Workplaces differ widely so it is not appropriate to try to devise a model policy to suit all work situations. Each organisation should develop a policy to meet its specific needs and circumstances. However, key factors for a successful policy are:

The more employees involved in the drawing up of a workplace policy, the more they will wish to see it succeed. representatives from management, personnel, occupational health, unions and employees should all have an input into the drawing up, implementing and monitoring of the policy. A Drug & Alcohol Policy has an effect on employees private lives and should therefore be based on broad consultation. An open, consultative style of management is more likely to generate a successful policy. There must be trust that confidentiality will be maintained and that the policy will not be used to discriminate against certain groups of workers because of assumptions about lifestyles and who uses drugs.

Employers should make sure that all employees are fully informed about the policy and that they understand the problems caused by drug abuse, the need for workplace policies and the content, controls and implications of any such policy. Education and training is essential for the workforce and those required to implement the policy. Putting a policy down on paper is not enough. Every employee must take on some responsibility in making it work. It is therefore a priority to provide all parties with drug awareness education and the availability of support and treatment programmes.

The educational approach should be directed at all levels within the company and should be fully integrated into training programmes rather than being made available only to identified sufferers or as a one-off exercise. This education should be included as part of employee induction programmes and ensure that new workers start off with a clear understanding of the issues and the company policy.

Programmes should not engender an atmosphere of intimidation and suspicion which will only serve to encourage employees to disguise their problems. Programmes targeted at workers who cross international frontiers in the course of their work should also promote awareness of the dangers and penalties involved in drug trafficking.

Line Managers, who carry the brunt of operating the policy, should receive in-depth training. A high degree of awareness should be maintained through refresher courses.

There must be commitment to the policy at the most senior level. The policy must apply to all members of the workforce from the Chief Executive downwards. If it is agreed that the use of alcohol and/or drugs is not appropriate in the workplace, then management must ensure that the message given by their drug/alcohol policy is not undermined by their attitude to their own consumption of, in particular, alcohol in the workplace. Is it necessary or desirable to have alcoholic drink available in the boardroom or the executive dining room? Clear minds are as important here as anywhere else in the company. Management should consider whether drinking is encouraged by having such things as subsidised bars. Is there evidence of drinking after work or at dinner times encouraged by peer group pressure? Are certain groups more likely to be susceptible to drink/drug use? Can stress of work be reduced? Giving separate and incompatible messages will not help the implementation of an alcohol/drug policy.

The policy should be monitored and reviewed jointly on a regular basis to assess its effectiveness. It should relate to existing policies and should be built on and supported by policies relating to disciplinary procedures, sickness schemes, training and welfare.

Although we are dealing here with a joint drug and alcohol policy, employers may wish to have separate policies for alcohol and drug abuse. Many abusers of alcohol deeply resent any connection with drug abusers. They do not view themselves as drug abusers and do not connect their use of alcohol in any way to the illegal nature of drug abuse. As the aim of the policy is to encourage self referral, it may be prudent to treat to two separately, even though in fact the two policies will be identical in every aspect other than those covered by the law.

To recognise that alcohol/drug misuse is a health problem.

To prevent alcohol/drug misuse by promoting sensible drinking, abstention from illegal drugs and solvents and the proper use of prescribed drugs.

To identify alcohol/drug problems in employees at an early stage.

To provide assistance to employees with a drink/drug related problem.

To ensure that all employees of the company or other persons who work on the premises, are not unfit through alcohol/drugs, nor consume them whilst on the premises.

The policy should apply to all staff without exception, and should not discriminate on grounds of sex, status or race at any level. Both management and employees should be covered by all aspects of the policy and should have the same opportunities for counselling and referral and the same considerations at all stages. The policy must also apply to anyone working on company premises. Care should be taken to inform all contractors of the

company policy and to include all contract personnel in education and communication.

The policy should clearly define drink/drug abuse, safety critical posts, safety critical incidents and alcohol/drug levels. (See Drug Testing).

The policy must set out clearly who has overall responsibility for implementing the policy. It must also set out the responsibility of managers, line managers and supervisors for implementing the policy on a day to day basis.

The policy should provide for strict confidentiality. No individual or agency involved in the diagnosis and treatment of an employee should disclose any details or records to the employer without the written consent of the employee. An employer should not enter details of drink/drug treatment on the employees personnel file. Personnel managers must accept that they will only receive minimal information from the occupational health department. Employees should expect the same degree of confidentiality as they would from their GP. Any information sought with the employees permission should only be sought by and available to personnel and occupational health staff.

The policy should guarantee a non-judgmental approach so that employees are encouraged to come forward.

It should ensure that any employee who has come to the notice of management through accidents, work deterioration or other alcohol/drug related problems, will have the opportunity to discuss their problems and be offered the opportunity for diagnosis and help.

The policy should offer counselling and treatment for employees, this to be proved by an independent outside specialist agency agreed by all sides. Employees seeking help with a drug/alcohol problem would be unlikely to wish to discuss such issues with people who know them and are known by them. Contacts should therefore be made with local drug and alcohol counselling services to develop employee assistance programmes.

The policy should give the employee the right to be accompanied at any discussion by a friend or employee representative.

The policy should ensure that any employee is entitled to receive normal benefits under the company sick pay provisions. Reasonable absence from work to receive treatment should be granted as normal sickness leave.

It should enable an employee to return to the same job after treatment or where this is not advisable, to try and provide suitable alternative employment.

The policy should provide for all managers, supervisors etc. to receive appropriate training. The training should ensure that all staff understand the policy, the reasons for it and their role in it. They should be made aware of the counselling and treatment that is available and how to approach employees who may need treatment. Education should also be provided for all existing staff and for all new staff at induction.

The policy should contain a commitment to identify and remove risk factors in the workplace. Sources of stress such as poor job design, sexual or racial discrimination and harassment should be identified and removed.

The policy should recognise that relapses may occur. In the event of a relapse, after treatment, the case should be considered in the light of expert opinion and the employer should consider providing the opportunity for further treatment.

Should an employee refuse diagnosis or help or discontinue a recovery programme, this should not in itself be grounds for disciplinary action, unless the employees behaviour would warrant discipline under existing procedures. It should be recognised that in the early stages, alcohol and drug abuse can essentially be solitary problems. The sufferer may be unable to admit to themselves that a problem exists, let alone admit it to anyone else. The employee should not be punished for failure to seek treatment or to carry on without treatment, but rather for any consequential actions stemming from those failures.

Drug/alcohol abuse should not constitute grounds for dismissal unless the employees behaviour or performance reach an unacceptable level. Each case should be dealt with under usual disciplinary procedures. The employers ability and willingness to carry out the threat of disciplinary action is vital to the effective functioning of the policy. Without the sanction of disciplinary action and ultimately dismissal, there is little point in having a policy. The policy should explain that if help is refused and impaired performance continues, disciplinary action is likely and that dismissal action may be taken in cases of gross misconduct.

In certain sectors of industry where safety considerations are of vital importance, disciplinary procedures are usually invoked immediately there is any breach of the rules. It is essential that the employer ensures that everyone is aware of the rules, what is regarded as a safety critical post and understands the consequences of non-compliance. Where the nature of the work may increase the risk of alcohol/drug abuse and the employee seeks help, the employer should offer counselling/treatment outside of disciplinary procedure by removing the employee from the safety critical post.

The policy should state the procedure for monitoring, evaluating and reviewing the policy. Policies need to keep up with the many changes in both substance abuse and the research and knowledge about it.

The policy should state that trafficking (this includes an offer to supply) will be reported immediately to the police. There is no alternative to this procedure.

All employees must be made aware that if they are in any doubt as to their fitness to carry out their duties whilst on medication, they must consul their supervisor or manager who should obtain advise from OHS if necessary.

* A 1994 survey suggests that at least one third and as many as 50% of young people will have tried an illegal drug by the time they are 20.

* Of the 5,020 people in the 11-35 age group questioned, two thirds knew somebody who took drugs. 70% had been offered and 45% had used. Most of these were in the 20-25 age group and males.

* Up to 50% were not aware of any health risks and 29% were not aware of any non-health risks.

* Between 1990 and 1993 heroin addiction has risen by 30% and cocaine addiction by 130%.

* Mortality Rates:

Alcohol deaths = 0.5% of heavy to very heavy drinkers per year.

Tobacco deaths = 0.9% of smokers per year.

Opiate deaths = 3% per year of notified addicts who inject.

* A 1989 study showed 7.4% of road traffic fatalities could have been due to drugs. A study being conducted today shows a figure of 20%.

* Government estimates show a possible 50,000 cases of drug driving in 1994.

* It has been estimated that around one fifth of the total cost of all acquisitive crime in the UK may have resulted from heroin users financing drug use.

* No estimates for cocaine, crack or other drugs.

* One survey found 20% of young people using drugs at the weekend financed their drug use though petty crime, drug dealing or debt.

* In 1994, 48,924 people were found guilty of drug offences in the UK. In one three month period 664 users committed more than 70,000 crimes.

* 25% of registered drug addicts are in full time employment.

* 75% of those seeking help for alcohol problems are in full time employment.

* 1 in 10 employees in any organisation may experience alcohol problems.

* 20 to 25% of industrial accidents are alcohol related.

* Alcohol costs British industry an estimated £1.7 billion a year.

* Social grades AB (professional.managerial) and C1 (clerical/administrative) appear slightly more likely to have come into contact with drugs than other social grades.

* CBI reports that 8% of its members have formal drink/drug policies.

* 1 in 10 job applicants in the City tested positive for illegal drugs.

* 20% of people surveyed said drug testing in work would make them seriously consider giving up drugs.

* In 1993/94 government spent £526 million tackling drug misuse.

* Strathclyde police estimate annual expenditure of £5 million on police drug issues.

Clare L & Parker Y. A Question of Education. P.A.D.A. (1996).

Goode, S. Drug Link, Nov/Dec 1996 Vol.11 Issue 6. Drug Testing at Work.

Institute of Personnel Management, IPM Guide on Substance Misuse at Work

Health & Safety Executive. Drug Abuse at Work, a guide for employers.

National Union of Rail, Maritime & Transport Workers and British Railways

Board, Policy of Alcohol & Drugs.

BIFU negotiating guidelines on alcohol & drug abuse. BIFU research on alcohol & drug abuse.

MSF Health & Safety Information No.31. Alcohol & Drug Misuse, Developing a Workplace Policy.

Home Office, Drug Misuse and the Criminal Justice System Part 11:

Police, Drug Misusers and the Community. Report by the Advisory Council on the misuse of drugs.

World Health Organisation Technical Report Series 833, Health Promotion in The Workplace: Alcohol & Drug Misuse.

Tackling Drugs Together. A Consultation document on a strategy for England 1995-1998. HMSO

Hansard Parliamentary Debate 21 June 1996 HMSO

ISDD - Drug Abuse Briefing. HEA, Drug Realities, National Survey.

Forward Together. May 1996. A Strategy to Combat Drug & Alcohol Misuse in Wales. Welsh Office, Central Office for Information.

ITF Drug & Alcohol Guidelines.

P.O.S.T. Common Illegal Drugs & Their Effects. May 1996.

The increasing incidence of drug misuse in Britain is being reflected by a growing proportion of drug abusers in employment. A drug-free workforce can no longer be taken for granted. In taking steps towards a drug-free workplace, employers are becoming increasingly interested in drug screening as a means of detecting such users in their workforce. Drug screening is a contentious and delicate issue and needs to be approached with great care.

The first thing employers must consider is the need for such a programme. This will depend on local circumstances such as the prevalence of drug abuse in the social group and locality where employees are recruited, the nature of the job (including the potential for accidents, disasters and diseases). and other factors such as existing medical practices within the company.

In a recent article in The Times, Phillip Bassett the Industrial Editor said "Between 10 & 15% of job applicants in the City currently test positive for drugs according to the evidence from the Institute of Personnel and Development, although some City insiders may regard that as an underestimation. According to the IPD’s magazine, most of those testing positive are City employees applying for other City jobs, and are often employed dealing with substantial sums of money." Dr Michael Turner, Chief Medical Officer for City Medical Services said in the report that "significant numbers of prospective employees regularly take drugs, many are already working for financial institutions and are often in senior positions. Most use cannabis and the remainder cocaine, LSD or amphetamines." Dr Turner goes on to say that a number of companies claim they do not have drug problems because they never find used syringes in the lavatories, and concludes, "If you measure the severity of your drug problems by the number of needles you find, you might as well give up now."

In addition to becoming increasingly more common, drug testing is becoming more sophisticated, and the tests are now available to identify someone who last used drugs up to six weeks earlier. There is no consensus over the relationship between dose and effect for drugs, unlike alcohol where maximum "safe" levels have been set. Moreover, the rate at which alcohol is metabolised is fairly predictable so that blood alcohol levels obtained some hours after an accident can be used to estimate the likely alcohol level at the time of the accident. With illegal drugs, the effects may vary considerably from one person to another, with some people developing tolerance to a drug and others becoming sensitized to its effects. Different drugs are also metabolised by different individuals at different rates. Cannabis is particularly problematic in this respect - it can take days or even weeks for the drug to be completely removed from the system, so that interpreting whether a person with moderate levels of cannabinoids in the body is still under the influence of the drug is very difficult. No consensus thus exists about what would constitute a "safe" level in the body for each of the illegal drugs. Levels of a drug detected will depend on the route of administration, rate of drug metabolism and the subject’s physical condition and fluid intake. The concentration of drug in urine can therefore in no way be related to the level of mental impairment. As there is no consensus among scientists as to what level of each illegal drug is likely to constitute impairment, and it is by no means certain that further research would lead to such an agreement emerging, it has therefore been suggested that a more realistic alternative would be that the arbitrary thresholds values could be based on the cut-off levels described hereafter.

Employers need to be clear about what they hope to achieve by drug testing and in what circumstances they are prepared to use such measures. Screening must form part of the Occupational Health Policy of a company, and must have the agreement of the workforce. It should be designed to prevent risks to others from the actions of the drug abuser and should not be used to target specific groups within the company because of assumptions about lifestyle. The written consent of any individual must be obtained and medical confidentiality assured.

Screening can be used in various ways, including:

1) Pre-employment testing of applicants.

This is the easiest form of screening to introduce. Applicants who are not happy to submit to such screening are free to withdraw their application.

This would not prevent a drug user from abstaining from drug use for a short time before his/her medical, but could possibly act as a deterrent to a more regular drug user who may be unwilling or unable to abstain for any length of time.

2) Testing all or part of the workforce either routinely at set intervals or on a random basis.

Testing in this way will require the full co-operation of the workforce. It is essential that such testing is seen to be applied fairly. Notification procedures need to be thought through as individuals who know that they will be tested on a particular day, may be able to abstain from their drug use to ensure a negative result.

3) Testing the individual in certain circumstances such as:

a) When being transferred to a safety critical post

b) After an accident or dangerous occurrence

c) When drugs are found on site or in the possession of an individual

d) Where there is evidence of drug abuse

e) Where an individual’s behaviour gives cause for concern.

Testing existing employees will be most readily acceptable for safety critical posts or after an accident. A full range of options must be considered for handling the consequences of a positive test before testing takes place, and these must be clearly communicated to all employees before introduction of the testing programme.

4) As Part of an After Care Rehabilitation Programme.

To ensure compliance with the programme.

Most people are familiar with a form of ‘on the spot’ detection of alcohol called the breathalyser, which detects alcohol vapour in the breath. This approach is only possible with volatile substances such as alcohol and solvents. None of the main categories of illegal drugs are sufficiently volatile for this approach to work. Therefore ‘on the spot’ detection of illegal drugs will always require the individual concerned to submit a blood, urine or other such sample. Urine samples are used in preference to blood samples for both ethical and safety reasons. Tests offering ‘on the spot’ detection for most of the major classes of illegal drugs are available. Merck/BDH offer a 7-substance screen in one test, Syva and Roche make individual tests for amphetamines, opiates and cannabinoids. Tepnol Diagnostics offer a compromise where individuals test strips clip together into the combination required.

These tests are reasonably straightforward but they do require a flat and stable surface whilst they work. Several minutes may be required before the result is known and a good light is required to detect the line, pattern or colour change involved.

LSD is the major omission in the tests available at the present time, mainly because of the tiny amounts of the drug involved. However, this may change soon as the LGC has recently developed a new (laboratory) test for LSD which may be easier to adapt to ‘on the spot’ testing.

The main limitations of ‘on the spot’ screening is their lack of specificity, which tends to lead to a high false positives rate (particularly for amphetamines and opiates). Moreover, levels in urine persist for some days and do not therefore prove impairment at the time. Consequently, for the foreseeable future at least, ‘on the spot’ testing can only be used as a preliminary screening method - any positive result will have to be confirmed by analytical methods in the forensic laboratory.

In order to satisfy principles of good practice in the laboratory, all tests should consist of two different stages. The first stage screens samples using immunological assays. Each sample is tested against a range of antibodies, each one designed to bind to a specific type of drug, and to trigger a colour or other detectable change when the drug is present. This initial screening stage may give rise to a number of ‘false positive’ results, since some of the antibodies used also bind to other, closely related drugs which are not illegal (eg opiates and amphetamines are similar to a number of common components of some ‘over the counter’ medicines). Antibodies against cocaine, LSD and cannabis on the other hand, are much more discriminating, and are less likely to give false positives.

Any samples testing positive in the initial screening process have to be further analysed using separation (chromatography) and detection (mass spectrometry; MS) techniques. For most drugs, the separation method used is gas chromatography (GC), where tiny amounts of the sample are blown through a ‘sticky’ porous column, which separates out the various components according to their chemical characteristics. Drugs can be identified by the amount of time taken to emerge from the column (the retention time). But, just to make sure, the stream is passed into a mass spectrometer which yields the molecular structure of each of the separated components. This is called GS/MS approach and is the nearest analytical science can get to an unequivocal identification of a molecule. The only exception to this procedure is with LSD, which does not tolerate the conditions of high temperature needed for GC. This where a screening assay suggests the presence of this drug, samples may be separated out using liquid chromatography - essentially the same as GC but with the sample being pumped through a column in a stream of liquid, before being analysed by MS.

In order to avoid acting on very low readings - eg arising from passive uptake ie being in the same room as a cannabis smoker, or legal medicines which may contain low levels of opiates or stimulants - only samples which exceed certain cut-off levels are counted as positive. Cut-off levels vary from drug to drug and between screening and confirmatory tests, and those used in the UK laboratories are based on the US (NIDA/SAMSHA) or Australian standards shown overleaf. These were designed specifically for workplace screening and may be too high for the context of driving.

Immunoassay screening test Analytical confirmatory

In general, blood samples are more expensive to analyze than urine, with a one-off screening and confirmatory test costing up to £350 (compared to £200 for urine). Where significant numbers are being screened, test prices may reduce dramatically (eg down to £50/£100 a test depending on throughput).

testing requires the introduction of chain of custody procedures, capable of withstanding detailed scrutiny. The three stages which the chain of custody must link together are:

1) The collection of samples, ensuring they cannot be tampered with and are actually provided by the person being screened.

2) Laboratory analysis, involving testing and confirmatory testing, and follow up action if a screening test proves positive.

3) Careful interpretation and review of the procedures for all positive results before they are reported.

Rigorous standards must be adhered to at all stages. Specimen collection procedures must protect the individual and guarantee sample integrity. To be secured against challenge, the analysis must involve two stages:

a) An initial immunoassay screen

b) Subsequent confirmation by gas chromatography/mass spectrometry.

Both stages of the analysis must be carried out within a designated area of a specialist laboratory. Any laboratory accredited by the United Kingdom Accreditation Service will have satisfied assessors that it provides a service which meets all these criteria.

The UKAS can be contacted on 0181 943 7140. Accredited laboratories include The Laboratory of the Government Chemist (0181 943 7452), The Forensic Science Laboratory in Chorley, Lancs (01257 265666) and Medival Ltd, Manchester Science Park (0161 226 6525). The Forensic Science Service is in the process of opening a new Urine Drugs Screening Unit which should be in operation by early 1997.

They will be able to offer a comprehensive service which includes a sample collection service, a medical review service, urine collection kits and all documentation including chain of custody forms, training in sample collection and expert testimony in court or at tribunals.

All accredited laboratories will be able to offer employers advice about drug testing, but it should be remembered that employee drug testing is big business and the employer should satisfy himself that the need for testing exists and that his workforce is well informed and happy about such measures. Drug testing should be supported by an on-going programme of education. Screening in itself will never be a complete answer to the problem of drug abuse and its results must always be supplemented by a professional assessment of the employee. The policy to screen will require audit on a regular basis (at least every two years) to ensure its continued relevance and smooth working.

Drug & alcohol abuse wrecks lives. Firstly there is the damage that can be done to the individual’s health and the anxiety and suffering than can be caused to his or her family and friends. Then there are the consequences of making mistakes whilst working in an intoxicated or drug impaired state, particularly the risk of serious accidents. There can be no compromise in the battle to ensure the highest standards of safety. All the more important then, that the means used to combat drug and alcohol abuse in the workplace are effective and work with the full co-operation of the workforce, rather than being aimed against them.

The aim is to motivate staff with problems to seek and accept help in the knowledge that both management and colleagues understand their difficulties. If they work in an environment that is not hostile to them, those people with problems are more likely to admit to their problems and to volunteer to have treatment.

Employers can benefit from the introduction of a drug & alcohol policy in several different ways:

1) Saving on reduced absenteeism and reduced productivity. Alcohol alone is estimated to cost British industry £1.7 billion through sickness and absenteeism. There are no reliable figures for drug abuse.

2) Reducing the risks of accidents. The employer is required by law to maintain a safe and healthy working environment.

3) Improving the morale of other employees. Drug abuse is often associated with a tendency towards violence and other anti-social behaviour. Drug abusers may be seen as non productive ‘passengers’ and tensions between members of the workforce can only result in a lowering of standards, productivity and morale.

4) Saving on the cost of recruiting and training new employees to replace those whose employment might be terminated due to their drug abuse.

5) Enhancing the public perception of the company as a responsible employer.

Diagnosis of drug abuse is not a matter for the untrained person. The results of a misdiagnosis can be catastrophic both for the person carrying it out and the person so described. Diagnosis of drug abuse should therefore only be made on the basis of a proper, formal observation and a sufficient and informed knowledge of the subject.

Key members of the workforce who will be involved in cases of suspected drug and alcohol misuse need to be aware of some of the work related problems which may result from such abuse, but they must also be aware that such symptoms may relate to a number of different illnesses. Whilst the following list of symptoms may relate to drug and alcohol problems, they should not form the sole basis of any diagnosis.

• Multiple instances of unauthorised leave.
• Excessive sick leave.
• Frequent Monday/Friday absences.
• Excessive lateness, eg Monday mornings, returning from lunch.
• Leaving work early.
• Peculiar and increasingly improbable excuses for absence.
• Unusually high absenteeism rate for colds, flu, gastritis etc.
• Frequent, unscheduled short-term absences, with or without explanation.

• Repeated absences from post.
• Frequent trips to the cloakroom etc.
• overlong coffee breaks
• Physical incapacity on the job.

• Accidents on the job.
• Accidents off the job eg at home, travelling to work.

• Work requires greater effort.
• Jobs take more time.

• Difficulty in recalling instructions, details etc.
• Increasing difficulty in handling complex assignments.
• Difficulty in recalling own mistakes.
• General forgetfulness.

• Alternate periods of high and low productivity.
• Increasing general unreliability and unpredictability.

  Reporting to work

• Coming to work in an obviously abnormal condition.
• Increasingly unkempt appearance/lack of hygiene.

• Missed deadlines.
• Mistakes due to inattention or poor judgment.
• Wasting more material
• Making bad decisions.
• Complaints from customers.
• Complaints from colleagues.
• Lack of attention to detail.
• Improbable excuses for poor job performance.

• Over-reaction to real or imagined criticism.
• Paranoia.
• Physical or verbal abuse of colleagues.
• Unreasonable resentment.
• Irritability.
• Complaints from co-workers.
• Borrowing money from colleagues.
• Avoidance of boss or associates.

Drug and alcohol abuse is expensive. Maintaining a habit can therefore lead to other problems such as theft or other forms of dishonesty.

In the case of alcohol abuse, there are often physical signs such as flushed face, hand tremors, general physical incapacity and the smell of alcohol. In the case of drug abuse there may be symptoms such as a runny nose and dilated or constricted pupils and redness around the eyes, but these may also be associated with a number of common illnesses. Drug effects are influenced by the type of drug and the frequency with which it is being used. Looking for common effects in individuals is a difficult task.

Managers need also to be aware of the paraphernalia associated with drug use, and to be on the look out for such items discarded in or around company buildings.

Sharps boxes should be kept on the premises in case of the discovery of discarded injecting equipment. Very great care should be taken with such items and cleaning staff especially should have access to knee pads and protective gloves should there be any likelihood of their coming across such items in the course of their duties.