EMPLOYEE DRUG SCREENING: What You Need to Know!

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1 EMPLOYEE DRUG SCREENING: What You Need to Know! Presented by: Murray Lappe, MD Chief Medical Officer, escreen Chief Innovation Officer, Alere Presentation Content History and background of drug testing DOT drug testing Non DOT drug testing Alternative specimens Point of Collection Testing (POCT) Important issues for drug testing policies Reasons for testing Challenges to drug testing programs 1

2 Drug Use in the Workplace *1 in 12 full-time workers in the U.S. having used illegal drugs in the past month *Source: MS-NBC 10% *Nationwide, almost 10% of employees use drugs in the workplace. *Source: National Institute on Drug Addiction *Studies have shown that substanceabusing employees function at about 67% of their capacity. *Source: SAMHSA Drug Use / Abuse in the Workplace 16.4 MM current drug users and 15 MM heavy alcohol users hold full-time jobs 77% of illicit drug users are employed 87% of employed illicit drug users work for small businesses 1 of every 6 workers has a drug or alcohol problem 1 in 6 workplace deaths involve drug or alcohol use 25% of workplace injuries involve drug or alcohol use Substance abusers are 5x more likely to file Workers Compensation claims Source: Substance Abuse and Mental Health Administration s (SAMHSA) study, Worker Substance Use and Workplace Policies and Programs 2

3 Header Sub header Sub header 1 Sub header 2 Sub header 3 Drug Use / Abuse in the Workplace Workplace drug abuse Costs an employer $7,000 to $10,000 per employee annually Costs employers 300% more in medical costs & benefits Illicit drug use and heavy alcohol use are associated with higher levels of absenteeism (up to 16x) and frequent job changes *Source: SAMHSA BOTTOM LINE: Substance use can pose significant risks to workers health and productivity, which in turn, costs you more Minimum Testing Requirements for all Programs Specimen Collection Transport to Lab (unless POCT) Specimen Screen- in the lab or at the POC Specimen Confirmation Test- always performed in a SAMHSA lab (5% of tests) Medical Review Officer 3

4 Pre Employment Reasons for Testing Random Post Accident Reasonable Suspicion Return to Duty Follow Up DOT = Department of Transportation employees covered under 49CFR Part 40 DOT Agencies: United States Coast Guard (USCG) Federal Aviation Administration (FAA) Federal Railroad Administration (FRA) Federal Motor Carrier Safety Administration (FMCSA) Federal Transit Administration (FTA) DOT Drug Testing Pipeline and Hazardous Materials Safety Administration (PHMSA) 4

5 DOT Urine Drug Test Panel (a) Marijuana metabolites (b) Cocaine metabolites (c) Amphetamines (d) Opiate metabolites (e) Phencyclidine (PCP) DOT Drug Testing Specific drugs Specific cut off levels Metabolites defined Additional metabolites recently added- 6 AM, Ecstasy Features of DOT Programs Urine collections only-procedures well defined Federal forms must be used (paper CCF) Samples must be tested in SAMHSA certified labs 5 drug panel only Medical Review Officer (MRO) procedures defined All regulations must be followed precisely 5

6 NON DOT Drug Testing Unless regulated by state law, all options may be modified to suit employer needs: Specimen: Urine, Hair, Saliva- 95% URINE Analysis: Lab based or POCT (rapid) Panel: 1-50 drugs- 5 MOST COMMON Cutoff levels may vary- NIDA common Reason for test defined by company Paperless chain of custody form solutions acceptable Saliva Drug Test May be laboratory tests or rapid (only 1 rapid test FDA Cleared) Best if laboratory based- several now offer Poor detection of THC THC Window of Detection may be hours Adulteration possible despite claims Has potential for test of impairment/accident monitoring 6

7 Hair Drug Testing 90 day window of detection for all drugs More expensive than urine testing May be challenging to collect certain (hairless) donors Longer turnaround times for status or results Only method offered is a lab based test (no rapid or instant at point-of-collection) Point of Collection Testing (POCT) Manual (non instrumented) tests Pregnancy-type test design, visually read without an instrument Instrumented POCT Uses a digital reader to obtain objective results escreen technology is installed in 2,700 nationwide locations Confidential negative results in 15 minutes for employer escreen ereader Digitally interpreted NON DOT instant testing system ecup : 5 panels, 3 adult panels, barcode, test under seal (no transfer, pipette, interpretation) 3-8 minute ereader screen, results back to employer via the web in 15 minutes 7

8 Turnaround Times TAT depends on: Specimen method used Lab-based vs. POCT Screening test vs. confirmation tests MRO Management system Problems of tests causing delays Delays in Testing Test collection delays may be caused by: Positive results - always tested twice Second test GC/MS -100% specific Positive results to MRO Challenges for MRO in contacting donor Shy bladder, interfering substances, canceled tests, D/L, CCF issues 8

9 Errors in Testing False Positive False Negative Pre-Analytical Analytical Post-Analytical Perfect Test- 0 False Neg 0 False Pos Electronic Chain of Custody - NON DOT Tests Electronic CCF options created dramatic improvement in information management: Can be used for all specimens Paperless account management, specimen management, results management Guarantees compliance Integrates to Background, ATS and HRIS 9

10 Vendor Selection Need Collectors, Lab, MRO Depending on size and complexity of your program you may need a Third Party Administrator (TPA) TPA contracts with vendors to supply integrated solution and a single source of testing management Collection site management most difficult TPA helps with compliance Collection Site Management Collections take place in a variety of locations - 15,000 Laboratory - owned PSC Occupational Health Clinics Primary Care Clinics - Urgent Care Workplace collections Private collection providers On-Site collections 10

11 Electronic Chain/HRIS Integration Front and back end integration with HRIS systems creates a distinct competitive advantage over the traditional paper-based testing process Increasing the ROI for electronic applicant on-boarding Digital scheduling improves network compliance to control costs Internal applicant tracking identifiers eliminate orphan tests Enables tracking of Cost per Hire metric (the real budget number!) Visibility to field hiring practices; non-conforming offers; broader view of policy violations; payroll integration to avoid invalid hires Customizable to meet language/access within HR infrastructure Drug Detection Challenges Medical Marijuana New drugs Bath Salts, SPICE, K2, designer drugs Adulteration methods Dilution and substitution Window of detection Cutoff levels 11

12 Medical Marijuana in the Workplace Medical Marijuana in the Workplace 16 States and Washington, D.C. have legalized marijuana use for medical reasons: 1. Alaska 2. Arizona 3. California 4. Colorado 5. Washington, D.C. 6. Hawaii 7. Maine 8. Maryland 9. Michigan 10. Montana 11. Nevada 12. New Jersey 13. New Mexico 14. Oregon 15. Rhode Island 16. Vermont 17. Washington An estimated 300,000 Americans use marijuana for medicinal purposes *Source: Americans for Safe Access (ASA) *Sources: USA Today; procon.org 12

13 Medical Marijuana in the Workplace Recent News: AZ passed proposition 203 legalizing use of marijuana for certain medical conditions and added: An employer may not discriminate against a person in hiring, termination, or imposing any term or condition of employment or otherwise penalize a person based upon medical marijuana use unless the patient used, possessed, or was impaired by marijuana on the premises of the place of employment. Other states are considering workplace issues for the first time Medical Marijuana Medical in themarijuana in the Workplace Ethical and liability questions for employers across America Columbia Forest Products: A manufacturer of hardwoods based in Oregon, one of the states that allows medical marijuana. Even as the company maintains its zero-tolerance policy toward drug use, it has faced legal action because its company rules conflict with Oregon's medical marijuana law. Newbridge Securities: A Florida-based provider of securities brokerage services, has embraced the notion of employees using medical marijuana at work. *Source: It's almost an untenable situation. Employers are screaming for answers. We know they're looking for clear answers, and there's not one out there right now. There's a lot of uncertainty. Employers are living in a dangerous situation. - Richard Meneghello (Employment Attorney, Fisher & Phillips, LLP) 13

14 Policy Considerations A written policy is very important Always comply with state laws Define medical marijuana Define the reasons for employee testing Define the methods used for employee testing Define procedures used for testing Explain spilt specimen options Explain consequences of violations Questions and Answers Thank you 14

15 About escreen, Inc. escreen a member of the Alere group of companies since early 2012 Deploys proprietary drug testing technology to Occupational Health Clinics nationwide; creating an electronic, web based preferred network of over 2,700 clinic partners who service businesses seeking superior program solutions Processes millions of healthcare and corporate data transactions a year through this clinic network called the escreen Occupational Health Network (EOHN) Provides advanced services and technology for employment screening programs, yielding significant productivity gains in hiring efficient workforces 15

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