Canadians are facing increased stresses, pressures, and health challenges, leading some individuals to turn to alcohol and drugs as a coping mechanism. Recent data from the Canadian Centre on Substance Use and Addiction highlights growing concerns around mental health and substance use. As a result, the risk of workplace substance abuse has escalated, prompting employers to take proactive measures. One key step is ensuring supervisors are equipped with reasonable suspicion training to help identify and address potential issues, ultimately supporting a safe and healthy work environment.

Alcohol and drugs are known to have harmful effects on the health, safety, and overall well-being of individuals, colleagues, and the public. In workplaces, it can result in:

  1. Increases in employee injuries,
  2. Increases in property or equipment damage,
  3. Increases in absenteeism and/or sick leave,
  4. Increases in conflict and violence,
  5. Increases in turnover,
  6. Reduced productivity,
  7. Increases in theft, and
  8. Decreased employee morale.

Employers cannot initiate reasonable suspicion testing without first going through the 5-step process. Reasonable suspicion training provides critical information about how to initiate reasonable suspicion training, including the 5-step process and other tools employers can use to help manage the misuse of alcohol and drugs in the workplace.

What is reasonable suspicion?

Reasonable suspicion is a term used to describe circumstances that usually indicate a reason to complete an investigation or assessment of an employee’s fitness for duty or to explore possible explanations for an employee’s unusual conduct, actions, or appearance. The findings of this assessment may conclude that an individual is either under the influence of a prohibited substance or facing other physical/mental strains. If the assessment points toward possible substance impairment, reasonable suspicion testing may be required.

What is included in the 5 Step Reasonable Suspicion Process?

To properly complete an investigation or assessment of an employee’s fitness for duty, it’s important for supervisors to fully understand each step of the process to ensure:

  • The observed behaviours correlate with possible alcohol and/or drug use
  • The necessary documentation is collected and reported
  • The appropriate conversation is had with the employee
  • The alcohol and drug screens are completed only when necessary

The 5-Step Reasonable Suspicion Process includes:

  1. Observation. There are 4 main indicators that will help you determine if someone may be under the influence.
  2. Confirmation. Get a second opinion.
  3. Documentation. All companies should have a reasonable suspicion checklist in their drug and alcohol policies that is readily available for all supervisors and managers.
  4. Confrontation. You must effectively communicate your findings with the employee.
  5. Testing. Check your policy – understand what testing is required.
RST Checklist

Important Considerations

Consistency. there must be a consistent process followed to ensure that there is no bias involved. Ensuring that a consistent checklist is used, and the same process is followed for each case will assist the employer. If there are inconsistencies in the process, it can have a negative effect on the employer in the case that a complaint is filed.

Confidentiality. The reasonable suspicion process is extremely confidential and is not to be taken lightly. The entire process is not to be shared with any individual who is not privy to this information.

SureHire’s Reasonable Suspicion Training Programs

Reasonable suspicion training is an important tool that employers can use to help manage the misuse of alcohol and drugs in the workplace. Properly trained and educated supervisors will be able to contribute to a healthy and safe workforce by having the ability to recognize the signs and symptoms of potential substance impairment and take the appropriate actions to manage reasonable suspicion circumstances, thereby preventing safety incidents from occurring.

SureHire offers a variety of interactive and self-study Reasonable Suspicion Training programs for employees and supervisors. Our courses have been completed by hundreds of individuals across North America and have been rated 5 stars.

Learn more about Reasonable Suspicion Training and get your workers certified today!

TAKEAWAY: Workplace addiction is a real issue that can impact employees in several ways. It adversely affects workplace safety and productivity, proving costly for business owners. Fortunately, employers can use several tools, programs, and resources to help curb addiction in the workplace.

Many employers may not realize technology can help improve addiction among workers. Therefore, this article highlights the benefits of using technology for addiction and explores the options available to employers. Read on to discover the best tips for using technology to help with addiction treatment.


By Elly McGuinness

What impact does addiction have on the workplace?

According to Dr. Kelly, a professor in addiction medicine at Harvard Medical School, more than 70 percent of individuals with drug and alcohol problems continue to maintain employment because they remain “functioning.”

However, “functioning” employees affected by drugs or alcohol are costly to businesses. Decreased productivity, increased turnover, high absenteeism, increased workplace injuries, decreased morale, and reduced work quality are all potential consequences of addiction in the workplace that ultimately affect the company’s bottom line. 

Addiction impacts individuals on a cognitive, emotional, and behavioural level and has far-reaching effects across organizations. The American Addiction Centers explains that alcohol and substance use disorders are prevalent in construction, mining, manufacturing, agriculture, and transportation, often among workers in safety-sensitive roles. 

They also highlight concerning statistics around addiction in the workplace. For example, a national survey of the U.S. workforce found that 15 percent of employers admitted working while under the influence of alcohol, and three percent reported being under the influence of illicit drugs.

Luckily, employers can take several action steps to help curb addiction problems in the workplace.

What can employers do to improve addiction in the workplace?

Employers can ensure they have robust drug and alcohol policies to help address the problem of workplace addiction. Drug and alcohol testing and reasonable suspicion training are strategies that can form part of the plan to reduce and eliminate workplace addictions.

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Substance Abuse Professionals (SAPs) are also crucial to the equation. SAPs help employers by assessing workers with a disclosed substance abuse problem or those who tested positive on a drug or alcohol test. The assessment results enable the SAP to explain legal obligations to employers, help everyone chart a path forward, and highlight ways to accommodate a substance problem safely.

Employers can also tackle the root causes of addiction by addressing mental health and wellness in the workplace. Emotional Intelligence, also known as Emotional Quotient or EQ, is a vital piece of the puzzle when recovering from addictions. It consists of five essential areas in addiction recovery: self-awareness, self-regulation, motivation, empathy, and social skills.

Benefits of using technology to improve addiction

Digital technology has expanded the scope of addiction interventions and offers several benefits:

  • It enables evidence-based treatments to reach a broad audience
  • Tailored support is crucial in addiction intervention, and digital technology can achieve this via interactive responses and face-to-face support.
  • It ensures timely treatment options so individuals can receive the help they need when needed, rather than waiting weeks or months for an in-person appointment.
  • Digital technology is more cost-effective, making treatments available to more people.

For these reasons, digital technology is an essential consideration for employers seeking practical solutions for combating addiction. Several options are available so employers can choose the technology that will best meet their organization’s and its individuals’ needs.

What type of technology is available for improving addiction?

Digital technology for addiction is available in various formats. For example:

  1. Web-based self-help interventions

Web-based self-help interventions vary in features and offerings. Some are designed to inform and educate but do not provide therapy. Others go a step further and offer personalized feedback following an assessment. 

Web-based self-help interventions can also include a human element, with support from peers or mental health professionals. Others consist of a step-by-step program the user can work through at their own pace.

  1. Online counselling and therapy

Online counselling involves communication with a therapist via an online channel, such as video calls. It enables one-to-one interaction that surpasses the distance barrier and eliminates travelling time. It may not be suitable for all types of addiction treatment or clients, but it will benefit many.

  1. Artificial intelligence (AI) and virtual reality (VR) software

AI is an emerging technology used in addiction treatment. Once limited to text only, the technology has evolved to voice communication and applications which can detect the user’s emotional needs. 

Some technology uses gamification or virtual reality to help with addiction recovery. Certain games can help retrain the brain in those with addiction, whereas VR uses virtual avatars to navigate pathways to addiction recovery and participate in online forums.

What specific technology is available for improving addiction?

Employers and employees have a wide range of digital options for tackling workplace addictions. A few are as follows:

  • The Therapeutic Education System (TES) is an interactive web-based intervention for substance use disorders. It focuses on the Community Reinforcement Approach, Contingency Management Behavior Therapy, and HIV Prevention. Research shows that TES has the potential to improve addiction treatment outcomes.
  • The Addiction-Comprehensive Health Enhancement Support System (A-CHESS) is a smartphone app that can help support recovery from alcoholism. Other addiction recovery apps include Nomo, Sober Grid, and Pear reSET.

In conclusion, when chosen well, digital technology can help improve addiction among workers and form part of an overall plan for a safer and healthier workforce.

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TAKEAWAY:  What is fentanyl, why is it used, and why are employers adding it to their drug detection program? Get answers to these frequently asked questions and more!



By Jennifer Crump

The opioid crisis continues to grow across North America, much of it driven by fentanyl and fentanyl derivatives. In many workplaces, testing for fentanyl abuse has become crucial to ensuring worker health and safety. Here are the answers to your questions about fentanyl testing.

What type of drug is fentanyl? 

Fentanyl is a prescription drug often prescribed as a treatment for severe or chronic pain following surgery or as a substitute for other opioids if patients have become tolerant of them. Prescription forms of this synthetic opioid analgesic include Actiq®, Duragesic®, and Sublimaze®. Fentanyl is often compared to morphine but is 50 to 100 times more potent. This makes also makes it more dangerous. 

In addition to its prescription form, fentanyl is produced in illicit labs and sold illegally. This is the fentanyl that is most often associated with overdoses. 

How is fentanyl used? 

Prescription fentanyl can be administered as a shot, skin patch, or lozenge. Fentanyl that is illegally produced generally comes in the form of a powder or liquid or is made into pills that look like prescription opioids. Illegal synthetic fentanyl can be delivered as a powder or liquid or made into pills that look like other prescription opioids. It is sold illegally on blotter paper, in nasal sprays, eye drops, or even candies. Street names for illegal fentanyl include apache, dance fever, friend, goodfellas, jackpot, murder8, tango, & cash. 

Because it is cheap to produce and requires relatively small amounts to create a high, drug dealers will frequently mix fentanyl with other drugs, including heroin, cocaine, MDMA and methamphetamine

What are the effects of fentanyl use? 

Like other opioids, fentanyl binds to the body’s opioid receptors in parts of the brain that control pain and emotions. This is what allows it to be used to manage chronic or severe pain. Illegal fentanyl produces an intense, short-term high and feelings of euphoria. However, over time, the brain can become less sensitive to fentanyl while failing to react to normal stimuli, leading to addiction and overdose. Additional effects of fentanyl can include: 

  • Sedation
  • Confusion
  • Drowsiness
  • Dizziness
  • Nausea and vomiting
  • Urinary retention
  • Pupillary constriction
  • Respiratory depression
  • Reduced blood pressure
  • Fainting
  • Seizures
  • Death

How long after use can fentanyl be detected? 

The timeline for detection of fentanyl differs for every person based on their metabolism, body mass, the amount ingested, the potency of dose(s), physical activity, health conditions and other factors, making it difficult to determine an exact timeline for detection. The estimated detection window for fentanyl in urine is 8–72 hours; in oral fluid, the detection window is generally 12 hours.

Will fentanyl be detected as an opioid on a standard drug test? 

Unfortunately, standard instant drug tests will not detect fentanyl, nor most other standard drug tests. This is because these tests are typically set up to detect opiates which metabolize into morphine. Fentanyl, unlike many opiates, does not metabolize into morphine. However, a targeted drug test can easily detect it in urine, hair and oral fluid tests. Fentanyl testing can be added to many standard drug tests. 

What type of fentanyl testing does SureHire offer? 

Fentanyl can be tested for as an add-on to any of the following SureHire tests:

  • Urine Express Panel 5, 8 or 13
  • Urine Lab Based 5, 8 or 13
  • Oral Fluid Lab Based 8 or 13
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How is fentanyl detected through lab-based urine testing?

Laboratory urine testing for fentanyl involves immunoassay testing with a cut-off threshold of 2ng/mL. The test seeks to detect Fentanyl metabolites, including norfentanyl, hydroxyfentanyl and hydroxynorfentanyl. 

What is the cut-off level for fentanyl drug testing?

Cut-off levels for fentanyl drug testing vary depending on the type of test that is ordered: 

  • Urine Express – 10ng/ml
  • Urine Lab – 2ng/ml screening and 1ng/ml confirmation
  • Oral Fluid – 1ng/ml

What is SureHire’s process for determining if a positive result for fentanyl is due to recreational or prescription use? 

As with any result confirmed as positive through GC/MS testing, the results will be forwarded to our MRO (Medical Review Officer), who will attempt to contact the individual within 48 hours. Once contact is successful, the MRO will ask the individual if there is any reason for fentanyl to be detected in their sample.

 If the individual discloses the use of fentanyl as being directed by their physician, the MRO will request proof of the prescription or evidence that the drug was administered at the direction of a physician, such as a letter from the physician. If the MRO receives these documents, they may overturn the test result and release it as negative. 

However, if the individual cannot provide proof of legitimate use of fentanyl or the MRO is unable to contact the donor within 48 hours, the result may be released as positive. Because of its potency and the long list of side effects, the use of prescribed fentanyl may still be deemed as “Negative – Safety Sensitive” by the MRO.

What is the turn-around time for receiving lab-based fentanyl test results? 

The turn-around time to receive lab-based fentanyl test results is between 2 to 5 business days.

What is the cost of adding fentanyl to a drug test? 

Contact us to request a quote today!

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TAKEAWAY: Drug testing specimen procedures are critical to ensuring fair and reliable results. Here are the answers to your questions regarding our urine specimen collection and dilution protocols. 



By Jennifer Crump

What is dilution?

Dilution occurs when a urine sample is diluted by the addition of large amounts of fluid, most often by someone attempting to affect the outcome of the test. However, it can also be caused accidentally by drinking large quantities of water or certain medications or illnesses. Laboratories leverage a substance called creatinine to measure dilution. If a sample lacks sufficient creatinine, it is considered diluted. 

What are creatinine and specific gravity?

Creatinine is a by-product created by the normal breakdown of muscle tissue and is excreted in the urine in constant quantities with average liquid intake. Excessive liquid intake or dilution reduces a drug’s concentration in the urine. However, it will also reduce the amount of creatinine, so urine samples used in drug-abuse testing are also tested for creatinine. If the concentration is below 20 mg creatinine/dl urine, the urine sample is usually rejected for drug testing.

When technicians find low creatinine levels in a sample, the lab will conduct another test known as specific gravity to confirm the results. This test compares the density of a urine sample to water, which has a specific gravity of 1.000. The lab will deem samples with a specific gravity of 1.005 to1.030 and low creatinine either negative dilute or positive dilute. 

Why is dilution a problem?

Positive dilute results mean that the worker tested positive for an illegal substance regardless of the dilution. A negative dilute, however, could mean that either there are no illicit substances present or the specimen was too diluted to permit detection. These outcomes pose a problem for employers who must either confirm or accept the results. This is where Medical Review Officers (MRO) can offer guidance. Dilution is a severe issue for employers because diluted samples make it more challenging to confirm that a person is using illegal drugs. 

Although a negative dilute test result alone cannot be used as grounds to reject applicants or action against existing employees, it does mean another test is warranted. Most of the time, employers require a second test following a negative dilute test. This suspends the delivery of results and can further stall hiring decisions or delay the delivery of critical help to employees who need it.  

What protocols does SureHire have in place to capture dilution? 

SureHire utilizes rapid specimen validity tests, which are semi-quantitative, colour comparison screens for the detection of creatinine and specific gravity within urine specimens. This assessment is a preliminary screen only. A more specific alternate chemical method must be used to obtain a confirmed analytical result at a Health and Human Services-certified laboratory. 

The participant is placed on a Dilution Log if a urine specimen is flagged as dilute at the collection site. Collection technicians will then ask the participant to produce additional specimens every 15–20 minutes to flush the excess water out of their system. The participant is given one (1) hour to provide an acceptable specimen before the test is deemed incomplete, and a re-test is required. 

SureHire's captured dilution specimen statistics (99.81% of urine specimens)

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How can testing participants prevent dilution? 

SureHire recommends that testing participants restrict their fluid intake two hours before their appointment and limit their fluid intake 24 hours prior to their appointment. This will ensure their specimen concentration is within normal limits and prevent them from having to participate in the one-hour dilution log process.

What should employers do if they receive a negative-dilute result? 

While SureHire’s dilution protocols prevent the occurrence of negative-dilute test results the vast majority of the time, there are limitations to the collection site specimen validity tests, and negative-dilute test results may still occur. If an employer receives a laboratory-confirmed negative-dilute test result, SureHire strongly recommends that a re-test be conducted to ensure test result validity.

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TAKEAWAY: What is an enantiomer? What are amphetamine enantiomers? Why is it essential to conduct an enantiomer analysis? Get answers to these frequently asked questions and more! 


By Jennifer Crump

What is an Enantiomer?

In chemistry terms, enantiomers are pairs of molecules that are chemically identical and exist as mirror images of one another. However, they cannot be superimposed on one another. The two isomers are designated as d- (Dextro) and l- (Levo), indicating the direction in which they rotate a beam of polarized light.

Despite their similarities, enantiomers often have very different effects on the human body. One enantiomer can be inactive, while another can have therapeutic effects. The enantiomers will also react with the body at different speeds and markedly different strengths. For example, methamphetamine is a controlled substance, but its L-isomer is used in several over-the-counter medications.

Because amphetamines are the primary metabolite of methamphetamine, assessing this drug is even more complex. For methamphetamines and amphetamines, the D-isomer is considered much more active biologically, and most illegal drugs are D-isomers. 

Important Note

Enantiomers are problematic in drug testing because standard drug tests, such as immunoassay, cannot distinguish between enantiomers. Because of this, they can deliver inconclusive results. Test results reported by a laboratory will not indicate the specific enantiomer because the laboratory procedure is set up to identify only the presence of amphetamine or methamphetamine. Labs must perform additional analysis to determine which enantiomer is present. 

What are amphetamine enantiomers?

Amphetamine is a central nervous system stimulant with 2 enantiomers: levoamphetamine and dextroamphetamine. The effects of dextroamphetamine on the central nervous system are more pronounced than levoamphetamine. Physicians prescribe it to treat attention deficit hyperactivity disorder and narcolepsy. However, athletes also use it to enhance performance. It is also sold illegally as an aphrodisiac and to induce euphoria.

Amphetamine and methamphetamine exist in 2 isomeric structural forms known as enantiomers. Enantiomers are non-superimposable mirror images. The 2 isomers of each substance are designated as d- (Dextro) and l- (Levo), indicating the direction in which they rotate a beam of polarized light. As with many pharmacological enantiomers, the d- and l-isomers have distinct pharmacological properties. In this case, the d- isomer of each substance has a strong central nervous system stimulant effect, while the l-isomer of each substance has a primarily peripheral action. Illegally manufactured amphetamine and methamphetamine are principally found as the d-isomer. However, significant amounts of the l-isomer of each substance may be present depending on the starting materials used by the clandestine laboratories.

When does D- and L-enantiomer analysis need to be completed?

Enantiomer analysis can help determine if positive drug tests are due to a lawful use of prescription or over-the-counter medications rather than illegal consumption. These tests may be warranted if the test participant indicates the use of a legal substance that contains the l-enantiomer. Medical Review Officers (MROs) can also order enantiomer testing for all specimens with positive amphetamines initial test results and all specimens with a positive methamphetamine confirmatory test result or request additional testing on a case-by-case basis. The analysis will differentiate between the d- and l-enantiomers. Urine containing 20% or more d-enantiomer suggests exposure to the schedule 2 substance. However, a sample with less than 20% d-enantiomer may indicate another reason for the positive test. 

Why is it essential to conduct an enantiomer analysis?

Although both are controlled drugs, the d- and l-enantiomers have very different effects on the body. From a safety perspective, l-enantiomers can be far much dangerous. Since standard drug tests do not distinguish between d- and l- enantiomers, enantiomer analysis is crucial in identifying the origin of a drug detected in a routine test. The test results will provide a percentage of the d- and l-enantiomers present in the sample. These percentages allow the MRO to more accurately determine whether the positive result was the illicit use of a banned substance or happened through a more innocent use of over-the-counter or prescribed medications.

This additional testing ensures that employers do not mistakenly rule out potential new hires or unfairly penalize employees inadvertently exposed to a drug.

What is SureHire’s process when enantiomer analysis is requested? 

SureHire does not require enantiomer analysis for every specimen. However, it is necessary if the participant has disclosed specific medical information (e.g., use of nasal inhaler within days of drug test) to the MRO. SureHire will notify the employer or recruiter who booked the appointment of the additional testing requirements and arrange for the specimen to be shipped to a certified laboratory for further analysis.

It takes approximately 5 to 7 additional business days to ship the specimen, test it, and have the MRO review the laboratory test results and issue a final result.

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TAKEAWAY: The opioid crisis in North America continues to balloon, much of it driven by fentanyl. According to CDC data, deaths involving synthetic opioids other than methadone (primarily fentanyl) have continued to rise, with 56,516 overdose deaths reported in 2020. Canada has a fentanyl problem of its own. Of all accidental overdose deaths in the first quarter of 2022, 85% involved fentanyl. 



By Jennifer Crump

What is fentanyl, and how does it work?

Fentanyl is a synthetic opioid used legally to treat severe pain and is often prescribed following surgery. However, it is also produced and used illegally. It is also often prescribed to patients suffering chronic pain who may have become tolerant to other opioids. Scientists believe fentanyl to be 20 to 40 times more potent than heroin and 100 times more powerful than morphine. 

Like other opioids, fentanyl binds to the body’s opioid receptors in the central nervous system, which controls pain and emotions. It reduces feelings of pain by interrupting the way nerves signal pain between the brain and the body. However, over time it can also change how the brain works, reducing sensitivity and creating a dependence on the drug. 

Fentanyl can be prescribed as an injection, a skin patch, or as lozenges that are sucked like cough drops. Illegally produced synthetic fentanyl is produced in labs and is usually sold as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills. 

How is fentanyl abused and what are the risks associated with it?

Illegal fentanyl is both cheap to produce and much more potent than other street drugs. It is also difficult to detect and can look exactly like prescription medication. All of this also makes it far more dangerous. Drug dealers often mix fentanyl with other drugs, such as heroin, to increase their effectiveness and because it is odourless and tasteless, users may not even realize they are taking it. The drug dealers who produce synthetic fentanyl seldom know or control how much fentanyl goes into each pill so users cannot be sure of what they are taking. 

Because of its potency, the risk of accidental overdose is high with fentanyl. And even small amounts of this drug can be lethal. In a recent study, the U.S. Drug Enforcement Administration found that 42% of pills tested for fentanyl contained at least 2 mg of fentanyl, considered a potentially lethal dose.

What are the signs of fentanyl abuse, and what should you do if you suspect someone is abusing it?

A worker abusing fentanyl may exhibit signs of paranoia, social withdrawal, lack of motivation, delusions and personality changes. They may also become increasingly impulsive. 

Some of the physical symptoms include:

  • Confusion
  • Depression
  • Difficulty walking
  • Muscle stiffness
  • Slowed or altered heart rate
  • Laboured breathing
  • Weakness
  • Dizziness, light-headedness and fainting
  • Shaking
  • Sleepiness
  • Slurred speech
  • Swollen arms and legs
  • Weight loss
  • Visual hallucinations
  • Nausea and vomiting
  • Itching and scratching
  • Pinpoint pupils

If you suspect someone is abusing fentanyl there are several things, you can and should do. 

  • Document everything, including complaints and anecdotes from fellow workers and observations from supervisors. 
  • Meet with the employee in person and note any apparent signs of use or intoxication. 
  • Have a supervisor or HR representative observe the employee directly. 
  • Remove the suspected user from any safety-sensitive position that could put themselves or others at risk. 

If reasonable suspicion of use is determined, arrange for immediate testing. 

How can fentanyl addiction be treated, and what are the long-term effects of abuse?

Fentanyl abuse can result in devasting long-term mental and physical effects, some of which can be irreversible. Workers may show poor judgement and mood swings, have difficulty controlling impulsive behaviour or develop depression or suicidal thoughts. Ironically, long-term fentanyl use can actually worsen pain in some patients, particularly if taken at high doses. Because of its potency, the risk of overdose and death is much higher with fentanyl than with other drugs. Physically, there are numerous long-term effects, including: 

Risk of anoxic injury or damage to body tissues from decreased oxygen supply

  • Multiple organ system damages
  • Poor nutrition and weight loss
  • Insomnia
  • Sexual dysfunction
  • Irregular menstruation

How can you prevent fentanyl abuse in your workplace?

Employers should start by helping remove the stigma surrounding addiction to encourage workers to seek help when needed. They can also foster an accepting workplace environment by integrating substance misuse prevention into existing workplace health and wellness programs, providing access to confidential screening tools and supports and educating workers on healthy ways to manage pain and stress. 

Other ways employers can help to prevent fentanyl abuse in the workplace include:

  • Reducing injury risk through education and other controls
  • Sponsoring take-back events to encourage workers to dispose of unused prescriptions and not share them with fellow workers
  • Purchasing naloxone to have on-site and train supervisors and others in how to use it
  • Ensuring health benefits and easy access to Employee Assistance Programs (EAPs)
  • Monitoring workers’ compensation claims for the possible need for pain education
  • Tailoring health and wellness programs to tackle substance abuse directly and include education on the effects of fentanyl as well as the signs of addiction
  • Training supervisors to recognize possible signs of fentanyl misuse, addiction and overdose
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Add Fentanyl to Your Testing Process

Fentanyl can be tested for as an add-on to any of the following SureHire tests: Urine Express Panel 5, 8 or 13; Urine Lab Based 5, 8 or 13; or Oral Fluid Lab Based 8 or 13. 

SureHire can also provide additional assistance to employers through education, training, and support, including reasonable suspicion training for supervisors.

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TAKEAWAY: Relapse is a very real danger for anyone who uses drugs. In fact, some studies suggest that up to 85% of drug users will use drugs again following intervention or treatment. The possibility of a relapse is why return-to-duty and follow-up testing is crucial for employers, particularly those with employees working in safety-sensitive positions. Here’s what you need to know.


By Jennifer Crump

What are Return-to-Duty and follow-up testing?

Return-to-duty and follow-up testing are usually part of the return-to-work process for a safety-sensitive employee who has failed a drug test. However, depending on an employer’s drug and alcohol policy, they may also be used in other circumstances. 

What are the legal obligations of employers conducting return-to-duty testing? 

Whether in Canada or the U.S., employees subject to Department of Transportation regulations must submit to return-to-duty testing before they return to a safety-sensitive position. They will also be required to take at least six additional random tests as part of their return-to-work plan. Substance Abuse Professionals (SAP) may require further random tests. SAPs may also prescribe follow-up testing for up to 5 years following a positive test

While return-to-duty testing is a requirement for DOT employers, it is a best practice for most non-DOT employers. These employers must ensure they clearly define procedures and consequences in their drug and alcohol policies. They will also need to meet additional requirements in municipal, state, and Americans with Disabilities (ADA) legislation. 

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In Canada, return-to-work testing is considered reasonable for any employee who has failed a drug test. A workplace policy could include such testing at regular or random intervals for a specific period of time. 

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Frequently Asked Questions

My employee is returning after being on leave. Shouldn’t they take a return-to-duty test? 

The short answer is no. An employee returning from leave, for whatever reason, or a re-hired employee should take a pre-employment drug test rather than a return-to-duty test. Although employers may use return-to-duty tests as pre-employment tests, it is essential to note that pre-employment may not be used as return-to-duty tests.

What is the difference between a return-to-duty and follow-up and a follow-up and a pre-employment or pre-access test? 

Follow-up and return-to-duty tests are conducted as part of the return-to-work process following a failed drug test. Pre-employment tests are included as a condition of employment, while pre-access tests are given as a condition of granting access to specific locations or duties in a workplace. For example, employers may request these tests to provide top-secret security access. However, the most significant difference between these types of tests is that an individual of the same sex observes the collection process in return-to-duty tests. In contrast, pre-employment or pre-access tests are generally unobserved. Employees who fail a drug test must also complete other steps in the return-to-duty process before taking their test. 

What is the return-to-duty process? 

Before a worker can return to a DOT safety-sensitive position, they must successfully complete a return-to-duty process. The return-to-duty drug test typically comes at the end of this return-to-duty process. Prescribed by a Substance Abuse Professional (SAP), it will often include: 

  • A thorough face-to-face assessment
  • completion of a required plan of treatment and education
  • Monitoring of the worker’s progress through that plan
  • A face-to-face follow-up evaluation to verify the completion and success of the recommendation

Once this process is complete, the SAP will send a report to the employer, who will order a return-to-duty test. If the employee passes, they will return to the job but be subject to follow-up or random testing. Positive tests mean a new violation and the process will restart or the employee may be dismissed. If the employee refuses to take a test, the SAP reports non-compliance to the employer. The employer’s drug and alcohol policy will determine the consequences at that point. 

How many follow-up tests have to be taken? 

The number of follow-up tests required for non-DOT employers is at the employer’s discretion. However, for DOT employees, there are specific requirements. For DOT-covered employees who fail drug tests, SAPs must set up a follow-up testing regiment that includes at least six unannounced tests over at least 12 months. However, the SAP can require additional tests over the next five months. All of the specimen collections must be observed. 

Do follow-up tests replace random testing? 

No, follow-up tests cannot replace random testing because follow-up tests require direct observation during the collection process. All employees must be included in the random testing pool regardless of any requirements of random testing and must also complete all of the regular requirements for follow-up testing. 

How can SureHire help? 

SureHire can service your testing needs across North America no matter the reason for testing. Our extensive suite of Drug & Alcohol Testing Services includes:

– Pre-Employment
– Pre-Access (Site Access)
– Return-to-Work (Return-to-Duty)
– Follow-up Testing
– Reasonable Suspicion/ Cause Testing
– 24/7 365 Post-Incident/ Near-Miss Testing
– Substance Abuse Programs
– Reasonable Suspicion Training
– On-site/ Mobile Testing

We offer 5, 8, and 13-panel drug tests; express and lab-based tests; and oral fluid, urinalysis, and hair follicle testing.

TAKEAWAY: Synthetic drugs, are becoming more prevalent in workplaces as users look for quicker, greater, and easier highs and dealers look for ways to circumvent drug laws. Here’s what you need to know as an employer.



By Jennifer Crump

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Looking for a reliable way to test for synthetic drugs? Ask us about Synthetic Drug Detection Today!

SureHire USA offers comprehensive synthetic cannabinoid testing. We have the ability to detect synthetic compounds in both urine and oral fluid specimens. Our extensive network of testing facilities are equipped with the latest technology so you can feel confident knowing results are reliable and accurate. Contact us today to learn more about our synthetic cannabinoid testing services!

When U.S. researchers looking first created synthetic cannabinoids to help them study the effects of marijuana, they probably had no idea how popular these so-called designer drugs would become. In 2009, there were just two varieties of synthetic cannabinoids and four types of synthetic stimulants (cathinones) identified in the U.S. By 2013, worldwide, there were 348 known designer drugs being sold to drug users, according to the United Nations. 

Today, more than 1700 of these designer drugs have been identified. These synthetic, or designer drugs, are becoming more prevalent in workplaces as users look for quicker, greater, and easier highs and dealers look for ways to circumvent drug laws. Most synthetic drugs are chemically different from the drugs they mimic, and legislators must continuously write new laws to cover them. But they also present an obvious danger in the workplace. Here is what you need to know as an employer. 

Common synthetic drugs

The 2 major categories of synthetic drugs are synthetic stimulants and synthetic cannabinoids. Synthetic cannabinoids mimic the effects of THC, the active ingredient in marijuana, and are by far the most commonly encountered synthetic drug in the workplace. Synthetic stimulants, also known as cathinone, are designed to mimic the effects of drugs such as cocaine and amphetamines. They include drugs such as bath salts, synthetic opioids, and ecstasy. 

Synthetic drugs in the workplace

Synthetic drugs can pose a massive problem in the workplace. They are notoriously difficult to detect. Many, such as synthetic cannabinoids, are also odourless. And because synthetic drugs are often chemically different from the drugs, they can often circumvent existing laws. The speed with which these drugs can be produced makes it almost impossible for lawmakers to catch up. But there are other concerns in the workplace. These same chemical variations can also make it difficult for drug testing programs to identify use among workers. 

That’s a problem because synthetic drugs can also be more dangerous. Routine drug tests rarely detect synthetic drugs. That’s because the chemicals used to create synthetic drugs vary widely and are frequently tweaked to make them more potent. This increases both their addictiveness and effects. There is also very little research on the impact of these compounds or their interactions with legitimate prescription drugs. In 2021, as the U.S. hit its highest number of drug deaths, over 75% of overdose deaths involved a synthetic opioid. 

Many synthetic drugs, notably bath salts, have been associated with violent behaviour in the workplace and elsewhere. Other effects can include:

  • Hallucinations
  • High blood pressure 
  • Tremors 
  • Anxiety
  • Paranoia 
  • Seizures
  • Suicidal thoughts 
  • Tachycardia (i.e., rapid heartbeat)
  • Delusions 
  • Nausea
  • Agitation
  • Psychosis

Synthetic cannabinoids vs. marijuana

Synthetic cannabinoids were first produced by U.S. research scientists who used the compounds to study the long-term effects of cannabis. But there are significant differences between synthetic cannabinoids and the real thing. For one thing, they tend to be odourless and far more challenging to detect through smell. Because there are now so many varieties of synthetic cannabinoids, their effects are also difficult to predict, which makes them much more dangerous.

Since producers often lace synthetic cannabinoids with other chemicals, including opioids, blood thinners and stimulants, they tend to be far more potent than natural THC. And because the process of making them is often imprecise and varies by dealer, the dosage is not predictable. They can also vary widely in terms of the intensity of their effect and the length of time a user will remain “high”. An additional problem with synthetic cannabinoids is that, unlike natural THC, they can also stimulate non-cannabinoid receptors in the brain, which leads to other unanticipated effects.

One thing that is certain is that synthetic cannabinoids are extremely dangerous. In fact, one study determined that they were 30 times more likely to harm users than natural forms of marijuana.

Common workplace approaches to synthetic drug use 

Employers are taking various approaches to solving the issue of synthetic drugs in the workplace and the potential safety hazard they represent. Education is becoming a key area of focus since many workers are unaware of the potential risks of using these drugs. These education efforts should focus on both the health risks and employment consequences of synthetic drug use. 

Many employers are wisely adding synthetic drug use to their workplace drug and alcohol policies. This should include a prohibition on synthetic drug use in the workplace and clearly defined consequences for use in the workplace. The latter could consist of everything up to and including dismissal. 

Finally, some drug testing service providers offer an option to add testing for synthetic drugs, particularly synthetic cannabinoids. This provides an extra layer of protection for workplaces experiencing a synthetic drug problem. Workers are tested for the presence of synthetic cannabinoids in the same way they are tested for other drugs. 

Detecting synthetic drug use 

Some testing providers, such as SureHire, have developed testing panels targeting synthetic drug use. Employers can add these panels to various testing situations, including pre-employment, reasonable suspicion, and post-accident.

At SureHire, in addition to a wide variety of available drug panels that focus on synthetic stimulants, employers can leverage synthetic cannabinoid tests to ensure the safety of their employers and the public. These tests can detect both the drug and its metabolites and are available as both urine-based metabolite testing and parent oral fluid tests. Laboratory confirmation testing is also available via LC-MS/MS testing.

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Looking for a reliable way to test for synthetic drugs? Ask us about Synthetic Drug Detection Today!

SureHire USA offers comprehensive synthetic cannabinoid testing. We have the ability to detect synthetic compounds in both urine and oral fluid specimens. Our extensive network of testing facilities are equipped with the latest technology so you can feel confident knowing results are reliable and accurate. Contact us today to learn more about our synthetic cannabinoid testing services!

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TAKEAWAY: A non-negative specimen is not the same as a positive specimen. A drug test result is categorized as positive if testing indicates the presence of a targeted drug or its metabolite at a level above the minimum cut-off. However, a non-negative specimen also does not clearly indicate that the test subject has not used prohibited drugs.



By Jennifer Crump

A non-negative result is a collective term that essentially refers to any test that is not negative. In other words, the test cannot accurately determine that no drugs are present in the testing subject’s urine, hair, or oral fluid sample. For example, because laboratory tests must confirm positive POCT tests, they cannot be considered positive. Instead, they are called non-negative. 

What non-negative tests are not, at least initially, is positive. The term implies that the results are inconclusive or that an additional confirmation test is required. 

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We can help ensure that your policy is implemented to fit your company’s needs and culture. Choose from test panels ranging from 5 to 13, POCT and laboratory testing, substance abuse professional services, online and in-person education and training, and benefit from SureHire’s extensive partnerships and advanced technologies. Learn more.

What is the difference between non-negative and positive drug tests?

While a non-negative test could be positive, it is not necessarily positive. While a positive test result proves the presence of a specific drug at levels that exceed allowable limits, a non-negative test merely proves that traces of a particular drug were present in the sample. Non-negative tests always require a second confirmation test unless a medical review officer (MRO) deems otherwise, however, a positive test can sometimes require a confirmation test. These confirmation tests are always lab-based and involve a second test of the same specimen.

Put simply, a non-negative test is one that is not definitively negative. There are several reasons why this could occur. The sample could be adulterated, substituted, invalid or positive, but further testing needs to happen to make a final determination. 

A positive test shows that the sample exceeded allowable limits, known as cut-off levels, for a specific drug. Cut-off levels vary according to the drug tested and the type of test – urine, hair, or oral fluid – used. If a rapid test was employed, the results are confirmed with a second lab test. While most employers in Canada can establish their cut-off levels, the Canadian Model does provide suggested cut-off levels. Employers governed by the U.S. Department of Transportation (DOT) must follow the DOT guidelines for cut-off levels. 

What does positive mean on a drug test?

If a drug test is deemed positive, that means that the detected levels of a drug exceeded the prescribed cut-off levels for that specific drug. However, it is essential to note that the Canadian Model and general best practices for drug testing recommend that employers forward positive results through an MRO.

What happens to a worker following a positive drug test depends on the company’s drug and alcohol policy. This policy should communicate the reasons for testing and the processes and consequences that follow a negative result. 

Many provinces and territories also have legislation covering the allowable consequences of a positive drug test. In most cases, these are contained in human rights legislation. For example, if the positive drug test results from an addiction, the employee may have the right to be accommodated under most provincial and territorial human rights legislation. However, courts can supersede this right if an employer demonstrates that it will cause them undue hardship. 

What does a negative on a drug test mean?

A negative drug test result means that testing did not detect the presence of a targeted drug or its metabolites in a particular sample. Negative drug tests are also referred to as negative results. 

To qualify as a negative result, the test specimen must contain either none of the targeted drug or its metabolites or a concentration level less than the minimum threshold amount for that drug, also known as the cut-off level. 

With a negative test result, no additional actions need to be taken by the employer or the employee, and the employee can carry on with their usual work assignments. 

What happens after someone receives a non-negative result?

It is critical to understand that a non-negative test does not imply that the test was either negative or positive. Think of it as inconclusive. What happens following a non-negative drug test result depends on the employer’s drug and alcohol policy and whether or not the employer follows the Canadian Mode or DOT. In most cases, a non-negative test will suspend worker duties, particularly anything safety-sensitive, until confirmation testing results are available. Labs generally complete confirmation testing fairly quickly for non-negative tests (typically 3-5 business days).

The Canadian Model requires that an MRO review all non-negative test results. The MRO will then determine whether the test is positive, negative, or negative with a safety advisory. A safety advisory could include a recommendation that an employee is not permitted to perform specific tasks. The MRO will provide a copy of these determinations and any applicable recommendations to the employer and the employee.

How SureHire Can Help Protect Your Workplace

A comprehensive workplace drug and alcohol policy is an employer’s best defense against the risks associated with drug and alcohol use in the workplace. It should clearly outline testing procedures, processes, and consequences. 


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TAKEAWAY: Drug use harms workplace health and safety, work quality, productivity, and the business’s bottom line. Here are 6 signs your employees may be abusing drugs and some preventative measures you can take to if you suspect impairment on the job site.


By Elly McGuinness

Book Impairment Awareness Training Today!

SureHire offers impairment awareness training to help supervisors and employees understand how to identify signs of drug abuse and when to carry out reasonable suspicion testing. We offer private sessions both virtually and in-person as well as self-study session through our online learning centre iNTELLECT. 

Employee substance abuse has an adverse effect at an individual and a company-wide level. Addiction costs American businesses an estimated $81 billion annually in lost profits, with mining, construction, and the accommodation and food service industries generally showing the highest prevalence of substance use.

Drug abuse negatively affects employers because it can increase absenteeism, turnover, compensation claims, violence, and theft. It compromises the safety of the drug abuser and others around them. The majority of substance abusers maintain employment and operate at a functional level, highlighting the need for employers to understand the potential workplace implications of substance abuse.

Ultimately, drug use harms workplace health and safety, work quality, productivity, and the business’s bottom line. Therefore, employers should understand how to identify signs of drug abuse and what to do on the job site when they suspect an employee is under the influence of drugs.

Signs employers can look out for if they suspect employees of drug abuse

It’s essential to recognize that there isn’t a definitive list of drug abuse signs. Sometimes drug abuse signs could be indicative of something else altogether. Employers can look for several signs if they suspect employees are using illicit drugs.

1. Behaviour

A sudden behaviour change may be indicative of substance abuse. Examples include:

  • A sudden disinterest in work
  • Neglecting responsibilities
  • Regularly showing up late or calling in sick
  • Lack of energy or motivation
  • Risk-taking or making dangerous choices
  • Secretive or suspicious behaviour

2. Change in performance

Employees who start making mistakes and display a drop in overall performance could be affected by drugs or alcohol. They may have difficulty concentrating on tasks or remembering things, decreased reaction time, and reduced mental sharpness.

3. Impaired motor function

Impaired motor skills are a sign of drug use. Look out for employees who appear unsteady on their feet. They might be swaying, staggering, falling over, or holding onto something to keep upright.

The person’s movements could be slow, and they may appear sleepy or disorientated. Conversely, they could be hyperactive or act nervously.

4. Physical appearance

An employee abusing drugs may start having a general lack of interest in clothing or grooming. They may wear dirty clothes and have a smelly or dirty body. Drug and alcohol users could smell like alcohol, tobacco, or chemicals.

Look at the person’s face for other signs. Their eyes might be watery, bloodshot, or glassy, with dilated or constricted pupils. Their skin may appear pale, flushed, or sweaty.

Signs around the mouth include slobbering or chewing gum or candy.

5. Speech

A person’s speech patterns can indicate drug use. An employee under the influence of drugs or alcohol could sound slurred or incoherent and may speak very slowly.

6. Personality

A drug-impaired employee could have drastic mood swings. They might suddenly act hostile, angry, paranoid, or fearful for no apparent reason. Other unexplained changes in attitude or personality could be a sign of drug abuse.

A combination of signs

An employee abusing drugs will likely present with several signs rather than one in isolation. Some are commonly associated with certain classes of drugs. For example, drugs like amphetamines, methamphetamine, and cocaine are stimulants that may present as increased energy, alertness, and restlessness. Conversely, slower reaction times and reduced coordination more likely indicate marijuana use.

Essentially, employers should pay attention to any drastic changes in an employee’s behaviour, performance, physical appearance, and personality and seek to find the cause, which may or may not be drug-related. Drug testing is the only definitive way to confirm substance abuse.

What should employers do if they suspect drug impairment on the job site?

Companies should have a clearly defined workplace drug and alcohol testing policy. As part of that, employers should document a course of action for reasonable suspicion should they suspect an employee is under the influence of drugs or alcohol. Steps employers can take in the case of alleged impairment include:

  1. Document complaints and concerns brought forward from co-workers in detail.
  2. Talk to the employee in person and observe any suspected signs of impairment. Then ask another supervisor or human resources (HR) representative to conduct a first-hand observation.
  3. Remove the employee from any safety-sensitive area if they may be putting themself or others at risk.
  4. Both observers should document their observations of abnormal behaviours, speech, appearance, odours, emotions, actions, or inactions.
  5. Determine whether observations and documentation support reasonable suspicion and if there is disagreement, bring in a third party to decide if further steps are necessary.
  6. Meet with management, HR, and the employee to explain the observations. Inform the employee that the company will send them for a drug and alcohol test to rule out the possibility of violation of the drug and alcohol policy.
  7. Arrange transportation to the testing facility, either in a taxi or with a management team member.
  8. Wait for test results and then respond to an employee’s refusal to take the test, or to a positive or negative result, as per the company’s drug and alcohol policy.

The 8-Panel drug test is the most popular screening test because it tests for the most commonly abused drugs. These are:

  • Amphetamine
  • Cocaine
  • Methamphetamine
  • Phencyclidine (also called PCP or angel dust)
  • Cannabis/marijuana
  • MDMA (methylenedioxymethamphetamine, also known as ecstasy or molly)
  • Opioids (heroin and synthetic opioids such as fentanyl)
  • Oxycodone (Roxicodone and OxyContin)

Drug abuse is a sensitive subject that can leave employers feeling unsure about an appropriate course of action. Reasonable suspicion testing can confirm substance abuse, yet the employer must understand when it’s ok to do it and the consequences if it’s done incorrectly.

At the same time, employers must take steps toward ensuring the health and safety of their workers. A drug-free workplace helps reduce the likelihood of drug-related accidents and injuries, ultimately helping to protect the workforce.

Employers must understand how to identify signs of drug abuse and when to carry out reasonable suspicion testing. Reasonable suspicion training is a cost-effective solution to educating supervisors and employees about the adverse effects of alcohol and drugs on workplace safety.

[Book a private training session for you and your team]

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