The complete picture of health Some Statistics • 40% of the working population have used illegal drugs. • 25% of those seeking help with drug problems are employed • 1 in 25 of people are alcohol dependent – most employed • Absenteeism is 60% higher in drug users • Recruitment and training costs increase at the rate of job loss in those with alcohol or drug problems, can be up to 50% higher. • Abermed find around 3% of all drug tests are confirmed positive (and rising rapidly) • Cocaine overtaking cannabis Employment Eye Drug Testing Cases Case Number 1 • Male – age 27 – scaffolder • Seen for OGUK medical, nil PMH • Admitted to benylin, lemsip for sore throat • Dipstick – positive for cocaine • Confirmation - cocaine Case 2 • Male – age 52 • Dip stick positive for benzodiazepines • Admitted to taking benzos that were his mother’s (allegedly), 6 days ago, as a one off • Confirmed by lab, GP confirms mother’s prescription • Question – he has taken benzos not prescribed for him – what view do we take? Case 3 • 33 year old man, on drilling rig, RTW medical • Off with wrist surgery • Admits to taking sleeping tablets, tranquillisers, and major painkillers – about to stop them • Dipstick test confirms use of these drugs • Immediate doubts – tranquillisers and sleeping tablets not usual in these circumstances. • Confirmation showed he was positive for all these but also showed the specific marker for heroin. • GP says he is being treated with these drugs for PTSD – but certainly not heroin • Patient is drug addict Case 4 • 33 year old mud engineer, for Norwegian Medical • Dip Stick positive for cocaine but sample not sent for confirmation because of abnormalities in test sample. • Noted to be a long time in the toilet, noise of paper ripping “like a sachet being opened” • Small sample, foaming at top and of a very clear colour • Temperature of sample 33C – too cold to have been freshly passed and unadulterated • Strange smell “like bleach” • Obviously an attempt at using one of the “drug neutralisers” that can be found on internet. • None has been found to work to date. How do we Ensure Sample is Genuine? • Patient has to take off all outdoor clothes and empty pockets. • Lavatory has “saloon” doors so privacy limited. • Test for temperature of urine – difficult to keep a doctored sample within body heat. • High index of suspicion. If patient cannot pass urine • Remains under observation • Given small frequent drinks of water • After 4 hours, considered a refusal to provide a sample. Alcohol • Stays in the system for a much shorter time than most drugs so timing of testing is crucial • Cannot easily “work back” to calculate what the likely level would have been some hours ago • Depends on over what period alcohol was taken and the particular metabolism of the person in question. • Prompt testing is vital. Metabolism Affected by 1. Liver enzymes – natural genetic variation between people 2. Regular heavy drinking induces enzymes initially so body metabolises alcohol more quickly 3. Sex, height, weight 4. Race 5. Food intake – slows absorption Well Worn Explanations • Of cannabis –”I was at a party where everyone was smoking –it must be from passive smoking” • Cannabis level has actually been set to ensure that it is well above anything possible from passive smoking. • Of everything except cannabis and opiates-“It must be a false positive from nasal sprays/ cough medicines etc “ • Whilst this may be the case (but only very rarely) with the Dipstick testing, it is never true with the lab confirmation. • Of opiates – it was Nurafen Plus, honest! • The lab can tell exactly which opiate was taken as well as estimating the dose.