Testing It Up

Ensuring safety in the workplace should not cross the right to privacy of any employee.

This appears to be the drive behind the decision of Canada’s Supreme Court June 14 against the employee policy of Irving Pulp and Paper Ltd. implemented in 2006. The company’s policy required all unionized employees to be subjected to random alcohol testing in order to ensure safety of the company’s manufacturing plant, according to a news report.

Local 30 of the Communications, Energy and Paperworkers Union of Canada (CEP) filed a grievance against the company in 2006.

According to the supreme court decision, the paper company’s policy encroaches on the rights of employees to privacy, even if the workers are employed in a critical area within the facility. The high court voted 6-3 against the company.

Furthermore, the decision stated that mandatory workplace testing only applies in the work setting under the following conditions: (1) the company has experienced worker impairment while employed; (2) an employee figured in a work-related accident or safety issue; and (3) the worker has a history or case of substance abuse, and has returned to work following necessary treatment.

CEP president David Coles was hopeful that this supreme court decision could lead to another triumph in a similar case in Alberta’s Suncor Energy, where plans to implement a random alcohol and drug testing system are being laid out.

Furthermore, he said that the ruling shows that policies on random testing in high-risk facilities do not guarantee employee protection. “It turns out to be nothing more than an invasion of ones’ privacy with no net gain for the consequence of safety,” Coles added.

A seemingly simple DUI case has turned into a racist issue and a possible lawsuit.

Jessie Thornton, 64, was stopped in Surprise, Arizona by police who claimed that he was drunk driving. According to Thornton, the police officers pulled him over because he ran the white line in the middle of the road. The cops then declared that his eyes were red, as reported in the Daily Mail.

“An officer walked up and he said, ‘I can tell you’re driving DUI by looking in your eyes.’ I take my glasses off and he says, ‘You’ve got bloodshot eyes,’” Thornton said. But the Ohio native said that he just came from swimming at LA Fitness, hence the red eyes.

Apparently the cops weren’t convinced, and proceeded to conduct a sobriety test. True enough, the breathalyzer read a blood alcohol level of “0.00″, which means that there was zero alcohol in his bloodstream. Thornton confirmed this, saying that he did not drink any alcoholic drinks prior to driving.

Despite this, the officers brought him to the station, where he was subjected to drug tests for possible substance abuse. The station’s drug recognition expert declared him completely “free from impairment” caused by drugs.

After being released, Thornton learned that his driver’s license was going to be suspended for the time being, and his vehicle impounded for three days.

Thornton claims that the arrest was fueled not by DUI but by race. He says he was DWB — driving while black. He is now in talks with a lawyer for a possible lawsuit against the Surprise police station, amounting to $500,000 in damages.

A recent proposal to decrease the blood alcohol content (BAC) threshold for drivers is getting flak from anti-drunk driving advocates.

The National Transportation Safety Board (NTSB) released a comprehensive report lobbying to reduce the legal limit of a non-commercial driver’s blood alcohol level from 0.08 to 0.05. By logic, this seems common sense, since drivers with lower alcohol content in their blood tend to function better on the road than drunk drivers.

However, critics and advocates are not pleased with this effort, according to a news release. In fact, the group Mothers Against Drunk Driving (MADD) believes that the government’s focus is slightly off-base. MADD President Jan Withers expressed her opposition to the proposal, saying that reducing the BAC limit “will take a lot of effort for a potential result that is many, many years down the line.”

In its report entitled “Reaching Zero: Actions to Eliminate Alcohol-Impaired Driving”, the NTSB discusses the relative crash risk of a driver with varying blood alcohol content levels. The study shows that drivers with a BAC of 0.05 have 38 percent likelihood of figuring in a drunk-driving accident, while at 0.08 the driver has more than 150 percent risk.

Despite the clashing sides, the NTSB and its critics agree that drunk drivers should be kept off the road, and that effective policies must be in place to reduce incidents of drunk-driving accidents. Driver education on the effects of drinking must be strengthened, while technologies to prevent drunk people from driving should be further developed.

NTSB Chair Deborah Hersman says that the statistics of road fatalities due to alcohol impairment may have plateaued, but the issue has not been totally solved yet.

A recent study by the US Preventive Services Task Force (USPSTF) formed the basis for updating its own recommendations on screening and counseling interventions related to alcohol misuse.

As representative of USPSTF, Virginia A. Moyer, MD, MPH conducted a comprehensive literature review in order to update the 2004 USPSTF recommendations related to screening and clinical counseling of people immersed in alcohol misuse. New evidence on the effectiveness of alcohol screening procedures was reviewed, particularly in the sections related to the improvement of health outcomes, procedural accuracy, impact of behavioral counseling on long-term results, disadvantages of screening and counseling interventions, and influence of the health care system on the effectiveness of alcohol screening and counseling interventions.

Based on the results of the literature review, Dr. Moyer and colleagues updated the 2004 recommendations by strengthening the definition of alcohol misuse to include the entire array of unhealthy drinking behaviors instead of limiting the meaning to hazardous or harmful drinking.

The team recommends the primary care screening of adults 18 years old and above for alcohol misuse. Meanwhile, people engaged in risky or hazardous drinking should be subjected to short behavioral counseling interventions in order to reduce alcohol misuse (Grade B recommendation). However, the same statement cannot be said for alcohol misuse in adolescents due to insufficient evidence.

While the recommendations were based on strategic and systematic review, USPSTF declares that the decisions should be based not merely on evidence presented, but also on other factors. Intervention and clinical decisions should still be tailor-fit to the specific patient or condition.

Drug use detection in individuals is often performed by means of urine, saliva, and blood tests. But a new study showed several banned substances can also be detected using breathalyzers.

In a study conducted by a group of researchers from the Karolinska Institute in Stockholm, more than 10 substances were successfully identified in the breath of 47 patients, who were recruited from a drug addiction emergency clinic, using a simple, commercially available breath test. The breath samples were analyzed using liquid chromatography and mass spectrometry, and later revealed the presence of cocaine, amphetamines, methadone, methamphetamine, and marijuana, among others.

The researchers’ findings were published on April 26 in the Journal of Breath Research.

Professor Olof Beck, lead author of the study, said they were surprised that there was still “high detectability for most drugs” even though the samples were taken 24 hours after intake of drugs.

Breathalyzers are rapidly becoming a preferred drug detection device particularly in DUI cases because they are non-invasive and less prone to adulteration. Early this year, the U.S. Navy announced the fleetwide rollout of breathalyzer tests in the hope of discouraging irresponsible drinking among sailors. Even a growing number of schools are subjecting their students to breath tests to prevent drunk driving.

“In cases of suspected driving under the influence of drugs, blood samples could be taken in parallel with breath when back at a police station,” Beck explained in a news release. “Future studies should therefore test the correlation between blood concentration of drugs of abuse and the concentrations in exhaled breath.”

Hollywood star Reese Witherspoon often portrays goody-goody characters in her films. But on April 19, she tackled a more daring role that landed her in jail.

Witherspoon was handcuffed and sent to the Altanta city jail following an altercation with a police officer who pulled over her husband, James Toth, on a drunken driving charge.

According to police report, Trooper First Class J. Pyland stopped Toth after seeing him weave in and out of his lane. After several coordination tests and a breathalyzer test, Toth was found to have an alcohol level of 0.139, which is way above the legal limit of 0.08 for a DUI charge.

Pyland said Witherspoon was advised to stay in the couple’s Ford Fusion, but the actress disobeyed the order. The trooper recalled Witherspoon asking him “Do you know my name?” and saying “You’re about to find out who I am.”

Witherspoon, 37, and Toth, 42, ended up spending a few hours in jail while their vehicle was impounded, CNN reports.

Atlanta municipal court officials say the first court hearing that was supposed to have taken place earlier this week was moved to May.

The Golden Globe-winning actress issued a statement on Sunday, April 21, apologizing for her behavior.

“But I do want to say, I clearly had one drink too many and I am deeply embarrassed about the things I said,” Witherspoon said in a statement. “It was definitely a scary situation and I was frightened for my husband, but that is no excuse. I was disrespectful to the officer who was just doing his job. I have nothing but respect for the police and I’m very sorry for my behavior.”

Over 600 drug and alcohol testing professionals gathered in Orlando, FL April 9 – 12 for the Drug and Alcohol Testing Industry Association (DATIA) 2013 Annual Conference.

The conference featured 65 exhibitors from the drug and alcohol testing industry, as well as educational sessions on various topics related to drug and alcohol testing, including: Certified Professional Collector Trainer Training; Advanced Drug and Alcohol Testing Program Management; Developing an Effective Supervisor Training Program and Alternative Specimen Collection Training.

Many big names in alcohol and drug testing spoke at the conference.

Barry Sample of Quest Diagnostics Inc. gave a 25 year retrospective of the Quest Diagnostics Drug Testing Index, examining long and short – term drug testing trends based upon insights derived from more than 100 million tests performed by Quest Diagnostics over the past 25 years.

Quest publishes the Drug Testing Index as a public service for government, media and industry and it has been considered a benchmark for national drug trends since 1988.

Doug Mullen of Airlines for America talked about aviation testing outside of the U.S. and the implications of the Federal Aviation Administration’s proposed regulations that will require some repair station employees outside of the U.S. to be drug and alcohol tested.

A three-member panel with Brian Drew of Nationwide Medical Review, Patricio Labatut of Global Partners Ltd. and Kirk Hardy of The International Drug Detection Agency explored how international drug testing programs in Latin America and Oceania are advancing and the issues which they are currently dealing with, as well as a discussion about iDATIA, DATIA’s international drug free workplace program accreditation.

Also on the subject of international drug testing, Bill Current, with WFC and Associates, talked about how drug testing in countries outside the U.S. is exploding and what laws, health codes, privacy regulations, labor agreements, and best practice standards U.S.-based drug testing providers need to know about to cash in on this burgeoning market.

The DATIA 2013 Annual Conference also featured presentations on drugged driving, alcohol testing, marijuana legalization, DNA testing and implementing a student drug testing policy, among others.

Several big name players in global alcohol policy gathered in Washington DC recently to talk about the legal drug and how best to regulate it to avoid exacerbating further problems related to alcohol abuse. 

Health risk factors, the global threat of alcohol abuse, alcohol pricing and ways to diminish the health risks of alcohol and its abuse were all on the agenda for the conference, which took place April 3 – 5. The conference featured many experts in the field of alcohol research and policy from around the world, allowing attendees to contrast and compare how different countries handle the constant threat of alcohol abuse.

For a summary of what happened at the conference, see my Twitter summary of the event.

With alcohol being the most widely abused drug, having a reliable way to test for it is important.

Pat Pizzo, Director of Toxicology at Alere Toxicology, presented a webinar Feb. 28 entitled; EtG & EtS: A New Way to Look at Alcohol Testing to explain the ins and outs of EtG and EtS testing.

Unlike more traditional forms of alcohol testing, which test for ethanol, EtG tests look at the level of Ethyl Glucuronide.

Pizzo said the biggest advantage of testing for EtG as opposed to ethanol is that EtG breaks down or metabolizes without oxidizing, creating an analyte that can be measured for up to four or five days after alcohol consumption compared to only eight to twelve hours after consumption when testing for ethanol. EtG can also be detected in urine, plasma, hair and body tissue.

Ethyl sulfate (EtS), a direct, bio-marker of alcohol ingestion that is not susceptible to degradation by bacteria hydrolysis, is tested in conjunction with EtG for confirmation purposes, Pizzo said.

Testing for EtG

At the moment, testing for EtG is done exclusively via laboratory screening, as there is no instant tests available.

EtG, in conjunction with ethyl sulfate (EtS) is a scientifically accepted biomarker, Pizzo added, to show exposure to alcohol. It’s stable in urine, meaning that if you must keep specimens for extended periods, fermentation of the specimens won’t give you a false positive.

Disadvantages of EtG testing

EtG/EtS testing does come with some disadvantages, though, Pizzo acknowledged, the main one being false positives from donors who have not consumed alcoholic beverages but have been incidentally exposed to alcohol through some other means, like cough syrup; mouth wash or hand sanitizer.

Scientific studies have found that EtG will show up in urine samples from people who regularly use things like mouth wash and hand sanitizer, but these levels will almost always be below the commonly accepted cut off limit of 500 nanograms per milliliter (ng/ml).

False negative and false positive results have also been noted in test results due to bacterial contamination from the presence of E. Coli bacteria but testing for EtS in addition to EtG, Pizzo said, has proven effective in avoiding most false positives and false negatives and provides analytical results that are acceptable in court.

Interpreting test results

It is important to consider not only the cutoff levels when interpreting results for EtG tests, Pizzo said, but also the normalization of results and the use of both EtG and EtS for confirmation of results.

In addition to the commonly accepted cutoff level for EtG of greater than or equal to 500 ng/ml the commonly accepted cutoff level for testing for EtS is 25 ng/ml.

If cutoff levels of below 500 ng/ml for EtG are used, the test runs the risk of giving false positives for samples of individuals who may have experienced incidental exposure to alcohol through items like hand sanitizers and food made with alcohol, as mentioned above.

If an EtG test shows a level of greater than 500 ng/ml, however, that is considered as a result that is consistent with the recent ingestion of alcohol.

Normalization

When testing a urine sample for EtG and EtS, it is important to not just look at the EtG level, Pizzo said, but to calculate the normalized level because that’s the only way you can account for possible dilution of the sample.

Normalization is the consideration of how the dilution or concentration of a urine sample impacts the result of a drug screen test. Drugs are measured in ng/ml and the more dilute the urine, the lower the drug concentration, she explained.

Normalization is done by using a calculation that requires not only the EtG levels of the sample, but also the levels of creatinine, a product created by the breakdown of creatine phosphate in muscle that is usually produced at a constant rate by the body.

This normalization calculation helps testers recognize when a drug user who is being monitored by giving samples at set intervals is reusing the drug or if the user’s body is still processing drugs from older usage but has not reused, referred to as residual elimination.

Workplace testing

It is important for corporate alcohol testing to specifically mention testing for both EtG and EtS, in your corporate drug testing policy, Pizzo noted, and educate your employees on the risk of incidental alcohol exposure. You should also give them a list of things that could expose them to alcohol and also notify them that it is only a partial listing, as opposed to a complete listing.

As useful as EtG and EtS testing are for detecting recent alcohol usage, though, Pizzo noted, these tests are not meant to prove impairment from alcohol or whether someone is currently under the influence of alcohol. The only tests that can be used to determine impairment are blood, saliva and breath based on ethanol levels in those substances. In California, urine tests can be used to prove impairment based on ethanol levels.

Aside from workplaces, EtG and EtS testing is done in the criminal justice system and in rehabilitation programs and is especially useful in court cases involving driving under the influence (DUI), custody battles and when determining a cause of death.

A local high school has announced that it will be implementing mandatory random drug testing among students beginning SY 2013-2014. But while the intentions are good, the announcement didn’t come without causing a buzz.

KSHB reports that Rockhurst High School in Kansas City will be collecting approximately 60 strands of hair from randomly selected students to test for the use of banned substances, such as cocaine, PCP, opiates, methamphetamine, marijuana. The hair follicle drug test will also detect evidence of binge drinking.

“Our point is, if we do encounter a student who has made some bad decisions with drugs or alcohol, we will be able to intervene, get the parents involved, get him help if necessary, and then help him get back on a path of better decision making, healthier choices for his life,” Rockhurst Principal Greg Harkness said.

Early this month, Fox4KC reported that the Rockhurst High School Board of Trustees unanimously decided to begin the drug testing program to address permissiveness and misinformation about substance abuse among students.

The board said its decision is a result of a two-year consultation with trustees, administrators, faculty, parents, alumni and students about drug and alcohol use among teenagers.

According to Rockhurst’s drug test policy, if a student tests positive for any illegal substances, the student’s guidance counselor will request a meeting with the student and at least one parent. A student with a first positive result will be re-tested in 90 calendar days.

If a student fails the drug test for the second time, the Dean of Students will be consulted to determine if the student may continue in the school’s rehabilitation program. At this time, a full examination of the student’s disciplinary record will be reviewed. For the third positive result, a student will be dismissed from Rockhurst High School.

Although some students do not take any issue with the school’s drug test policy, there are others who consider the initiative an invasion of privacy. Matthew Brocato, the junior class president at Rockhurst, said “Some parents think that they’re the role of parenting away from them. There’s different issues that come up, but for the most part, the majority are okay with it.”

KSHB revealed that Rockhurst principal Harkness fielded calls from around the country following its report about the Jesuit school’s drug testing policy. In addition, Harkness reportedly accommodated a CNN interview for its own story on the school’s drug testing program.