General Questions

 

 

 

Are there standard guidelines for workplace drug testing & analysis in the UK?

 

Much of the background, science and theory for workplace alcohol and drug testing originated in the United States where mandatory testing (of urine) was carried out by federal employers. European Guidelines now exist (www.ewdts.org) for collection of samples and laboratory analysis of oral fluid (saliva) and urine. The laboratories which carry out analytical work are fully accredited for this type of testing.

 

 

 

Why test for drugs?

 

Many companies are concerned with the welfare, health and safety of their employees and have a drugs and alcohol policy in place.  Testing is often included in the policy, as it has been shown to deter inappropriate drug and alcohol use leading to reduced accident rates & staff wellbeing. Corporate insurance premium reduction can also reflect the successful implementation of a drug and alcohol testing programme.

 

 

What types of testing are there?

 

Depending upon company policy, recruits may be tested before they are employed (pre-employment testing), on existing employees (unannounced testing), or if a safety-critical incident occurs (for-cause testing).

 

 

Isn't drug testing an invasion of privacy?

 

If the program is properly administered and within agreed guidelines, the courts have determined that drug testing is not an invasion of privacy. The primary factor (among others) with respect to court decisions is the welfare and safety of others.

 

 

Do employers have the right to require that employees be tested for drugs and alcohol?

 

Yes on both counts. But a company has to do it fairly and have systems in place to deal with the consequences of positive results.

 

 

Are my records confidential?

 

Individual names are usually not shown on laboratory reports. Your employer and the MRO (Medical Review Officer) are required to keep test result records confidential, in a safe, restricted place. Testing records cannot be released to others without your consent.

 

 

What is a MRO?

 

Medical Review Officer. If your test result is 'negative', the information can be given directly to your employer. However a 'positive' test result is usually sent directly to a nominated Medical Review Officer (MRO), a qualified physician who reviews and interprets the results on behalf of the employer and independently of the laboratory. The doctor may consider your medical history and prescribed medication when assessing the results. Sometimes he may ask to speak with you.

 

 

What information do they put on the forms that go with my sample to the laboratory?

 

When samples are sent to the laboratory for analysis, a special chain-of-custody form is completed. Laboratory reports are linked to an individual donor’s sample by unique identifiers; donor names are generally not included in the laboratory report.

 

 

What kinds of tests would I have to take? What drugs would be tested for?

 

Your employer has the right to set up a testing program for alcohol and drug abuse. Under most circumstances the types of tests, and the drugs included in the test panel, can all be determined by your employer. There are 'standard panels' however which are used by many employers. Local drug abuse patterns may also be taken into consideration by your employer when choosing a drug panel.

 

 

What are cut-off levels?

 

A cut-off level is a drug concentration value used to determine if a sample is to be considered positive or negative. Much research has been carried out to determine optimum cut-off levels and these have been standardized within the drug testing industry. For example, if the test were to be too sensitive (low cut-off), there could be the danger of a positive result being given for innocent exposure to a drug - such as 'passive' smoking of cannabis.

 

 

How reliable is drug testing?

 

When both screening and confirmatory tests are conducted, the combined tests themselves are virtually 100% dependable.

 

 

What happens if I decline to be tested?

 

Most company drug testing policies call for some form of disciplinary action up to and including dismissal.

 

 

Where would I be tested?

 

Collection usually occurs on company premises. Sometimes the collection may take place in NIVHA premises.

 

 

What are the collection site requirements?

 

A urine collection site must at a minimum provide:

- An enclosure where privacy for urination is possible.

- A toilet for urination

- A source of water for washing hands; alcohol-free wipes can also be used.

- A suitable writing surface for completing the required paperwork

- Restricted access so that the site is secure during collection.

 

An oral fluid collection site does not require the availability of toilet facilities.

 

 

What actually happens when I go to be tested?

 

Most employee drug testing involves the collection & testing of urine or oral fluid (saliva) specimens. Test results are reported as either POSITIVE or NEGATIVE for drugs.

Analysis cannot determine if a particular individual is "impaired" by the drug, and it cannot tell accurately when an individual last used a drug.

 

 

What steps are involved in the testing process?

 

Testing is a two-stage process. First, an initial (screening) test is administered. If it is positive for one or more drugs, then a second, confirmatory test is conducted for each identified drug.

Screening tests may be carried out on-site (at the time of collection) or in the laboratory.

 

The confirmation test uses a different, more sophisticated analytical process in a laboratory. It ensures that any drugs present are identified with certainty and their concentrations determined.

 

Samples to be submitted for laboratory analysis are collected by a person trained in the collection process. Samples are sealed and labeled and along with accompanying paperwork, are sent to the laboratory. Each step of the process is documented on a "chain of custody" form. The collection and chain of custody procedures ensure the specimen is properly identified and tracked throughout the testing process.

 

A urine specimen is divided into 2 or 3 portions at the time of collection. All bottles are sent to the laboratory, but only the primary specimen is opened and used for the initial screening and confirmatory tests. The other specimen bottle remains sealed and is stored at the laboratory.

 

In oral fluid testing, a single sample of fluid is initially collected and usually tested on-site using a screening device. If a positive screening result is obtained, a further sample of oral fluid (or urine) must be collected for laboratory analysis. In some circumstances a laboratory sample can be collected at the outset and sent to the laboratory for analysis.

 

If the confirmation test on the primary specimen is positive, the employee can request that the other specimen (commonly referred to as the ‘B’ sample) be sent to another accredited laboratory for analysis. The split specimen procedure essentially gives employees an opportunity for a "second opinion" if their drug test comes out positive.

 

 

Are donors required to strip, wear a hospital gown or empty pockets?

 

You do not have to strip or wear a gown. The collector however can ask the individual to remove any unnecessary outer garments such as a coat or jacket that might conceal items or substances that could be used to tamper with or adulterate the individual's urine specimen.

It should also be noted that if a collector, during the course of a collection procedure, suspects an individual may attempt to tamper with or adulterate a specimen, as evidenced by a bulging or overstuffed pocket, for example, the collector may request that the donor empty his or her pockets, display the items and explain the need for them during the collection.

Oral fluid collection is much less susceptible to tampering or adulteration.

 

 

How much urine must I provide for the drug testing sample?

 

Not very much. At least fifty (50) milliliters is required.

 

 

What if I just can't "go" at the time of urine collection?

 

If the donor is unable to provide a specimen initially, water is offered, with the dual objective of assisting the willing donor and encouraging the non-willing donor. If after a reasonable waiting time a specimen is not forthcoming, the employer is informed that the donor has been unable to provide.

If fluid is ingested during this time period it is highly unlikely that a sample could not be provided. In such circumstances it may be necessary to determine if there could be a medical reason for the inability to provide a sample and consequently the case can be referred to a Medical Review Officer (MRO) for review.

 

How long after use can drugs be detected in urine and oral fluid?

 

Urine - That depends on the drug, the amount of drug and your metabolism. Many of the tested drugs can be detected for several days after use. Cannabis metabolite can be detected for longer - up to several weeks in regular users.

Oral Fluid – in general, the detection window  for drugs in oral fluid is shorter than for urine, depending on dose.

 

 

Can I test positive if exposed to secondhand cannabis smoke?

 

Research experiments have been conducted where non-smoking individuals have been exposed to heavy concentrations of marijuana smoke in confined spaces. Although nonsmoking individuals can absorb some of the drug, it would be highly unlikely for the drug concentration to exceed the industry standard cutoffs.

 

 

Should I avoid taking any foods or medicines before the test?

 

If you are taking prescribed medication for a specific condition, you should continue taking it. You will be given the opportunity to declare any medication at the time of sampling and advise the MRO of this fact. As for food and drink, there's no reason not to eat and drink as usual. Women need not declare use of the birth control pill. Men need not declare use of erectile dysfunction drugs such as Viagra.

 

 

What does testing "positive" mean? What does testing "negative" mean?

 

Testing laboratories use "cutoff limits" to determine if a specimen is positive or negative. Cut-off limit guidelines are used for both oral fluid and urine drug testing. A negative result indicates the level of a drug or alcohol being tested for is either not present or is below the cut-off concentration. A positive result indicates the substance is present at a level above the cutoff limit.

 

 

Who establishes the cutoff limits?

 

Internationally agreed  and standardized cut-offs are usually used for this type of work.

 

 

What level of drug indicates that an individual is impaired?

 

Physical impairment according to a given concentration is not the issue. The issue is whether or not illegal drugs are being used at all, and whether or not drug and alcohol abuse is taking place.

 

What is a "false" positive, and how can they occur?

 

This is probably the most confusing issue regarding drug testing. Simply put, the tests are very accurate. If, during screening, a positive result is obtained, it is called a "presumed" positive. Some over-the-counter and prescription medications can give rise to presumptive positive results, but the subsequent confirmatory tests will rule out any illicit substances. What is generally called a "false" positive is simply a result that has not been confirmed to be a target drug of abuse.

 

 

What qualifications are the MRO required to have?

 

The MRO is a registered physician with knowledge of substance abuse disorders. Typically an MRO is a qualified occupational physician.

 

 

What can I do if I'm wrongfully accused?

 

You can request a re-test. You will not be permitted to provide a new specimen. The secondary specimen (‘B’ sample) taken at the time of donation will be opened and tested in another laboratory to confirm or refute the first positive report. You will normally have to pay for this re-test. It is worth noting that ‘B’ samples are routinely transferred directly between laboratories and are not returned to the individual concerned.

 

 

What should I do if someone I work with has a drug problem?

 

That's a question you have to answer for yourself. But you owe it to yourself, the people who work with you and the person with the problem to seriously consider discussing it with your supervisor, shop steward or union representative. Whether or not you discuss it with the person who has the problem depends to a great extent on your relationship with that person. Most of the time it's not advisable. A person with a serious problem, whether it's drugs or alcohol, usually needs professional help.

 

 

Can I go to management for assistance if I have a drug or alcohol problem? What would happen?

 

That depends on your company and its policies and procedures. However, company policies usually facilitate treatment & encourage self-referral.

 

 

What will happen to me if I test positive?

 

Study your company's Policies and Procedures carefully.

 

 

Will I have to pay for a confirmation test out of my own pocket?

 

Usually not. However, if you dispute a test and request a re-test in another laboratory, you will normally be expected to pay for it.

 

 

Will I have to pay for a confirmation test out of my own pocket?

 

Usully not. However, if you dispute a test and request a re-test in another laboratory, you will normally be expected to pay for it.

 

 

Why was most workplace testing directed towards urine sample collection?

 

Urine alcohol and drug testing is well established. Since the 1980's many millions of specimens have been collected throughout the world for this purpose and much research has taken place with respect to workplace urine testing.

 

Oral fluid testing is now increasing in popularity due to its ease of collection and donor acceptance. Guidelines exist for oral fluid testing practices.

 

 

What are the alternatives to urine testing?

 

Because of health and safety issues the sampling of blood from individuals for workplace testing is not recommended. Oral fluid testing is now becoming the primary testing sample type.

Alcohol - breathtesting is the primary means of detecting alcohol. The technology for breathtesting is well established and the principles are enshrined within drink-drive legislation.

Drugs - saliva (oral fluid) testing represents an attractive alternative to urine drug testing and is now mainstream in many circumstances.

 

 

How about Hair Testing?

 

Hair Testing can be appropriate if retrospective drug abuse is to be detected. The detection of drugs in urine is only possible for a finite time after the last instance of use (several days, although cannabis can be detected for weeks). Drugs however become incorporated into growing hair and the analysis of a hair sample can provide useful historical drug abuse information. As scalp hair grows at about 1 cm per month, the analysis of a proximal 3-cm length of hair represents a 3-month retrospective time period. Hair testing reflects drug use over the entire growth period of the hair however and is unlikely to detect occasional or low-level use. Hair analysis can also be used to help in the assessment of alcohol consumption.

 

 

 

Oral Fluid Testing

 

How can drugs be present in oral fluid?

 

The presence of drugs in oral fluid is related to their concentration in blood, although they can also arise from residual drug remaining in the mouth.

Because the persistence times of drugs in oral fluid is shorter than those in urine, their presence in oral fluid is more likely to correlate with psychoactive effect or impairment. Studies of drugged drivers have generally shown a high correlation between oral fluid drug levels and observed impairment.

 

 

 

Can you list some advantages in using oral fluid instead of urine?

 

1.  Oral fluid collection is non-invasive and likely to be more acceptable than urine. Collection is easy and requires minimal facilities to carry it out. It is also faster.
   
   
2.  The sampling of oral fluid is always in sight of the collector; it is more difficult for a donor to adulterate the sample.
   
   
3.  Oral fluid samples can be taken quickly following an incident. Toilet facilities are not necessary.
   
   
4.  Oral fluid testing is more likely to measure impairment at the time of sampling; therefore, it may well be preferable as a testing basis under Information Commissioners Guidelines.

 

 

How long does it take for drugs to appear in oral fluid?

 

• Drugs which are smoked, inhaled or taken orally appear immediately after use because of mouth contamination

 

• Drugs that are administered orally in capsules, do not contaminate the oral cavity.

 

• Drugs administered intravenously are detected in oral fluid about 10 minutes after injection

 

 

Is oral fluid testing reliable and valid?

 

Yes. As with urine, international guidelines are available for the collection and analysis of samples. Laboratories must be accredited for oral fluid analysis.

 

 

What screening devices are available for oral fluid detection?

 

Screening can be carried out using inexpensive manual devices (eg.Drager DrugCheck3000) as well as sophisticated, automated electronic devices, such as the Drager DT5000. The particular choice of device will depend largely on budget.

 

 

Is passive exposure to drugs likely to give rise to a positive drugs test?

 

It is possible, but cutoff levels are likely to exclude all but the most extreme conditions.

 

 

With oral fluid confirmatory testing, is a duplicate ‘B’ sample taken

 

Yes

 

 

How can you be sure a sufficient oral fluid sample has been collected?

 

The oral fluid collection devices contain a visual sample volume indicator, which shows that sufficient sample has been collected.

 

 

Are there any circumstances when a sample of oral fluid cannot be supplied?

 

Apart from physical disability or injury, the vast majority of individuals should be able to provide a sufficient sample. Dry mouth conditions are occasionally encountered due to nervousness or stress. Hover they can also be caused by drug use.

 

 

Is there a deprivation period before an oral fluid sample can be taken?

 

Yes. A period of at least 15 minutes is usually associated with workplace sample collection as this eliminates the possibility of mouth alcohol being present in a breath test sample.

It is important that there is nothing present in the mouth, such as food, drink or gum.

 

 

 

 

Collection & Breathtesting Procedures

 

Can the donor request a witness to be present?

 

Usually yes, but will depend upon the company substance abuse policy.

 

 

Can the collector request a witness to be present?

 

Yes

 

 

Can I reprint results at a later date from the Drager DT5000?

 

Yes, the software in the DT5000 allows for retrospective data access.

 

 

My breath-tester’s calibration has expired; can it still be used for screening?

 

Although the calibration status of the device is likely to be maintained after the expiry date, the manufacturer cannot support the evidential value of results obtained.

 

Why do I need to wait at least 15 minutes before processing a donor?

 

A period of at least 15 minutes must elapse before a breath sample is taken. This is a sufficient period to allow any mouth alcohol present to disperse. Mouth alcohol is the residue remaining after the last alcoholic drink.

 

 

What if a positive screen has been obtained and the donor declares that they have taken drugs; does a confirmation sample still need to be taken?

 

Yes. Positive screening tests must followed up with confirmation testing in the laboratory. Declared medication may or may not correlate with a particular drug detected.

 

 

If a donor is suspected to be under the influence of alcohol do I need to complete a drug screen as well as a breath test?

 

No, it is not essential to carry out a drug screening test if alcohol alone is suspected.

 

 

Why are two breath samples taken for alcohol?

 

This is routine practice. The lower of the two results is taken as the final result. Duplicate sampling enhances the quantitative certainty of the test and can detect anomalies such as mouth alcohol arising from regurgitation.

 

 

Is breath testing for alcohol reliable?

 

Yes. It is routinely used around the world for alcohol detection, including within a law enforcement environment.