Changing Patterns in Drug Abuse

 " Drug abuse in the American workplace is worse than ever, due to the availability, 

purity, and lower cost of “street” drugs."

Prescription Drug Abuse

Over the past decade, the abuse/non-medical use of prescription medications has risen dramatically, continues to represent to most serious threat to workplace health and safety.  In middle and high school, prescription drug abuse, specifically prescription pain relievers, have replaces marijuana as the first drug of choice for initiates.  This trend is accelerating on a worldwide basis.

" Misuse of prescription drugs is second only to marijuana as the nation’s most prevalent drug problem, and the annual average number of people using pain relievers nonmedically for the first time in the past 12 months has exceeded the number of new marijuana users since 2002. "

- Colliver, J. D., Kroutil, L. A., Dai, L., & Gfroerer, J. C. (2006). Misuse of prescription drugs: Data from the 2002, 2003, and 2004 National Surveys on Drug Use and Health (DHHS Publication No. SMA 06-4192, Analytic Series A-28). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Prescription pain relievers such as Oxycodone (Oxycontin®, Percoset®) and Hydrocodone (Vicodin®, Lortab®), represent the most highly abused of all prescription drugs in the United States, and may account for more than 30% of serious drug-related issues in the workplace.  Oddly, these drugs are not test for by the DOT, FFA, or similar organizations and are relatively infrequently included in general workplace drug testing.

Deaths related to opiate-class drugs are higher than any other category, while deaths specific to Oxycodone/Hydrocodone reportedly account for at least 25% of all Opioid-related deaths. Opioid addiction of this type may also lead to heroin abuse.

To combat trends like this one, substance management techniques must adapt accordingly.  Testing for opiate class drugs such as oxycodone, oxymorphone, hydrocodone, and hydromorphone, in addition to the three opiates typically covered by the traditional “five-panel” DOT or SAMHSA urine test (morphine, heroin, codeine), is an important consideration.  Meanwhile, testing for PCP, also a “traditional testing requirement,” may no longer be required.  The “positivity rate” of PCP is typically  less than 0.3%.

IMPORTANT : Traditional “DOT” urine-based drug testing and associated confirmatory testing currently includes the following:  

         Amphetamines/Methamphetamines (not including Ecstasy),

         Cocaine (metabolite – benzyclonine)

         Marijuana/THC (metabolite (THC-COOH)

         Opiates (heroin, codeine, morphine),

         PCP

In addition to obvious concerns of urine adulteration and substitution, the 2,000 ng/ml cut-off for Opiates makes it highly unreliable as a screen to detect opiate abuse.

Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs

Urine Sample Adulteration and Substitution

The long suspected practice of drug abusers circumventing drug tests by altering or substituting specimens graduated to the status of a known pervasive problem in the years 2006 and 2007, culminating in Congressional hearings on the topic and an investigation by the United States Government Accounting Office (GAO).  The GAO published below following its investigation of 24 United States Department of Transportation (DOT) drug testing sites nationwide.  The DOT concurred with the GAO’s findings.

GAO Report (GAO-08-225T, November 2007) Key Findings:

1. The DOT urine-based drug testing program is “vulnerable to manipulation by drug abusers, especially given the wide availability of products designed to defeat drug tests.”

2. Investigators were able to defeat the DOT test protocol at all 24 sites selected across the country.

3. In all cases, the SAMHSA-approved urine laboratories, which are responsible for detecting altered specimens, were unable to detect either adulterated or substituted specimens.

Statistics - Drug Abuse in America

Primary References:

2008, Substance Abuse and Mental Health Services Administration. Results from the
2007 National Survey on Drug Use and Health: National Findings (Office of Applied
Studies, NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville, MD.

• 15% of all Americans (aged 12 or older) reported abusing illicit drugs or prescription drugs (not including alcohol) within the past year.
• 77% of drug abusers are employed.
• Highest rates of drug abuse (use within last month) reported by occupation:  hospitality / food preparation (19%), construction (14%), service occupations (13%), transportation (10%).
• 20% of workers impacted by drug abuse: put in danger, had to work harder, redo work.
• 40% of fatalities and approximately 50% of workplace injuries linked to substance abuse.

• 4% of all Americans report driving under the influence of drugs (not including alcohol) within the past month.

• 9% the population (aged 12 or older) were classified with substance dependence or abuse in the past year based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSMIV).

• 8% of all Americans (aged 12 or older) reported abusing illicit drugs or prescription drugs (not including alcohol) within the past month.
•   
• 20% of all Americans (aged 18-25) reported abusing illicit drugs or prescription drugs (not including alcohol) within the past month
• 6% of all Americans (aged 26 or older) reported abusing illicit drugs or prescription drugs (not including alcohol) within the past month.

Illicit Drug Use / Abuse

The SAMHSA National Survey on Drug Use and Health (NSDUH) obtains information on nine different categories of illicit drug use: use of marijuana, cocaine, heroin, hallucinogens, and inhalants; and the non medical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives. In these categories, hashish is included with marijuana, and crack is considered a form of cocaine.

Several drugs are grouped under the hallucinogens category, including LSD, PCP, peyote, mescaline, psilocybin mushrooms, and "Ecstasy" (MDMA).

Inhalants include a variety of substances, such as nitrous oxide, amyl nitrite, cleaning fluids, gasoline, spray paint, other aerosol sprays, and glue.

The four categories of prescription-type drugs (pain relievers, tranquilizers, stimulants, and sedatives) cover numerous medications available by prescription and drugs within these groupings that may be manufactured illegally, such as methamphetamine, which is included under stimulants. Respondents are asked to report only "non medical" use of
these drugs, defined as use without a prescription of the individual's own or simply for the experience or feeling the drugs caused.

Use of over-the-counter drugs and legitimate use of prescription drugs are not included. NSDUH reports combine the four prescription-type drug groups into a category referred to as "psychotherapeutics."

Illicit Drug Use within Past Month among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs

Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs

Symptoms of Drug Abuse

• Inconsistent work quality
• Poor concentration
• Lowered productivity
• Increased absenteeism
• Unexplained disappearances from the workplace
• Carelessness
• Mistakes
• Errors in judgment
• Needless risk taking
• Disregard for safety
• Extended lunch periods and early departures
• Avoidance of friends and colleagues
• Blaming others for own problems or shortcomings
• Deterioration in personal appearance
• Complaints and excuses of vaguely-fined illnesses

Intervention

When an employees performance deteriorates and/or is otherwise suspects of substance abuse the following principles of intervention are recommended by experts.  A supervisor need not be an expert in substance abuse to apply these items.

Maintain Control

• Stick to the facts as they affect work performance
• Do not rely upon memory, have supporting documents and records if available
• Do not discuss drug or alcohol use

Be Clear and Firm

• Explain company policy concerning performance
• Explain company drug-free workplace policy
• Explain consequences if  performance expectations are not met

Be Supportive, but Avoid Emotional Involvement

• Offer help in resolving performance problems.
• Identify resources for help in addressing personal problems.

Employee Benefits of a Drug Free Workplace

• Safety
• Health
• Productivity
• Morale
• Security
• Well-being

Employee Benefits of a Drug Free Workplace

• Staff morale
• Employee motivation
• Employee creativity
• Customer satisfaction
• Customer retention
• Positive public image
• Cost savings through reductions in: insurance premiums, litigation costs, accidents, property damage, employee turnover, absenteeism, worker errors, workers compensation costs

Protecting Workplace - What Employers Can Do

• Drug-free workplace policy
• Employee education
• Supervisory training
• Employee assistance
• Drug testing

Testing Methods

Traditional methods of dealing with

substance abuse, primarily urine-based pre-employment drug testing, have been largely ineffective. New drug-free workplace technologies, methods, and approaches need to be applied on a widespread basis to more effectively identify and deter improper workplace drug and alcohol use.      

Alternative specimens, such as oral fluid, enable on-site collection and screening as well as the implementation of RANDOM TESTING, note by experts as the most effective deterrent to drug abuse.  Post-accident, reasonable suspicion, and return-to-duty can also conveniently and non-invasively be applied in the workplace using oral fluid technologies.

Corporate-wide commitment, education, and awareness building, along with comprehensive drug and alcohol management programs that include random drug testing technologies and employee assistance/counseling programs, are also requisite components of successful strategies.                                                                     

Workplace Drug Policy and Program Management

The safety profession is likely best suited to play a central role in the establishment and implementation of corporate drug-free workplace programs, as it combines the requisite expertise, motivation, and ability to be heard at CEO/boardroom levels.  

Safety professionals understand the importance of mitigating the on-the-job hazards posed by substance misuse because they are exposed to its negative impacts on a daily basis.   Improving overall employee health and productivity, through the development and implementation of all available technologies and best practices, is a challenge that many safety professionals are beginning to establish as a priority.  

It is the responsibility of safety and risk professionals to be familiar with these available and evolving tools.  It is equally important that the group clearly communicate that comprehensive workplace substance abuse management programs are not complex, illegal, onerous, or invasive of personal privacy.  Properly designed and implemented drug and alcohol management programs are an important benefit to everyone: employers, employees, family members, business owners, insurers, and organized labor as a whole.

Employers have a right to expect employees to perform tasks in a safe, efficient manner. They also have a legal responsibility to provide a safe work environment that complies with applicable federal/state regulations.

References:

2006. United Stated Department of Health and Human Services, SAMHSA, 2008, National  Institute on Drug Abuse (NIDA), http://www.drugabuse.gov/about/organization/despr/hsr/da-pre/SteeleWorkplacePartB.html, 2003, Drug Abuse Warning Network, (DAWN) Area Profiles of Drug-Related Mortality.

2003, DAWN.

International Committee Report.

2001, Office of National Drug Control Policy, The Economic Costs of Drug Abuse in the United States, Washington,   D.C., Executive Office of the President.

 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs

News Related Events

- Methamphetamine user steals dozens of identities at Utah Department of Workplace Services.  Random testing believed to have prevented the incident and now being considered. (Salt Lake Tribune 4/27/08)