Work Place Drug TestWork Place Drug Test

Drug-testing in the work place

Giovanni Serpelloni

Elisabetta Simeoni

Department of Anti Drug Policies

Presidency of the Council of Ministers

Drug-testing in the work place

Giovanni Serpelloni

Elisabetta Simeoni

Department of Anti Drug Policies

Presidency of the Council of Ministers

Work place drugs test and general anti-drug strategies

PET

THC e Working Memory

Alteration and impairment of procedural memory ( memorize operational sequences, automatisms and contemporaneity)

 Alteration of  coordinationAlteration of stability

Consumo di marijuana

Riduzione dello spessore corticale nelle aree temporo-mesiali e nella corteccia cingolata anteriore (in blu)

Associazione con deficit neuropsicologici (attenzione e memoria)

Emisfero sinistro mesiale

Emisfero sinistro laterale

N = 6

Volontario sano

0,52 mm

4,22 mm

0,57 mm

ADDICTION NEUROSCIENCE Verona Group 2010

Effects of Marijuana - SPECTIn our experience, the effects of marijuana use typically cause decreased activity in the posterior temporal lobes bilaterally. The damage can be mild or severe, depending on how long a person used, how much use occurred,

what other substances were used (nicotine is a powerful vasoconstrictor) and how vulnerable a particular brain is. For more information see Dr. Amen's article High Resolution Brain SPECT Imaging in Marijuana Smokers with

AD/HD, Journal of Psychoactive Drugs, Volume 30, No. 2 April-June 1998. Pgs 1-13.

18 y/o - 3 year history of 4 x week useunderside surface viewdecreased pfc and temporal lobe activity

16 y/o -- 2 year history of daily abuseunderside surface viewprefrontal and temporal lobe activity

38 y/o -- 12 years of daily useunderside surface viewdecreased pfc and temporal lobe activity

28 y/o -- 10 years of mostly weekend useunderside surface viewdecreased pfc and temporal lobe activity

Alterazione funzionale del cervello nell’alcolismo

NormalHealthy levels of brain

activity

AlcoholicDarker Colouring indicates depressed brain activity

10

Strategie e politiche antidroga

The 4 elements of the National Drug Action Plan

National Drug Action Plan5 intervention areas 2009-12

Italy

Prevention information

earlywarning universal

and selectiveearly detection and educational

approach

TreatmentEarly contact Acceptance

Diagnosis and appropriate therapies

and prevention of related

pathologies

Rehabilitation and

Reintegration social

and employment

Monitoring of phenomenon

and Assessmentof results

(criterion of financability)

1 2 3 4

Combatting and reducing

supply of illegal drugs:

On territory

On Internet

5

An Italian “matrix” on European indications

Prevention

INTERNVETION AREAS

1

Earlier and more explicit information on the damage caused by drugs and alcohol abuse

Universal prevention through permanent media communication

Selective prevention for high-risk groups in places of entertainment

Early detection of young consumers to reduce lag time before start of treatment

Drug tests on workers with at-risk duties

Specific interventions to prevent drug and alcohol-related traffic accidents (information, education, on site drug and alcohol tests)

Educative approach in schools with support available for families

Priority actions

Drug test policy(SIANN 2009)

On site Drivers test

Work placeEarly detection

of young drug use

Certification for beginner driving

Drug testIn the school

“Self-applied”Drug test

DRUGS TEST

NO TEST

Legislative sources

• Pres. Decree

309/1990

• State/Regions MoU

• State/Regions Agreement

• Leg. Decree 81/2008

Art. 125 (Checks for drug addiction)

Order no. 99/CU of 30 October 2007

Rep. Acts no. 178 of 18 September 2008

Art. 41, para. 4 and 4 bis (as modified by article 26, para. 5, of Leg. Decree no. 106 of 3 August 2009)

Pres. Decree no. 309/90•Article 124Drug-addicted workers

1. Workers who are confirmed to be drug addicts, who intend to start therapy and rehabilitation programs at the healthcare services of local health services or other therapeutic-rehabilitation and socio-assistance structures, if employed on a permanent basis have the right to keep their work position for the time in which the suspension of their work is due to undertaking rehabilitation and, in any case, for no more than three years.

2. Collective labour contracts and work agreements for the public sector may establish specific means for exercising the right in para. 1. Without prejudice to any more favourable contractual arrangement, long-term absence for therapy-rehabilitation is considered, for regulatory, economic and social security purposes, as unpaid leave of State employees and similar. Workers who are relatives of a drug addict may, in their turn, be put on unpaid leave, on request, to contribute to the therapy and rehabilitation program of the drug addict should the drug addiction service declare such a need.

3. For the substitution of the workers as set out in para. 1, it is allowed to recruit on a fixed-term basis, pursuant to article 1, para. 2, letter b), of Law no. 230 of 18 April 1962. As part of public employment fixed-term contracts cannot last more than one year.

4. There is no prejudice to the provisions in force which require the possession of particular psychophysical and attitudinal requisites for access to employment, as well as those for staff of the armed forces and police, those who act as security personnel and those to which the limits envisaged by article 2 of Law no. 874 of 13 December 1986 apply, and which regulate suspension and removal from service.

Pres. Decree no. 309/90•Article 125Checks for drug addiction

1. Those belonging to categories of workers destined to duties which entail risks for the safety, security and health of third parties, as identified with the Decree of the Ministry of Labour and Social Security, together with the Minister of Health, are subject to care in public structures under the national health service and, at the cost of the employer, to a check on the absence of drug addiction before being recruited and, subsequently, to periodic checks.

2. The Decree as set out in para. 1 also establishes the frequency and means of carrying out such tests.

3. In the case of ascertaining a state of drug addiction during the employment relationship, the employer is required to remove the worker from carrying out the duty which entails risks for the safety, security and health of third parties.

4. In the case of failure to observe the provisions as set out in paras 1 and 3, the employer is punished with arrest from two to four months or with a fine from ten to fifty million lire.

Unified Conference Agreement

30 October 2007

Procedures for healthcare checks on absence of drug addiction or taking of drugs on workers with duties which entail particular risks for the security, safety, and health of third parties in application of provision no. 99/cu of 30 October 2007

PERMANENT CONFERENCE FOR RELATIONS BETWEEN THE STATE, REGIONS AND AUTONOMOUS PROVINCES OF

TRENTO AND BOLZANO

PROVISION of 18 September 2008Agreement between the Government, Regions,

and the autonomous Provinces of Trento and Bolzano

Procedures for healthcare checks on absence of use of drugs on workers with duties which entail particular risks for the security, safety, and health of third parties

Technical-scientific groupTechnical-scientific group

Italian Railways (FRI.) – State Railway Group – Healthcare Division

Contracting body

National Association of Company Doctors (ANMA)

Italian society of Work Medicine and Industrial Hygiene (SIMLII)

Transport Association (ASSTRA)

Italian Railways (FRI.) – State Railway Group – Healthcare Division

Contracting body

National Association of Company Doctors (ANMA)

Italian society of Work Medicine and Industrial Hygiene (SIMLII)

Transport Association (ASSTRA)

Ministry of Infrastructure and Transport – Legislative Office

Presidency of the Council of Ministers –Secretarial Office – State Regions Conference - Service for healthcare and social policies

Minister of Labour and Social Policies – Legislative Office

Ministry of Defence- Legislative Office – Head of human rights section

Ministry of Health – Healthcare Prevention Directorate

Ministry of the Interior – Police Department - Healthcare Directorate – Central healthcare operating centre – Research Centre for forensic laboratory work and toxicology

Ombudsman for the protection of personal data

Ministry of the Interior – Healthcare Office Fire Brigade, for public assistance and civil defence

Enav Spa

Ministry of Infrastructure and Transport – Legislative Office

Presidency of the Council of Ministers –Secretarial Office – State Regions Conference - Service for healthcare and social policies

Minister of Labour and Social Policies – Legislative Office

Ministry of Defence- Legislative Office – Head of human rights section

Ministry of Health – Healthcare Prevention Directorate

Ministry of the Interior – Police Department - Healthcare Directorate – Central healthcare operating centre – Research Centre for forensic laboratory work and toxicology

Ombudsman for the protection of personal data

Ministry of the Interior – Healthcare Office Fire Brigade, for public assistance and civil defence

Enav Spa

Institutional GroupInstitutional Group

PROBLEMS TO BE ADDRESSED Lack of centralised and standardised data to allow analysis of the

outcome of investigations that quantify the use of drugs by workers with at-risk duties;

Need to have available constantly updated information in order to support any actions to combat the phenomenon and to regulate the sector;

Need to finalise a standard form for the transmission of clinical and toxicological data (case history, objective examination, toxicological history, laboratory examination, diagnostic therapies) from the drug addiction services to competent doctors;

Verify the case for introducing forms of randomisation to check the absence of drug addiction and the taking of drugs;

Reassess the model by which this check must happen at least annually as envisaged by the specific procedures, with periodic and timely updating in reference to new recruits and to subjects who have accepted at-risk duties.

GENERAL OBJECTIVE

Creation of a constant and periodically updated flow of data regarding cases relating to toxicological and analytical checks (level I) and diagnostic and verification checks (level II)

Establishment of a network among operative units that exist to develop systems for monitoring and standardised assessment of tests carried out at companies in order to record the use of drugs in workers with duties which entail particular risks for the security, safety and health of third parties

SPECIFIC SUB-OBJECTIVES1. Establishment by the DPA of a permanent technical-scientific

group to assess the impact of the Drug Test program for workers with at-risk duties

2. Realise, in collaboration with the support of the DPA Observatory, a permanent data flow which is centralised at the DPA of the exams carried out (levels I and II) and the outcomes of these tests (aggregate data) through a specific website;

3. Realise periodic reports on the trend in the tests;4. Analyse and propose additions and changes to the relevant

institutional acts;5. Set up proposals for technical-scientific guidelines, specific

training and study and research;6. Promote international activities and cooperation for the

purposes of scientific and operative discussion.

A basic principle

Not only drug addiction but also the occasional use of drugs must be considered incompatible with undertaking at-risk duties

For prevention purposes, Use-Abuse-Addiction are to be considered as at-risk conduct and conditions which are incompatible with undertaking at-risk duties or driving

Areas of application for healthcare checks

1. Pre-engagement check for at-risk duty;

2. Periodic check, normally annually;

3. Reasonable doubt check, i.e. when there are sufficient indications or evidence of possible taking of illegal substances;

4. Post-accident check;

5. Follow-up check (precautionary monitoring) at least monthly for 6 months;

6. Return to work check for at-risk duties, after a period of suspension due to a previous positive result for drug-taking.

Procedures for checks

1. First-level checking procedures by the competent doctor: Clinical checks by means of a medical

visit Screening tests (biological matrix: urine) Confirmation test

2. Second-level diagnostic – checking procedures done by competent healthcare structures:

Clinical checks through medical check-ups

Toxicological-analytical checks (biological matrix: urine and hair)

General procedure for checking workers with at-risk duties

Legitimateimpediment

suitability

exemption

means

recovery

The use of drugs in Italy in workers with at-risk dutiesThe use of drugs in Italy in workers with at-risk duties

Case studies

Categories of people tested

Railway staff

City and regional bus staff

Air transport staff

Air traffic controllers

Goods movement staff

Military personnel

First-level checks2010

86,987 people examined

+60.7% compared to 2009 (54,138 people)

First-level checks2010

People examined by gender

551 positives with

confirmation test (0.63% of those

tested)

- 11.7% compared to 2009 (624 people)

People examined by drug

First-level checks2010

Substance 2009 2010 Diff. %

Cocaine 13% 19.6% +6.6%

Opiates 9% 4.2% -4.8%

Codeine 4% 4.5% +0.5%

Methadone 6% 3.8% -2,2%

Cannabis 64% 64.6% +0.6%

Other substances 4% 3.3% -0.7%

People examined by type of substance

First-level checks2009 - 2010

Second-level checks2010

122 occasional drug-users

-59.2% compared to 2009

23 drug addicts

-66.7% compared to 2009

Second-level checks2010

People examined by type of substance

Armed forces2006 - 2010

Navy (*)

  2006 2007 2008 2009 2010

Tests carried out

50,525 43,747 41,476 43,958 43,752

Positive tests 26 19 15 7 4

% Positives 0.05 0.04 0.04 0.02 0.01

(*) on average a person undergoes 4 to 7 tests

Italian army (*)

  2006 2007 2008 2009 2010

Tests carried out

47,993 39,523 48,306 42,417 57,034

Positive tests 625 340 54 446 204

% Positives 1.30 0.86 0.11 1.05 0.36

+ 34.5%

Forze ArmateAnni 2006 - 2010

Airforce (*)

  2006 2007 2008 2009 2010

Tests carried out

63,378 43,617 64,108 70,258 82,805

Positive tests 57 42 41 27 0

% Positives 0.09 0.10 0.06 0.04 0.00

Total (Army, Navy, Airforce) (*)

  2006 2007 2008 2009 2010

Tests carried out

161,896 126,887 153,890 156,633 183,591

Positive tests 708 401 110 480 208

% Positives 0.44 0.32 0.07 0.31 0.11

+ 17.9%

- 56.7%(*) on average a person undergoes 4 to 7 tests

Carabinieri2006 - 2010

Carabinieri

  2006 2007 2008 2009 2010

Tests carried out

1,670 249 1,632 638 810

Positive tests 5 6 14 6 2

% Positives 0.30 2.41 0.86 0.94 0.25

+ 27% - 66.7%

(*) on average a person undergoes 4 to 7 tests

Conclusions

Three commitments for the future

1. The application of the protocol will be subject to

monitoring and checking for effectiveness,

efficiency and financial sustainability

2. The classes of workers undergoing checks must be

redefined with a realignment to those envisaged for

alcohol

3. Redefinition of competent second level

structures, introducing, besides drug addiction

treatment services, also other structures which

undertake such work for air and rail traffic

controllers.

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