Tag: Drug &amp; Alcohol Testing

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!

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.

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.

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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

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.

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.

Looking for a Provider in the US?

SureHire USA has more than 6,500 testing locations in the USA including facilities in Texas State. Contact us today to inquire!

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.

Looking for a Provider in Canada?

SureHire has an extensive network of testing locations across Canada. Browse our locations and services and book an appointment today!

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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 S ervices 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.

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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.

Jump Ahead

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.

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

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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.

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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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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

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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:

Document complaints and concerns brought forward from co-workers in detail.
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.
Remove the employee from any safety-sensitive area if they may be putting themself or others at risk.
Both observers should document their observations of abnormal behaviours, speech, appearance, odours, emotions, actions, or inactions.
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.
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.
Arrange transportation to the testing facility, either in a taxi or with a management team member.
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.

Browse Our Drug & Alcohol Services

SureHire offers a range of drug and alcohol testing services, including drug and alcohol testing, DOT and non-DOT random testing, and mobile testing. Our Substance Abuse Support Services use professional support personnel to help employers assess employees with a disclosed substance abuse problem or those who have tested positive on a drug and alcohol test. These services help prevent discrimination and protect workers’ rights.

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TAKEAWAY: Canada’s prescription rate for opioids is one of the highest in the world. Construction workers are among the highest group affected in Western Canada. Here’s what you can do to address the opioid crisis in your workplace.

Canada’s prescription rate for opioids, an effective but highly addictive painkiller, is one of the highest in the world. Worse, 10% of people who are prescribed this medication admit to problematic behaviours that can include taking too much, taking it too often, or using it to get high. And these numbers do not include the large numbers of people accessing illegal opioids, such as Fentanyl, which has increased rapidly driven by the isolating effects of the pandemic. The crisis is worse in certain parts of the country, particularly the west, and males, particularly those working in specific industries such as construction, appear to be more at risk.

Risks of Opioids Use in the Workplace

In the workplace, opioid abuse puts everyone at risk. It has been associated with increased absenteeism and loss of productivity. Still, more importantly, the effects of these drugs pose a serious threat to the health and safety of all workers.

Opioids can cause a host of short-term side effects from drowsiness to dizziness and confusion, all of which can cause impairment and prevent workers from doing their jobs safely. They can impair thinking and reaction time and increase the potential for errors and accidents. The risks are compounded for those in safety-sensitive positions.

Over the long term, even legal use of prescription opioids can quickly develop into dependence, and users seek out illegal drugs to fill the void. Addiction can make it difficult for the workers to focus on the job at hand, not to mention the effect this has on the individual’s mental health and well-being as well as the well-being of those around them. Finally, there is also the genuine threat of overdose as long-term dependence increases the need for more and more of a drug to achieve the desired effect.

Thankfully, there are many things an employer can do to help.

Establish a Workplace Drug and Alcohol Policy

An effective workplace drug and alcohol policy can help cement a positive workplace culture that rejects drug abuse and embraces safety. It should include statements that the organization will not tolerate drug use on the job and possible punitive measures that could be taken. Include testing requirements and procedures such as which type of tests will be required and what will happen if an employee tests positive. However, a drug and alcohol policy must also focus on preventative measures, supports, and services for employees seeking rehabilitation. This can include education on drugs of abuse, training on recognizing the signs of addiction, and a description of the mental health and substance abuse services sponsored offered by the company.

Encourage Reporting

Another risk prevention strategy involves creating a clear process for workers to report impairment, their own and suspected impairment in others, and providing training on the reporting process. It is important that employers make privacy and safety a focus, rather than punitive measures. If a worker self-reports, ensure the consequences are focused on getting them the help they need. Train company supervisors to recognize when medical intervention is required and carefully document incidences.

Book Reasonable Suspicion Training for Your Supervisors Today!

Provide Safe Disposal

Workers may hold on to old medications just in case or provide them to fellow workers or family members. In fact, many people begin an opioid addiction this way with drugs supplied to them by well-meaning friends or family. Offer a safe disposal option for workers to rid themselves of medications they no longer need or want and encourage workers to use them.

Raise Awareness

Provide education about the dangers presented by opioid prescriptions and encourage workers to discuss alternatives with their employers. Offer information to help workers and supervisors recognize impairment in themselves and others. Include the use of prescription medication in your workplace impairment policies and tell your workers not to share drugs with others. Help prevent injuries by providing education and training on preventing musculoskeletal disorders and back injuries.

Learn More about Musculoskeletal Injury Prevention in Your Industry:

Common Musculoskeletal Injuries in the Mining Industry & Proactive Prevention Tips for Employers

Employees in the mining industry face many risks and hazards every day on the job — here’s what you need to know to help keep your workforce safe.

Common Musculoskeletal Injuries in the Manufacturing Industry & Proactive Prevention Tips for Employers

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How to Prevent Musculoskeletal Injuries in the Transportation Industry

Employees in the transportation industry face many risks and hazards every day on the job — here’s what you need to know to help keep your workforce safe.

Common Musculoskeletal Injuries in the Oil & Gas Industry & Proactive Prevention Tips for Employers

Preventing Musculoskeletal Injuries in the Oil & Gas Industry

The Oil & Gas industry faces unique challenges with respect to the risk prevention of MSD’s. Find out how you can protect your workforce.

Provide First Aid Training and Tools

Consider adding naloxone to your first aid tool kit (a fast-acting drug that can be used to temporarily reverse the effects of opioid overdoses), and provide training to supervisors and first aid providers on how to use it to reverse an overdose. Train everyone in the appropriate responses and safety protocol during drug-related incidents, whether they involve law enforcement, first aid, or post-incident testing first aid.

Offer Return-to-Work Programs

Returning to work too quickly can put a worker at increased risk for abusing painkillers. Encourage an appropriately timed return with a return-to-work program that allows them to recuperate or ease back into their job with appropriate accommodations. As part of a broader program, mandatory medical assessments before an employee’s return to work can protect everyone. SureHire helps hundreds of companies manage their return-to-work programs. Contact us for details.

Deliver Sick Leave or Similar Benefits

Workers at higher risk for opioid abuse tend to have less job security and no access to sick leave benefits. Because of this, these workers may feel the need to return to work too quickly following an injury. Mitigate this risk by offering sick leave or similar benefits to injured workers to ensure they return to work when they are ready and not before when they may feel pressure to mask lingering pain with the use of opioids.

Support Recovery

Ensure your workplace policies support those who seek help. Addiction is an illness, and it should be treated like one. Provide support and remove stigmas in your workplace to ensure that anyone who needs help knows they can ask for it and receive it. These supports can include access to mental health and wellness programs, addiction counselling, substance abuse professionals or ongoing substance abuse education.

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KEY TAKEAWAY: Here are some key elements to keep in mind as an employer when you select a drug and alcohol testing provider.

There is an abundance of available options for organizations looking to launch a drug and alcohol screening program as part of their workplace drug and alcohol policy. In fact, the sheer number of companies offering these types of services can be intimidating — as an employer, you want to ensure you’re making the right choice for your workforce. [To learn more about how drug testing can benefit your workplace, check out “7 Reasons Your Company Should Invest in Drug Testing”]. After all, while there are many screening companies out there, not all drug and alcohol screening companies are the same. Whether you are just starting your search, are switching providers, or are simply looking to enhance your existing screening, here are a few key elements to consider.

Current and Future Needs

Before you begin to investigate the various offerings of testing companies, start with an assessment of your current needs with respect to drug testing. Will you want to test on-site, or do you prefer an off-site location for your employees? Where will your drug testing programs fit into your processes, and what is their intended purpose? Are they for new hires? Are you trying to proactively prevent substance abuse in your workplace, or do you want to have something in place for post-incident testing?

And, don’t stop with your current needs. Consider your future requirements as well. Will you need a drug testing provider who has the capacity to scale alongside you as your organization grows? These are all important elements to consider as you narrow down your search.

Logistics

Your drug testing program must be safe, secure, and reliable. That means choosing a supplier for whom collection process integrity is paramount. For example, can your potential partner articulate what constitutes a correctable flaw and a fatal flaw in the testing process, and the correct procedures in each instance?

There is no room for error or data breaches when it comes to drug testing, so your provider must also be trustworthy and have transparent processes that guarantee necessary procedures such as a chain of custody. They must also have professional, accurate systems that support the following:

Privacy protection
Thorough collection processes
Rigorous evaluation standards
Secure and comprehensive positive test procedures
Extensive reporting options

The Types and Purposes of Tests Offered By The Company

Unless you have very narrow testing needs, you will want to consider the variety of testing a provider offers and their level of expertise in each. For example, do they offer testing options for urinalysis, hair follicle, and oral fluid? Does the provider have the capacity to test for the variety of drugs you want to test for? [To learn more about one of the most common types of drug tests, check out “8-Panel Drug Testing: The Most Popular Workplace Drug Test”].

Employers utilize drug testing for various purposes. Each requires different processes and must adhere to different rules, from collection to testing to reporting. Potential drug test providers should be capable of providing services for:

Finally, if you are or may be subject to Department of Transportation (DOT) testing, the company you contract with should have experience in DOT, non-DOT, and Canadian Model focused drug testing.

Flexibility of Testing Delivery

Another key factor to consider is how your employees will be tested. Do you want to send your workers to a lab for testing, or would you prefer to set up in-house testing? There are several options available to employers. Providers can deliver point-of-care or rapid testing at the worksite, and mobile testing services can provide a similar service with a prepackaged setup. Traditional lab-based services are another option.

There are advantages and disadvantages for each. It’s ultimately a matter of what is the best choice for your particular workforce’s needs. You want to be sure that your provider has the capacity and experience to deliver the testing program that works for your workplace.

Extended Supports

Your drug testing program should not be solely focused on the tests themselves. It also requires initiatives related to education, training, and other services, such as mental health support, to assist your workers in dealing with addiction and substance abuse. You may also need to employ the services of Substance Abuse Professionals or Medical Review Officers. Of course, you can contract for all of these services separately, but working with a full-service drug testing company means you can work with a single service level agreement and enjoy the safety and security of a seamless process.

Technology

Technology is enhancing every aspect of drug testing. From ensuring random testing is genuinely random to providing automated reports and data. Other technologies can provide you with an automated dashboard and appointment bookings, along with alerts and reminders. Even chain of custody approaches is changing as technology improves.

Make sure the drug testing provider you go with is committed to staying on top of the latest in the industry. That way, they’ll be able to provide your company with technology designed to enhance your program.

Partnerships/ Networks

Drug and alcohol testing companies leverage partnerships and networks to enhance and extend their services. Look carefully at these partnerships and consider how and if they can advance your drug testing program. Every drug testing provider provides something a little different. Focus on the totality of the services and tools they can deliver on their own and in conjunction with their partners.

Why SureHire?

SureHire stands above its competition as a full-service occupational testing company serving more than 8,000 clients in over 1,200 locations across the globe. That experience and expertise will help ensure your drug and alcohol testing program runs smoothly and remains in compliance. When you work with SureHire, you have access to the vast accumulated knowledge of their many experts and you can rest assured that they’ll leverage innovative technology to give you the most accurate results.

SureHire provides a variety of testing services in addition to drug and alcohol testing as well, such as audiometric and lung testing, allowing you to handle all your workforce’s testing needs with one reliable provider.

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KEY TAKEAWAY: Understand drug testing cut-off levels for various test types, including urinalysis, oral fluid, and hair follicle testing.

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