PERSPECTIVES ON WORKPLACE DRUG TESTING IN SOUTH AFRICA

Transcription

1 PERSPECTIVES ON WORKPLACE DRUG TESTING IN SOUTH AFRICA Dr Tim Laurens [PhD, FRSC, MFSS] Forensic Division, Dept of Chemistry Tel: / Website:

2 Introduction Substance abuse part of society for the past few millennia!

3 Heroin Heroin A bottle of Bayer's 'Heroin'. Between 1890 and 1910 heroin was sold as a non-addictive substitute for morphine. It was also used to treat children suffering with a strong cough.

4 Cocaine Mariani wine (1875) was the most famous Coca wine of it's time.

5 Cocaine Very popular for children in 1885.

6 Opium The good old days!

7 TODAY.. Faces of Meth (TIK)

8 Methamphetamine

9 Cocaine

10

11 TODAY..

12 Today Rationality???? 3 Heroin Tobacco Street Methadone Cocaine 2 Alcohol Barbiturates Physical Harm Cannabis Buprenorphine Benzodiazepine Amphetamine LSD Methyl Phenidate Ketamine 1 Khat GHB Ecstacy Solvents Alkyl Nitrites Anabolic Steroids Dependence Nutt D, King LA, Saulsbury W, Blakemore C Lancet 369 (9566): (2007). "Development of a rational scale to assess the harm of drugs of potential misuse".

13 Drug and Alcohol Policy Substance Abuse Policy

14 Possible reasons for increased drug abuse No of Euphoric Substances Technology Clandestine lab technology Horticultural techniques Cannabis THC content 3% 15% International Distribution

15 Designer drugs: Synthetic Cannabis

16 Designer drugs: Synthetic Cannabis CH 3 OH OH OH H 3 C H 3 C O CH 3 Delta-9-Tetrahydrocannabinol HO CP 55,940 O N JWH-073

17 Proudly South African Nyape: Heroin + Cannabis + Ratpoison/Lanthanum oxides Cannabis + ARV

18 LEGAL OBLIGATIONS Legal Obligations Employees Trade Unions Employer

19 LEGAL ASPECTS OF EMPLOYEE TESTING The two prime factors to balance are: The obligation of the employer/employee to ensure a safe and healthy workplace. The workers privacy of his own private life.

20 LEGAL ASPECTS OF EMPLOYEE TESTING Employee s perspective: Confidentiality! Dignity and personal privacy/security. Section 12 of the South African constitution protects the right to human dignity and security of the person which includes the right to protection of their body information. It is therefore of prime importance to respect human dignity by performing test in privacy.

21 Drug testing - Two sides of the coin de Drug testing is conducted as a deterrent to drug abuse. Society seeks to protect the rights of individuals in the workplace Invasion of Human privacy False accusations Safety of Colleagues & Public Safe harm the organization s interests

22 The need for a drug testing program Cost of drug testing Economic expense Effects on employee morale Health Benefits: Safety (Employee & Public) Productivity Medical Aid & Unemployment claims Liability from employee acts.

23 Basic elements of e a drug testing policy POLICY Statement of Need Statement of Purpose Employer Responsibilities Legally correct Ethically sound Scientifically accurate Disciplinary Action!!! Policy should Accommodate Employee assistance program Supervisory training Self referrals & Voluntary drug testing Testing of employee in safety sensitive positions Employee Responsibilities Not to obstruct the drug testing process in any means

24 Key Policy e Issues Key Issues Decision as to who to test based on Safety & Security concerns Overly broad categories of groups subject to testing not always acceptable Policy apply to all staff!!! Irrespective of Race, Color, Sex, Religion, Political opinion Irrespective of position in the organization (CEO & Managers included!) Communication of the policy Enhance employee acceptance Awareness of substance abuse problems Help the program to withstand legal scrutiny An employee s right to refuse testing Consequences of refusal should be stated!

25 Consequences for positive Test Results Primary goal of Workplace Testing Rehabilitation Rehabilitation Disciplinary action strong deterrent! Punitive Action Only for confirmed positive results with no legitamite explanation

26 On-duty versus off-duty use??? Some might argue that off-duty use is of no concern to the employer Off-duty? On-duty use use INTOXICATION Case studies On-duty IMPAIRMENT Marijuana in pilots 24 h after smoking Hangover effects of alcohol

27 On-duty versus off-duty use??? Some might argue that off-duty use is of no concern to the employer Off-duty? On-duty use use INTOXICATION Case studies On-duty IMPAIRMENT Marijuana in pilots 24 h after smoking Hangover effects of alcohol

28 On-duty versus off-duty use??? Some might argue that off-duty use is of no concern to the employer Off-duty? On-duty use use ZERO TOLLERANCE!! ZERO TOLLERANCE!! INTOXICATION Case studies On-duty IMPAIRMENT Marijuana in pilots 24 h after smoking Hangover effects of alcohol

29 Choice of Bio ` Sample Matrix Years Hair Nails Weeks Urine Sweat 6 h Saliva Breath 0 h Blood

30 Choice of Bio Sample Matrix Years Technology problematic Collection procedure!! Patch collection Weeks Hair Nails 6 h Urine Sweat 0 h Saliva Blood

31 Choice of Bio Sample Matrix External contamination problematic Years Weeks Hair Nails 6 h Urine Sweat 0 h Saliva Blood

32 Choice of Bio Sample Matrix Matrix of Choice Years Weeks Hair Nails 6 h Urine Sweat 0 h Saliva Breath Blood

33 On-duty versus e off-duty use??? Some might argue that off-duty use is of no concern to the employer! Off-duty? On-duty use use ZERO TOLLERANCE!! ZERO TOLLERANCE!! INTOXICATION Case studies Cut-off levels SAMHSA guidelines On-duty IMPAIRMENT Marijuana in pilots 24 h after smoking Hangover effects of alcohol

34 What to test for? Drugs Alcohol Recreational Drugs Schedules of the Medicines and Related Substances Control Act, Act 101 of 1965 Drugs and Drug Trafficking Act, Act 140 of 1992 Typically: Marijuana, Cocaine, Opiates, Amphetamines Prescription medication NO DISCRIMINATION towards employees with a valid medical condition & valid prescription! Barbiturates, Benzodiazepines Employer may dictate by his policy that the person may not be permitted to perform any safety sensitive tasks

35 Types of Tests Tests triggered by employee: Reasonable cause / suspicion Post accident & post rehabilitation Tests triggered by employer: Random Periodic

36 Random Tests Pre-announced drug testing allows time for the employee to defeat a test by in-vivo and in-vitro tampering Drink excessive amounts of water Change urine ph (baking soda, lemon juice, vinegar etc) Drug test Cheating kits can be obtained over the internet Substitute their own urine with clean urine from someone else. Random means arbitrary Eliminates management s discretion as to who to test. Employees cannot be singled out or discriminated against. Use a random-number generator / colored balls

37 Adulteration can take place mainly in two ways: Products taken orally to flush drugs from the body Adulterants are added to urine after donation to invalidate drug testing Synthetic urine Can be bought via various Internet sites Cost R R Diuretic medication Beating Drug tests (1) dilute the drug concentrations to below the cut-off.

38 Beating Drug tests (2) Drinking of excessive amounts of water Caffeine Herbal medication To obscure a drug test result If tested positive the herbal medication/tea is blamed. Stealth Liquid (hydrogen peroxide) + peroxidase (solid)

39 Household chemicals Beating Drug tests (3) Sodium chloride Vinegar Hand soap Liquid laundry bleach Ammonia Sodium bicarbonate (baking soda) Denture cleaning tablets (sodium perborate) Concentrated lemon juice Ascorbic acid (vitamin C) Some teas (producing dark urine) Eye drops Hydrogen peroxide Ethanol and propanol Dettol

40 Drug testing A multifaceted process Legal Aspects Drug Testing Ethical aspects Written consent Sampling privacy Human dignity Scientific aspects Sampling procedure Accuracy and validity of results Use and application of reported results Testing methodology

41 Key stages: Drug testing strategy What is the purpose of testing? Decision Intervention Results Scientific validity Analysis Specimen collection Sampling protocol Legal/Ethical procedures

42 Testing Philosophy Screening / preliminary test Off-site Laboratory Turn-around-time concerns. On-site with screening device Immediate answer!!! ALL non-negative results Confirmation Specialized laboratory (GC-MS) University of Pretoria Competent to provide evidence in a disciplinary hearing or a Court of Law

43 Testing Philosophy Screening / preliminary test On-site testing provides results quickly At a potentially reduced cost (7X lower price) The worker can be temporarily removed from a safety sensitive position awaiting confirmation The confidentiality of the initial test results must be maintained!!!! ALL non-negative results Confirmation by GC-MS

44 Specimen Collection Collecting Officer Collection Supplies Legally Defensible Specimen Collection Collection Site Collection Procedure 44

45 Workplace Drug Testing: 3 Stage Process Specimen Collection Collection, packaging, transport Crucial part of drug testing process Ethically correct and legally defensible Informed & voluntary consent of prime importance Testing Screening vs. Confirmation Interpretation Medical Review Officer 45

46 Specimen Collection: Urine Collection Procedure Take necessary steps to avoid sample adulteration Donor donates the specimen Collecting official evaluates temperature and volume of specimen Sample A and B is secured and donor initials specimens Collecting official performs direct contact tests Specimens is prepared for dispatch to the laboratory Donor and collecting official completes identification labels and chain of custody documents 46

47 On-Site Immunoassay screening

48 On-Site Immunoassay screening

49 Metabolism Pharmacology increase water solubility enhance urinary excretion Hepatocyte

50 Metabolism - Opiates NCH 3 CH 3 COO O OOCCH 3 Heroin NCH 3 Testing Philosophy NCH 3 NCH 3 HO O OOCCH 3 HO O OH CH 3 O O OH 6-Acetylmorphine Morphine Codeine Conjugation

51 Metabolism - Opiates ILLEGAL Poppy Seed LEGAL Codus, Myprodol, Syndol etc Testing Philosophy Opiate Class Conjugation

52 Classes of Compounds Opiates : Heroin, Morphine,Codeine etc Cocaine Benzoyl ecgonine Amphetamines Amphetamine, Ecstasy, TIK, CAT, Ephedrine Interferences Cold & Flu medication Benzodiazepines Valium,Rohipnol etc Cannabis THC

53 On-Site Immunoassay screening What is a lateral flow immunoassay device?

54 Non-Selective Immunoassay cross reactivity Positive control for Cannabis Confirmed by GC-MS Both positive!!! + indicated by a single magenta line

55 Non-Selective Immunoassay cross reactivity Efavarens Study 30 HIV Patients on Efavarens (ARV) 28 of the 30 nonnegative for THC Confirmed negative for THC (Cannabis) by GC-MS

56 Non-Selective Immunoassay cross reactivity Efavarens Study

57 Confirmation by GC-MS How does confirmation improve quality of results?

58 Confirmation by GC-MS How does confirmation improve quality of results?

59 Confirmation by GC-MS How does confirmation improve quality of results? A b u n d a n c e S c a n ( m in ) : A 2 _ s c a n. D ( ) ( - ) CH 3 N O O O O Cocaine m / z - - > units means 303 amu = 303 X kg = kg 51 units means 51 amu = 303 X kg = kg 1 units means 1 amu = 1 X kg = kg

60 Confirmation by GC-MS How does confirmation improve quality of results? Abundance Ion ( to ): OPIATE63852R.D 5.03 Ion ( to ): OPIATE63852R.D Ion ( to ): OPIATE63852R.D Codeine Morphine 1500 Time-->

61 Confirmation by GC-MS How does confirmation improve quality of results? Abundance Ion ( to ): Opiate 96252r.D Ion ( to ): Opiate 96252r.D Ion ( to ): Opiate 96252r.D Morphine Codeine 6-Acytelmorphine Time-->

62 Exclude factors Diet and Herbal Result interpretation What happens after a true positive? Medication Herbal Cannabis Coca tea - Cocaine Dietary supplements - Amphetamines Positive Opiate (Codeine / Morphine / Heroine?) Positive Amphetamine/Extacy (Flue medication?) Company policies Re-testing Continuous monitoring by normalized values

63 Breath Alcohol Analysis One can normally smell if someone has consumed alcohol 1-2% EtOH is excreted in breath (BrAC) Breath Alcohol instruments provid a fast and non-invasive way of monitoring BAC

64 Preliminary testing Testing Philosophy Confirmatory / EVIDENTIARY testing

65 Preliminary testing devices Handheld screening devices Raises reasonable suspicion for the confirmation test to be performed. Screen out the non-negatives Normally based on Fuel cell technology Acetone from diabetics isopropanol alcohol Sometimes a pass / warn / fail device

66 Preliminary testing devices

67 Preliminary testing devices Saliva based technology

68 Preliminary testing devices Chemical colour change

69 Fuel cell technology Preliminary testing devices

70 Evidential Breath testing devices Operational principle: Requires two independent measurements Mosty two IR measurements 9.5 micrometers for O-H strech vibration 3.4 for C-H strech vibration IR + Fuel cell technology 9.5 for O-H Fuel cell

71 Rules: Evidential Breath testing Requires a deprivation period of 15 minutes Person must be actively observed!!! Alcohol may still reside in the mucous membrane of the mouth resulting in increased BrAC concentrations. Person may not hick-up / burp / belch / regurgitate during observation Look out for hyperventilation

72 Analytical protocol Pre-analytical phase Subject preparation (Observation period) Air Blank Breath Test 1 Air Blank Analytical phase Breath Test 2 Air Blank Control Test Air Blank Printout / recording of results

73 Cut-off concentration Normal drivers (public) 0.24 mg / 1000mL Breath Professional drivers 0.1 mg/1000ml Breath

74 Evidentiary Breathalyser

75 Evidentiary Breathalyser

76 Conclusions Workplace drug testing in South Africa Common Law rights of individual Constitutional rights of individual Law suit free program Three key stages Donor (specimen collection) with due consideration of legal and ethical principles On-site and laboratory analysis with a scientifically accurate procedure. Analytical result reporting and interpretation

77 Thankyou END