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Before Screening

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What is a drug and alcohol policy?

A drug and alcohol policy is a document which describes the organisation's stance on drugs and alcohol in the workplace. It is there so that any related issues that arise can be dealt with using a universal set of rules and guidelines. Having this policy in place is for the benefit of everyone involved with the organisation, and helps to put ‘a line in the sand' to exactly what is required of the workforce in terms of drugs, alcohol and impairing substances.

Details, such as permitted levels of alcohol, the implications of being found with drugs in your system and what happens after that should be featured.

We recommend being up to date with your policy, as an employee, or potential Testing Officer involved with drugs and alcohol screening.

SureScreen do offer a policy review service, and an update to your document is especially useful if you are thinking of introducing on-site screening to support your policy.

What do I need in place before screening?

You'll need to have a drug and alcohol policy in place, which often forms part of operational or terms of employment documentation.

You'll need to decide which method of testing you want to do, whether its ‘pre-employment', ‘for-cause', ‘random' and which matrix (sample type) you want to test too. There is a preferred matrix for each scenario, and a choice of which drug types you test for. We can help and advise you, impartially, to make those decisions.

We would suggest that you consider training your personnel who will be undertaking drug and alcohol screening, as there is a best practice involved, and if a case gets to a disciplinary status, you need to know that the process has been undertaken to the correct standard so that there is little chance of a challenge.

The Consent Form

Before screening, it's important that the donor has given consent to test. Any cellular material taken from the body for analysis in the UK does need consent according to the Human Tissue Act (2004).

The consent form should feature personal details about the donor, such as christian name, surname and date of birth.

Key features for a drug and alcohol screening consent form are:

  • Identification – You'll need to positively identify your donor. Photo ID is the preferred method, making sure they are who they say they are, but if you can positively identify them, then that is ok. Either way, the method of identification should be noted on the form.
  • Medication – Prompt the donor to disclose any medication, both ‘over the counter' or prescription, that they have taken in the last 2 weeks. It is a good idea to mention cold/flu medication, painkillers and CBD oil when you ask, as anything routine may be dismissed by the donor. In some cases, higher doses of medication can cause a ‘non-negative' result on a drug test. In our experience, it tends to be medication in the Benzodiazepine or Opiate groups. We advise that ‘non-negatives' that are suspect of being due to medication are confirmed by laboratory confirmation to ensure that there isn't something else causing the screening result, and that the result lines up with the information declared by the donor.
  • Donor and collector's (and witness) name and signatures are required before sample and screening commences.
  • Test results are often recorded on the donor consent form, once the screening has been completed.

What are the UK drug laws?

There are 3 key pieces of legislation in the UK when it comes to drugs:

  • Drug Misuse Act (1971)
  • Medications Act (1968)
  • New Psychoactive Substance Act (2016)

The Drug Misuse Act is that main piece of legislation that governs the possession and dealing of illicit substances in the UK. It classifies drugs of various types into classes from A to C, which have different monetary penalties and jail sentence periods associated with them. An overview can be viewed here.

Looking through the substances listed, you may have spotted that there are some pharmaceutical drugs included, and that leads us on to the Medications Act which controls the public use and availability of common and more potent substances used in the treatment of health conditions. These drugs are illegal to possess without a prescription, and there have been changes made to the law in recent years regarding medicinal cannabis and the recognition as a treatment for epilepsy and other psychological conditions (2018).

The New Psychoactive Substance Act was put into force in 2016 in response to the prevalence of synthetic cannabinoids and other 'legal highs' that, due to the ever changing chemicals used in their production, left the law unable to prosecute for possession or the dealing of these substances. The introduction of this law made it illegal to possess and trade substances which have a detrimental affect on the user due to their psychoactive effect. The legislation was so far reaching that caffeine, alcohol and nicotine had to be specifically written out of the act, as well as prescription and over the counter medication. The laboratories that are part of the established pharmaceutical industry in the UK also had to apply for special licence to develop novel chemicals.

In the main, the introduction of this act has worked in reducing use of these types of substance, though there are still former ‘legal highs' out there being used, often pushed on the marginalised as they offer a cheap form of escapism. In the main they remain a dangerous, unregulated category of illicit substance.

Understanding an overview of the law is useful as it gives an understanding of the severity of the different drug types most prevalent in the UK today and the implications on substance use around the workplace.

How many people take drugs?

Official figures from the Office for National Statistics show that around 1 in 12 people (8.5% of the population) between the age of 16 and 59 used an illicit drug during 2018 in England and Wales.

The statistics also show that 16 to 24 year olds are almost twice as likely (around 1 in 5, or 19.5%) to use illicit substances.

Source: https://files.digital.nhs.uk/publication/c/k/drug-misu-eng-2018-rep.pdf

What are legal Highs and New Psychoactive Substances?

The term ‘Legal Highs' has been used to categorise a collection of drugs of abuse which do not fall under the Drugs Misuse Act (1971). The term has been in use for a while, encompassing abused substances such as glues and other inhalants, but became notorious with the popularity of synthetic cannabinoids in the last 5-10 years.

The term ‘New Psychoactive Substances' can from a new piece of legislation of the same name that was put into force in 2016 in response to the prevalence of synthetic cannabinoids and other ‘legal highs'. The introduction of this law made it illegal to possess and trade substances which have a detrimental affect on the user due to their psychoactive effect. The legislation was so far reaching that caffeine, alcohol and nicotine had to be specifically written out of the act, as well as prescription and over the counter medication. The laboratories that are part of the established pharmaceutical industry in the UK also had to apply for special licence to develop novel chemicals.

In the main, the introduction of this act has worked in reducing use of these types of substance, though there are still former ‘legal highs' out there being used, often pushed on the marginalised as they offer a cheap form of escapism. In the main they remain a dangerous, unregulated category of illicit substance.

What is CBD oil?

CBD, or Cannabidiol, is a phytocannabinoid found in cannabis plants. Anecdotally, CBD has been found useful in alleviating physical pain associated with mobility conditions, and is often used for its calming, positive affect on people experiencing anxiety and cognitive conditions.

At the time of writing, there is a thriving market in the vitamin and supplement market for CBD, even though the clinical research that allow medicinal claims to be made hasn't been presented yet.

There has been a stigma around CBD due to its association with cannabis and the psychoactive cannabinoid, THC (tetrahydrocannabinol); however, CBD products from a reputable source contain no, or only trace amounts of THC and are therefore legal to possess and use. From a workplace point of view, CBD will not impair the user or cause an undesirable result when testing a sample during drug screening. That said, due to the growth in the market, we have encountered some products which are of poor standard and with dubious sources of CBD, so its very much a case of buyer beware. We'd advise the user to obtain their CBD from a reputable source.

CBD extract comes in the form of an oil, most commonly available in a bottle with a dropper and administered under the tongue. More recent entrants to the market are creams and oral sprays. CBD is sometimes available as a vape liquid instead, although the dose is often difficult to regulate.

What signs and Symptoms may show someone is taking drugs?

In many cases, someone who is either under the influence of illicit drugs, or a habitual user, will exhibit some sort of change in their behaviour, demeanour or routine. Observing change in a person is the best way of observing that illicit drugs are being used, but in some cases there will be signs or symptoms that will be apparent, and they tend to fall into two groups, physiological and psychological.

  • Physiological
    • Short-term
      • Bloodshot eyes
      • Unusual pupil size for environment
      • Overly energetic or twitchy
      • Overly lethargic or ‘dopey'
      • Unusual smells on breath, body, or clothing
      • Tremors or impaired co-ordination/balance
      • Impeded speech
    • Longer-term
      • Changes in appetite or sleep patterns
      • Disheveled appearance
      • Weight loss or weight gain (over weeks)
      • Change in routine or attendance
  • Psychological
    • Short-term
      • Lack of motivation
      • Unreasonable behaviour
      • Anxious, paranoid, or mentally unsound without reason
      • Sudden mood swings, irritability, or angry outbursts
      • Delusional
      • Addictive behaviour
    • Longer-term
      • Unexplained change in personality or attitude
      • Mental health issues
      • Longer term change in personality

Windows of detection

This term relates to the period of time that a substance, both drugs of abuse and alcohol, is detectable in the body, and covers different time periods in different matrix; in this case, breath, oral fluid, eccrine sweat, urine and hair.

It is important to understand that different types of illicit substances stay in the body for different periods of time too. In general the fastest moving and first to leave the body are the most chemically volatile, the stimulant group.

Typically, medication types such as benzodiazepines last for the longest duration, as the substance is metabolised by the body and the active ingredients get to work.

Matrix types and typical duration

Breath: TODO: Add this

Oral Fluid: <1 hour - 24 hrs

Eccrine sweat: <1 hour - 24 hrs

Urine: Typically 4hrs - 7 days but up to 6 weeks in some cases

Hair: Once captured in the hair root, the drug metabolite is there indefinitely

As you can see from these retention times, or windows of detection, there is time overlap for some of these matrix. Therefore, it is possible that if you could have a ‘non-negative' result using two different testing types, but we tend not to mix matrices, as each one stands on its own for its intended purpose.

In general, we use oral fluid, eccrine sweat testing - via fingerprint, and breath (alcohol screening) to detect very recent use, which may still be affecting the donor.

Urine is used to detect recent and habitual use, and hair, historical use.

Which drugs test is best for me?

This question often comes up, and really the answer depends on how and where you are wanting to conduct screening.

Each matrix has its advantages and has been designed specifically for its application. These include:

  • Location of use
  • Preparation of screening area
  • The range of drug types that the test will detect
  • If you are looking at short, recent or long term drug detection

In general, we use oral fluid, eccrine sweat testing - via fingerprint, and breath (alcohol screening) to detect very recent use, which may still be affecting the donor.

Urine is used to detect recent and habitual use, and hair, historical use.

For a considered approach, please get in touch for some impartial advice with specifics of your situation.

Which drugs should I be testing for?

Classically, there have been 6 main categories of drugs of abuse that we'd recommend testing for:

  • Amphetamines
  • Benzodiazepines
  • Cannabis (THC)
  • Cocaine
  • Methamphetamines (inc. Ecstasy)
  • Opiates

But it rather depends in which industry you are based. Industries such as rail or construction have a preferred mix of drug types, and if you are screening within health care or rehabilitation, Methadone should certainly be part of the mix too, along with other medications.

Recently, with the rise of synthetic substances, such as Spice, K2 etc. casting a wide net is sometimes a good solution, so a 10 parameter oral fluid test, or a 13 parameter urine test cup. We find that being vague about exactly what you are testing for prevents forewarning for the donor. It's likely that typical drugs of abuse will be included in a drug test, like cannabis, cocaine and amphetamines, but the more obscure ones present a risk of being detected and will make the user think twice before using. As well as detecting drugs of abuse, screening is about deterring the use of these substances in the first place.

Screening Matters

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What do Adulteration, dilution and substitution mean?

Drug and alcohol screening is a reliable and efficient way to support your drug and alcohol policy, and deter substance issues from arising in a working environment. However, there are a few loopholes that the donor can exploit, and therefore, using a robust procedure is a must.

These loopholes are often practical and can prepared by the donor ahead of time, so some preparation is required on our part to close the temptation of trying.

Adulteration

This applies to urine screening, and is the action of interfering with the sample by adding an unknown substance. Typically, an acidic or alkaline liquid or powder is hidden in the sample collection area or concealed about the donor's person, and added to the sample causing the drug test to fail (a Control Line doesn't form, and therefore the test is void). Other forms of adulteration include products that are added to a sample and claim to eradicate particular drug metabolites. These do not work.

To combat adulteration, adopt a robust procedure - which we can assist you with, use features in your test product, and have a tube of colour change adulteration strips to hand. If you find yourself with a suspect sample, you can run further analysis for piece of mind or to identify a rogue sample.

Dilution & Substitution

This is the process of adding liquid, often water, to a sample. Increasing the volume of a sample artificially will decrease concentration per volume of any drug metabolite that is present in the sample, and therefore, the possibility of a sample becoming negative after dilution becomes viable. Each test parameter has its own cut-off level, measured in ng/ml, and this is the threshold of concentration required to give ‘non-negative' result. If the concentration is below this, the test will give a negative result.

When urine screening, the main diluting agent we encounter is water, but it is possible to purchase small bags of urine via mail order that is certified as drug-free, or someone else's sample which is hidden in the collection location or secreted about the donor's person to be used in a screening situation. If you have any doubts over the validity of a sample, you can use an adulteration test strip, which changes colour if the parameters of the sample are outside the expected range.

To combat dilution in urine screening, it is important to have a robust procedure in place that minimises the likelihood of dilution happening. We can assist you with this if required. Often drug tests have features, such as temperature strips, built in, so a rogue, diluted sample is identified with ease.

When screening oral fluid and breath, there are far less opportunities to dilute the sample when compared to urine screening, but we must observe an empty mouth for 15 minutes before testing, so no food, drink, smokes or chewing gum during this time. This period ensures that the donor has not retained liquid in their mouth to dilute the sample, but this time frame also allows the mouth to refresh the oral fluid that is naturally retained there, so you are sure to get a fresh sample. In the case of alcohol testing using a breath sample, 15 minutes is also observed, allowing time for any residual alcohol around the gum line or throat to have dissipated.

What happens if the donor refuses to give a sample?

Occasionally, we find situations where the donor is reluctant to give a sample, either because they think they may fail a test, they find the process invasive, or because they have a medical condition that they haven't divulged which either they are embarrassed about or has implications on their ability to work. These are situations we have encountered, and I'm sure there are many more excuses out there that we haven't yet heard.

A drug or alcohol screen is a way of detecting recent drug or alcohol use. In some cases, once the procedure is detailed and the implications described, the donor will be happy to give a sample.

If the donor still reuses to give a sample, you can remind them that a drug screen is linked to the drug and alcohol policy which forms part of the terms of employment. By refusing to give a sample, the donor is in violation of this, and therefore non-conformance which can end up going down a disciplinary route.

If you are part of a situation that gets this far, the donor will either give consent to screening, or in some cases walk out.

How do I collect the oral fluid sample?

Whichever oral fluid drug test you are using, the collection procedure is largely the same.

Ensure that the donor has had nothing in their mouth for 15 minutes prior to testing. This includes: drinks, food, chewing gum and smokes.

Before collection, the donor will need to have completed a Donor Consent Form, which is required before the sample is taken. The 3 most important bits of information on the form are:

  • Identification of the donor
  • Declaration of any medication, OTC or prescription, taken in the last 14 days.
  • The donor's signature

Ask the donor to select a test from the selection you have available. This removes any accusations of fixing or rigging the test result.

We recommend wearing a pair of gloves (vinyl or similar) when handling oral fluid samples, so the first step is to glove up, ready to collect the sample.

Open the swab packaging at the handle end of the collector, then offer the handle end to the donor. This is to avoid any claim that the swab was contaminated during this process, but it is also good hygienic practice.

We find that the best way to collect an oral fluid sample is as follows:

  • Close lips around the stem of the swab
  • Manipulate the swab with the teeth and tongue at the front of the mouth. This process usually prompts the saliva glands to release some primary saliva which helps in collection
  • Continue until the swab is saturated, and no firm areas remain. This may take as long as several minutes.
  • Add the collector to the test product/vial as directed in the product insert
  • If the quantity is insufficient to run all test parameters, you can re-swab the donor as detailed above, which is preferable to opening a new test.

For more in depth instruction, please consult the product insert, or get in touch with SureScreen.

How do I collect the urine sample?

Whichever urine test product you are using, the collection procedure is the same.

Before escorting the donor to the collection area, you should take precautions against manipulation of the collection process by the donor. This falls into 3 categories: Adulteration, Dilution and Substitution. We have a procedure for this preparation, in line with EWTDS guidelines, so please get in touch to discuss.

Before collection, the donor will need to have completed a Donor Consent Form, which is required before the sample is taken. The 3 most important bits of information on the form are:

  • Identification of the donor
  • Declaration of any medication, OTC or prescription, taken in the last 14 days.
  • The donor's signature

If you are using a cup product, at this stage, ask the donor to select a test from the selection you have available. This removes any accusations of fixing or rigging the test result. If you are using a test product which does not include a collection vessel, you can run this step when you return from the collection area.

Accompany the donor to the collection area, and wait at a discreet distance, or as directed in your procedure or policy, until the donor has produced a sample.

We recommend wearing a pair of gloves (vinyl or similar) when handling urine samples, so the first step is to glove up, ready to collect the sample.

As soon as you receive the sample cup/vessel back from the donor, the first thing you should do is check the temperature strip, to ensure that the sample is a legitimate temperature (Close to internal body temperature, which is 37oC).

It is possible for the urine to be several degrees cooler by the time you see it, but you should be wary if the sample is warmer than 37oC.

For more in depth instructions, please consult the product insert, or get in touch with SureScreen.

How do I collect the IFP sample?

The fingerprint drug test works by detecting the presence of drug metabolites in eccrine sweat secreted by the fingers. Drug metabolites are substances produced by the body when it processes drugs; a process called metabolising.

It is quick and easy to collect the fingerprint sweat sample using the test cassette. The finger is pressed for 10 seconds onto the collection pad before protecting the sample with the tamper-evident cover, which slides into place.

The testing of the sample requires a sophisticated luminescence reader, which gives you step by step instructions of the process, including when to activate the buffer solution in the test, and when to begin the analysis process.

Collection and the testing process take approximately 15 minutes.

How do I collect the sample for hair analysis?

As hair grows it captures within it small traces of what is in the blood at the time. This is why a sample of hair that is ancient or involved in a criminal case can be used by scientists to paint a picture of diet, lifestyle and environment, but also to look for specific metabolites that indicate drug or alcohol use. Indeed, hair of Egyptian mummies have shown evidence of drug metabolites in several cases.

Hair analysis is often used in cases which are a little more involved than routine workplace screening, such as court cases or in a screening process for a prominent role, as when compared to fingerprint, oral fluid or urine testing, it is more expensive and the results take longer to come back from the lab.

The sample should be around 50 hairs from the crown of the head; a section of hair around the same diameter as the cross-section of a pencil. Cut the hair as close to the scalp as you can by laying the scissor blades against the donor's head. Take care to keep the hair aligned as you wrap it in the foil (part of the SureScreen hair collection kit).

If the donor has short hair, a sample can be taken from elsewhere, but again, keep the hair aligned and note where the hair has been sampled from, as hair from different areas of the body have different growth rates. If you are sampling from an area other than the head, please get in touch for further guidance.

What do I do if a donor denies use?

If you find a sample is ‘non-negative', the process, in most cases, is to have further analysis conducted by a laboratory to clarify precisely what has been found in the sample. This process gives peace of mind to you and the donor, especially if they deny any wrong doing.

It is advised not to use language such as ‘positive' or ‘fail' at this stage, as we do not have all the information to make such an accusation; it's in the best interests of all parties that the process remains calm.

The donor may deny use but have divulged information about medication. In this case, the laboratory confirmation acts as a way to confirm or deny that the medication has been a causal factor in the screening result.

The Excuse list - passive smoking, drug particulates, poppy seeds etc.

We have heard many concerns and excuses over the years, and here we collate some of the most common so that you are forewarned and know how to respond.

Comment:  "I was at a party on Saturday, and there were lots of people smoking cannabis. I'm concerned I will fail…"

Response:  This is a legitimate concern, however, the smoke that comes from the end of a cigarette containing cannabis has virtually no THC content, as it is burnt off at the tip. Each drug test has a cut-off level, the concentration level at which the test will become non-negative. This threshold is set so that even if there was some passive smoking involved, it is extremely unlikely that environmental contamination would cause a non-negative test result.

Comment:  "I'm taking pain medication for my knee"

Response:  If it's a medication that is prescribed or bought over the counter, it should be noted on the consent form prior to screening. In the case of a non-negative result, the sample is further analysed by the laboratory which will find if medication was the cause of the result. Bear in mind that the donor may use a prescription medication as a decoy for some more unsavoury substance, so it is our recommendation to back up your screening with lab confirmation where necessary.

Comment:  "I eat a lot of poppy seeds"

Response:  This refers to trace amounts of morphine that can be found in some types or origins of poppy seed. A false non-negative is unlikely, however, If a non-negative result is found, the sample will be sent to the laboratory for confirmation which is able to determine the analyte that caused the screening result. In the case of poppy seeds, we'd expect to find Thebaine in the sample.

Comment:  "I think I might have handled items with drug particles on them."

Response:  Even if you have been in contact with illicit drug particulates, they don't permeate the skin, and drug tests have a built in threshold, called a cut-off level, to prevent any environmental contamination form causing a false ‘non-negative'.

Comment:  "I take stimulants to help me stay wake"

Response:  Legal stimulants like caffeine, energy drinks etc will not interfere with the drugs test. Illegal stimulants will. We hear this comment occasionally from donors working night shifts.

Comment:  "I use mouthwash, will that have an effect on the alcohol test?"

Response:  Remnants of alcohol found in mouthwash will only remain in the mouth for a few minutes. So long as you observe the recommended 15 minutes interval of nothing in the mouth during that time, you can rest assured that any alcohol in the mouth or throat will have dissipated.

Comment:  "I've used an alcohol based hand gel. Will this affect my alcohol screening result?"

Response:  The alcohol in hand sanitiser doesn't permeate the skin, therefore there is no problem, unless the individual has consumed it!

What do I say if the donor challenges the result?

On-site screening tests are highly accurate as they look specifically for metabolites of various drug families. Non-negative samples should, in most cases, be sent to the laboratory for further analysis, and next steps will be dealt with after the results are confirmed.

What does the term "non-negative" mean?

We use the term ‘non-negative' when an analyte is found in a donor's sample. At the screening stage, the status of the result is an assumed positive result, but it requires clarification through the process used by the laboratory to find out exactly what is present in the sample. We tend not to use ‘positive', or ‘fail', as at the screening stage, we do not know for certain the reason for the result.

Why hasn't my test run ?

Oral:  Possibly due to insufficient oral fluid provided by the donor. We suggest removing the swab from the test and the donor re-swabbing.

Urine:  Possibly due to an insufficient sample. Check that you have the minimum quantity collected.

How do I ensure I read the results correctly?

A control line must be present to show the test has worked successfully. A present test line, even if it is very faint is a negative result. No test line is a non-negative result.

Why do some tests have faint lines?

If a faint Test Line (T) appears on a drug test, this still counts as a negative test result. Drug tests work in binary way, so any line that forms can be regarded negative. Always make sure that when reading faint lines, the area behind the lines has returned to white, for best contrast.

How do I complete the laboratory confirmation process for a non-negative result?

You will need a confirmation kit with the required ‘chain of custody' measures included, which makes it impossible for the sample to be switched or tampered with in any way. The confirmation kits for Finger print, Oral Fluid and Urine vary a little, but essentially use tamper evident seals and unique numbered enclosures to secure the samples before transit.

A soon as the sample is securely packaged, it should be sent to the address detailed on the box by recorded post, or courier. If you cannot send the same day, we recommend to store in a fridge, which will minimise any degradation in the sample.

When we received the sample, we check all of the seals before processing the sample for conformation analysis. Once the results have been obtained, we contact you direct and issue you a certificate of analysis for the sample.

What is a metabolite?

A metabolite is a small chemical structure which is unique to the chemical it is derived from. Metabolites are formed in the body as the parent substance is broken down by the body in a process called metabolism. This process largely takes part in the liver, which houses the enzymes necessary to perform this task. In immunoassay drug testing, the sample is evaluated for presence of drug metabolites

What is a cut-off level?

A cut-off level is a pre-determined level of concentration built into each drug test, at which the result switches from negative to non-negative. Cut-offs are usually measured in nanograms per millilitre, ng/ml, which is the equivalent to 1 billionth of a gram; so they're really super sensitive, but set at a sensible level which indicates legitimate use of the substance in question.

For example, a urine cocaine parameter has a cut-off level of 300ng/ml, so if the sample contains 300ng/ml or greater of cocaine derived metabolite, that test will show a non-negative result.

What about medication?

If the donor is taking medication, its important that the detail is documented on the consent form. This should cover all prescription and over the count medication taken in the last two weeks. In many cases, we wouldn't expect there to be any influence on the screening result from medication, but a full disclosure is useful if we find any further detail at the lab in the event of a non-negative result.

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