Drug Screens and the Medical Review Officer

Transcription

1 Drug Screens and the Medical Review Don Bucklin Certified MRO Faculty AAMRO Medical Director US HealthWorks Why drug test? 1

2 Why drug screen? Prevent the hiring of employees who abuse drugs. Dissuade current employees from abusing drugs. Provide a safe workplace. Save money on the treatment of injured employees. Save money on Workers Compensation Insurance. Have a more successful company. What is the MRO s Function? The essence of the MRO practice is the interpretation of forensic drug testing results within the context of a policy or regulatory framework. & To interface with the donor to discuss results and facilitate appropriate actions and requests. 2

3 Overview of Verification Process Review Custody and Control Form. Is a new urine collection needed? Is there a correctable error or flaw on the paperwork? Contact Donor Determine if there is an Acceptable Medical Explanation. Report verified results to employer. Is there a policy violation? Questions for you and your legal counsel in consult with MRO if necessary: Are the analytical results evidence of a donor s violation of a policy or regulation? Is this evidence of illegal drug use? AAMRO Training Program 6 3

4 Limitations of Drug Testing Many new drugs that are abused are not tested for on routine drug screens. Marijuana variations: K2 and Spice; more to come. Methamphetamine variations: Bath Salts, Ecstasy/Molly (Ecstasy -recently added to DOT) Many more to come. Europe has almost 50 new drugs to be seen here soon. Limitations of Urine Drug testing. Urine detection of a drug says nothing about impairment Urine concentration does not equal blood concentration Urine detection not equal to impairment Not all drugs are tested for. (K2, Krocadile ). Prescription drug abuse is largely invisible Limited detection times 4

5 Detection Times in Urine Cocaine: hours Methamphetamine: hours Marijuana: days, weeks, up to 1 or 2 month (s) Long term use saturates fat and acts as a reservoir. Opiates: 2-4 days MDMA: 3-4 days Drug Screens in the US million drug tests are done per-year Most tests are pre-employment 7 million are federally mandated tests 6-8% of tests are oral fluid Small but growing market for hair test 5

6 Hair Testing Hair Testing It takes more than 1 time use to be positive 6 month history of drug use is common. On the hair vs. in the hair-washing at the lab. Different hair colors have markedly different positivity rates. Most useful in pre-employment testing where large numbers of applicants are screened (and stakes are small). Alternative Testing Matrix Oral Fluid Every test is an observed collection (substitution nonexistent) Similar detection time to urine. Does not take a trained collector. Can be used for expanded testing panels. DOT will probably approve this year. Positive oral fluid still does not tell impairment. 6

7 Instant Drug Screens Equivalent to immunoassay (screening test at lab). Instant Negatives are very strong results. Non-Negative DOES NOT EQUAL a positive! Immunoassay or antibody tests are very sensitive, But not very specific (false positives are a given). Non negative screen tests must be sent for confirmatory testing. Impairment from Drugs Written into the Arizona Law. Most agreed upon blood level of THC is 5ng/dl for impairment. Problems with this. New vs. Chronic smokers. Not well established by science Law enforcement needs a number 7

8 Impairment Police s go through a 2 week course for DRO Certification (Drug Recognition ). Diplomats of such training have been referred to as: A walking talking drug-testing machine. They might have been kidding Impairment. Supervisor training is available in recognition of impairment. Marijuana Eyes: Sclera is reddish, pupils relatively dilated. Difficulty tracking with both eyes. Eye Lid faciculations, mild tremor. Time distortion (slow internal clock). 8

9 Impairment Marijuana alone has effect of 2-4 hours but FAA has detected influence up to 72 hours. Impairment Influences Polypharmacy- users mix and match (esp alcohol). Physical tolerance to effects Several not drug-related conditions mimic drug effects Exhaustion, excitement, disease 9

10 Emerging Drugs Emerging Drugs. Marijuana analogs are all much more dangerous than marijuana. None adds to the experience, only to the toxicity. Methamphetamine s first derived drug was MDMA (ecstasy). Bath salts are variations on Methamphetamine and everything else. No consistency in product composition, concentration, or toxicity. Whatever is in your home medicine cabinet. Prescription abuse Prescription abuse is greater than drug abuse today. Phenergan with codeine-purple Drank, Sizzurp. Soma (muscle relaxant). Valium/Xanax and benzo s in general Synthetic opiates-oxy, Vicodan, Percocet, Demerol, Fentanyl. Internet purchase Perceived as safer than street drugs. Find them in the home medicine cabinet much like stealing liquor in our childhood. 10

11 Approximate Costs Per Test Average comprehensive workplace urine drug test is about $40.00 (not including breath alcohol tests) Collector $ Laboratory $ MRO $ Administrative $