AberMed presentation

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
• 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
• 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
• 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
• Confirmation showed he was positive for all
these but also showed the specific marker for
• 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
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 33C – 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
• 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.
• 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
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
• Of opiates – it was Nurafen Plus, honest!
• The lab can tell exactly which opiate was taken as well
as estimating the dose.