.
    • Informal training (& practice) is available many places.
    • Training materials available FREE from government and labs!
    • Most important ingredient is a CONSCIENTIOUS person doing the collections.
    • Requirements for a “legal” collection site are VERY SIMPLE!
    • Just a few collections each month will maintain skills and competence.
    • “OUTSIDE” collection sites are also very easy to find, but are VERY EXPENSIVE!
    • Almost every clinic is willing to do collections — Typical price for collection = $10-30.
    • WEB SITE listing collection sites is at: http://www.wpa.org/nacs/members.htm
    • SAAPA will soon publish a complete list of all collection sites nationwide
  16. FOR CAUSE TESTING:
    • “For cause” testing is fine but conditions must be spelled out in your policy and well documented BEFORE such testing is done.
    • Examples could be: thrice tardy, definable drop in academic performance, fighting or other definable forms of violence or loss of impulse control. sleeping during work-time or class,
    • Most successful programs require TWO WITNESSES to sign written documentation of observed “offense” before lab results return. A “check sheet” can be developed to simplify this…… but signatures of witnesses are critical!
    • Provision should be made for a student (employee) to announce a problem and “volunteer” for assistance — without consequences (or with defined consequences.)
  17. COMPETENT REVIEW IS CRITICAL (Certified Physician MRO is recommended)
    Advantages of “outside MRO” are:

    • Eliminates “politics” and the potential for having to pronounce someone positive who is a neighbor, a patient, or a family member.
    • They are most knowledgeable about the drugs and the testing, …. and most competent to eliminate false negatives, false positives, and invalid tests.
    • Lessens the danger of retaliation or “mischief” by an angry abuser.
    • Increases impartiality and confidence in the system if professional MRO is used.
    • Abusers will always know that the person who pronounced them positive is NOT the same person who enforced the consequences.
  18. DEFINE THE CONSEQUENCES OF A POSITIVE TEST!
    • One person should be in charge and only that person should receive positive results.
    • A “committee” can be considered to monitor compliance and manage “appeals.”
    • Only consequences may be appealed…. not drug test results………..unless….
    • If you choose “split specimen” collections, appeal for a re-test (in a different lab) is available (at donor’s expense.) [Costs about $85.00]
    • Define the controversial issue of ASSIGNING AND ENFORCING CONSEQUENCES. SEE APPENDIX A
  19. DEFINE TREATMENT OPTIONS
    • There should be a pre-defined list (or set of criteria) for approved counselors and/or treatment options required for those who test positive!
    • Federal standards in 49-CFR-49 are considered the best guidelines!
    • Ministers, Shamans, astrologers, crystal ball therapists, witch doctors etc. must all be approved ahead of time unless meeting federal guidelines.
    • Therapists must be accountable to program administrator for WRITTEN summaries of treatment including goals and predicted outcomes.
    • Also define clearly who is responsible for cost of counseling.
  20. EDUCATION IS CRITICAL!
    • Schools and businesses may consider a course (for credit/with pay) covering Substance Abuse and explaining how their particular program works.
    • Federally mandated programs MANDATE training for both employees and supervisors!
  21. SELECTION OF A LABORATORY [All the following may affect the choice of a lab]
    • Define your documentation and chain of custody system.
      • Best to use a recognized system rather than inventing your own.
      • D.O.T. 7-part form is the “gold standard.”
    • Define whether collections will be single or “split” specimens
      • Split specimens give added confidence and protection against litigation.
    • Define which substances will be tested for. [This is discussed at the end of the paper.]
    • COST! [Cost is inevitably the “final compromiser”]

WHAT DRUGS SHOULD BE TESTED FOR:
The ones in bold are in prominent use today!

  • DANGEROUS SUBSTANCES THAT ARE ALWAYS ILLEGAL:
    Marijuana, Cocaine, LSD, Heroin, Psilocybin (Mushrooms), anabolic steroids, PCP,
  • DANGEROUS SUBSTANCES THAT ARE ILLEGAL without a prescription:
    Amphetamines, Opiates, Benzodiazepines, Propoxyphene, Methadone, Barbiturates
  • SUBSTANCES THAT ARE NOT ILLEGAL (even in minors if dispensed by parents)
    Tobacco, Alcohol, Over-the-counter medications
  • THREE TESTS ARE ALSO NEEDED TO ASSURE SPECIMENS ARE VALID:
    pH, Specific Gravity, and Creatinine
  • TESTS FOR ADULTERATION MAY OCCASIONALLY BE NECESSARY.
    An “adulteration protocol” should be defined in your policy
  • MAKE “TEST PANEL” FLEXIBLE
    Give program administrator(s) authority to change testing panel or randomization without written notice if circumstances warrant

TO AVOID LEGAL PROBLEMS AND LITIGATION:

THE CARDINAL RULE:
DO NO TEST unless there is specific requirement for THAT test on THAT person on THAT occasion IN WRITING in your policy! NO “DISCRETIONARY TESTING!”TO SEE OUR FAVORITE POSTERS FOR POLICY MAKERS CLICK: A, B, or C


APPENDIX A
ADMINISTERING THE “CONSEQUENCES” OF POSITIVE TESTS

The most controversial issue in all discussions about Drug Screening is the issue of whether a positive result should result in the same consequences for every person and every drug in the system.

APPENDIX B
AGREEMENT TO AVOID USE OF ILLEGAL SUBSTANCES

[to be read and signed by employee/student] UNDER CONSTRUCTION SAMPLE POLICIES AND/OR AGREEMENTS ARE HEREBY SOLICITED…. drewb@nmrllc.com


QuestDiagnostics has a wonderful PowerPoint Presentation regarding “Zero Tolerance” DFW policy. Please email us if you would like to receive a copy.

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