Testing It Up

There are a number of legitimate reasons why an employer should consider drug testing workers. Whether you’re running a small business or a large enterprise, it’s important that you let your employees know that illegal substances will not be tolerated in your workplace and so are people who report to work under the influence of drugs or alcohol. This message should be properly communicated to the workforce through the organization’s drug free policy.

But despite the benefits of workplace drug testing, many employers skip or delay implementing such policy because they are uncertain about how far they can go in screening job applicants and existing employees for drug use. This is understandable, though, as there are several federal and state laws that employers must adhere to in order to avoid future legal battles. Some of these laws include the Americans With Disabilities Act, the National Labor Relations Act, the Fair Labor Standards Act,  the Drug-Free Workplace Act, and the Omnibus Transportation Employee Testing Act.

In addition to getting familiar with a handful of workplace-related laws, an employer is also deemed liable for the conduct of their drug testing service agents, such as the medical review officers, specimen collectors, and laboratories. Hence, some employers would rather hire a lawyer with solid background in corporate drug testing to help them create an effective and flawless drug-free policy.

A well-crafted drug testing policy does not only state what kind of drug tests will be conducted, when the drug test will be conducted or who will be subject to the drug test. It must also comply with federal and state laws governing labor employment and fair workplace practices. This way you prevent the chances of your workplace drug testing policy from becoming a source of liability.

In perhaps one of the most startling pieces of news to come out of Hollywood in recent times, Angelina Jolie publicly disclosed last Tuesday that she recently underwent a double mastectomy.

Her decision to go under the knife came from the diagnosis that she was carrying a BRCA1 gene mutation, which Genetics Home Reference describes as a precursor of breast cancer through abnormal cell growth and eventual tumor formation.

Jolie’s declaration appears as a double-edged sword. While public disclosure of her mastectomy operation sends a strong message for women to make an empowered choice to remove both breasts for cancer prevention, it can also fuel the trend for unnecessary breast removal procedures. In fact, several doctors in recent years have reported an increasing number of women who choose preventive mastectomies of both breasts even if one of the breasts is still healthy.

Nevertheless, this bold decision is most welcome in some circles, especially for women who are hesitant to undergo surgery or even subject themselves to genetic tests. Barron H. Lerner, author of “The Breast Cancer Wars”, applauds Jolie for the decision to go out in public about her condition, saying that her stature as a world-famous actress will definitely influence women in profound ways.

Jolie wrote a column in the New York Times to share her experience. She said she had her double mastectomy done at the Pink Lotus Breast Center in Beverly Hills. The whole procedure included reconstructive surgery, and lasted for three months until its completion on April 27. She was especially thankful to partner Brad Pitt, who was with her through every minute of the process.

Vermont’s attempt to replace criminal penalties with a civil fine for possession of limited amounts of marijuana finally gained victory on Monday. All it takes now is for Gov. Peter Shumlin to sign it into law.

House Bill 200 was introduced by Rep. Christopher Pearson (P-Burlington) and co-sponsored by more than 35 other state lawmakers. Its main provision is to impose fine-only penalties for individuals 21 and older, who are caught possessing up to one ounce of cannabis. Those under the age of 21 who are caught with marijuana will be required to undergo substance abuse screening.

On May 13, Gov. Shumlin tweeted the following: “Decriminalizing small amounts of marijuana will allow courts and law enforcement to focus limited resources more effectively to fight highly addictive drugs that tear apart families and communities.”

Shumlin is expected to sign HB 200 in the coming weeks. The legislation will then take effect on July 1, 2013.

Marijuana supporters in the state are ecstatic of the lawmakers’ approval of the bill. Matt Simon, a legislative analyst for the Marijuana Policy Project said Vermont Legislature has just set an example for other states by adopting a kind of law that America really needs.

“The exceptionally broad support demonstrated for this measure reflects the progress our nation is making toward adopting a new and more sensible approach to marijuana policy,” Simon told The Daily Chronic.

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.

A small town in Pennsylvania has recently been given a medical equipment upgrade.

In their press release, Easton Hospital Health and Wellness Center reported that it is now home to the latest technology in breast cancer detection: 3D mammography. This breakthrough technology allows for a three-dimensional examination of the breast tissue for a closer scrutiny. The procedure improves the assessment of the breast structure by distinct separation of overlapping tissues.

Also called breast tomosynthesis, this novel technique reduces the physical pain during scanning. Unlike conventional mammography wherein the breast tissue is subjected to pressure, this technique uses no pressure. This development alone has sparked interest in women who are hesitant to undergo mammography because of the pain. The 3D mammography system used in Easton is called Selenia Dimensions breast tomosynthesis, which is ergonomically designed for better patient comfort.

But more than the benefits of a pain-free procedure, the greatest advantage of 3D imaging is the clarity of the images. Easton’s 3D Mammography system generates crisp imaging details, thereby giving radiologists a higher confidence level in diagnosis. Results from a 3D mammography system are expected to be far better than the conventional method.

The procedure involves scanning the breast in several angles. The machine then takes 1-mm scans of the tissue, and then reconstructs the images to form a three-dimensional image of the breast. From the digital image, radiologists can then examine the breast for abnormalities or signs of breast cancer.

Easton Hospital Health and Wellness Center is located in Forks Township, Northampton County, PA.

Pharmaceutical companies are slowly closing in on the treatment of Type 2 Diabetes with the FDA approval of Invokana (canagliflozin), a sugar-controlling tablet manufactured by Janssen.

According to Mary Parks M.D, chief of Division of Metabolism and Endocrinology Products under the Center for Drug Evaluation and Research of the FDA, Invokana is part of a family of drugs that inhibit subtype 2 sodium-glucose transport proteins (SGLT2), which are responsible for re-absorption of glucose in the kidney. The breakthrough drug also enhances the excretion of glucose, and regulates blood sugar levels of people with diabetes.

Clinical trials in Type 2 Diabetes patients showed remarkable improvement in hemoglobin A1c and blood sugar levels. The drug has been tested to be taken as-is or in conjunction with other more notable antidiabetic drugs such as metformin and insulin.

While trials showed success in treating Type 2 Diabetes, Invokana is not advisable for people with Type 1 Diabetes, high ketone levels in urine or blood, or extensive renal disease. Meanwhile, side effects identified after taking Invokana are urinary tract infection, yeast infection in the vagina, and increase in LDL cholesterol. Frequent urination may also be experienced, as well as sudden drop in blood pressure especially when in an upright position. Expect dizzy spells during the first few months of taking the drug.

Several studies are still being done to ensure safety of Invokana as an approved antidiabetic drug. Some of the studies include monitoring for malignancies, effects on cardiovascular health, potential issues on hypersensitivity, pregnancy-related issues, and effect on bone strength. Despite all these, Aaron Cypress M.D. of Joslin Diabetes Center says Invokana looks to be a promising alternative.

The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) announced last week its plans to create new recovery courts that will be instrumental in fighting the state’s mental health and substance abuse problems.

Recovery courts are specialized courts that make use of intensive judicial supervision, treatment services, sanctions, and incentives to address the needs of nonviolent drug offenders. The state has been approved with a budget of $1.56 million to establish nine new recovery courts that will target juvenile and adult offenders.

One of the biggest substance abuse problems in Tennessee is the non-medical use of prescription medicines. Effective April 1, health care providers are required to use the state’s controlled substance monitoring database in an effort to fight prescription drug abuse. This move is in addition to the pain management clinic registry created last year.

“We are facing a major prescription drug problem in our state,” TDMHSAS Commissioner Douglas Varney said in a news release. “We need to focus all of our resources in the most efficient, effective, and collaborative way to maximize our impact on this issue and drug abuse overall. And because so many people who are dealing with a substance abuse issue also have a mental health issue – a situation referred to as a co-occurring disorder – these recovery courts will be able to help them get all the help that they need at one time and in one location.”

The new recovery courts will combine the services currently found in mental health courts and veterans courts to address mental health, substance abuse and veterans affairs issues in one location, as well as to maximize the allotted funds. TDMHSAS officials are currently working with community leaders around the state to determine the best possible sites for the nine recovery courts.

Tobacco smoking has long been established as the primary risk factor of lung cancer. But it appears that the same danger cannot be said for those who smoke marijuana, whether occasionally or habitually.

In a study presented at the annual meeting of the American Association of Cancer Research, a group of researchers reported that regular cannabis smoking has no significant association with lung cancer risk.

Dr. Li Rita Zhang of the University of California, Los Angeles, and colleagues examined the role of cannabis smoking in lung cancer risk using data from six case-control studies in the United States, Canada, the United Kingdom and New Zealand. All of the studies were part of the International Lung Cancer Consortium (ILCCO), according to The Oncology Report.

The risk of lung cancer was assessed between the frequency, intensity, and duration of use, while adjusting for age, sex, sociodemographic factors and tobacco packyears. In the end, the researchers found that regular pot smokers had no significant increase in lung cancer risk when compared with marijuana smokers who also used tobacco.

“The conventional wisdom is that cannabis smoking is not as dangerous as cigarette smoking,” said pulmonologist Dr. Michael Alberts, chief medical officer of the Moffitt Cancer Center, Tampa, who wasn’t part of the study. Still, he cautioned that smoking anything can have some negative effects to the respiratory system.

Dr. Zhang, on the other hand, did not comment on the study but she noted that their findings “cannot preclude the possibility that cannabis may exhibit an association with lung cancer risk at extremely high dosage over long periods of continued exposure.”

Steroids abuse has been linked to a number of adverse health effects, yet most American adults do not think it’s a massive concern compared to other drugs of abuse, eating disorders, obesity or sexually transmitted diseases.

Of the 1,002  people surveyed by The Gallup Organization, 97 percent believe steroids negatively impact the health but only 19 percent consider steroids abuse a huge problem among high school students.

The American Public’s Perception of Illegal Steroid Use survey, conducted Oct. 9 to Nov. 10, was commissioned by the Taylor Hooton Foundation, the National Baseball Hall of Fame and Museum and the Professional Baseball Athletic Trainers Society.  It is by far the most comprehensive opinion survey that assesses Americans’ knowledge, perceptions and beliefs about the use of performance-enhancing substances among youths.

“The results of this study show that steroids and performance-enhancing substances remain a mystery to the American public,” Jeff Idelson, President of the National Baseball Hall of Fame and Museum, said at a news conference held last week.

According to a news release, the survey was conducted to provide a foundation for a national dialogue about the misconceptions of steroid use, as well as education on the harmful impact of steroids and other performance-enhancing drugs.

The survey also found that 64 percent of respondents believe high school boys are likely to use performance-enhancing substances, while 21 percent believe high school girls are likely to use performance-enhancing substances. More than 60 percent think steroid abuse is a problem among professional athletes, and just 46 percent consider it a problem among college athletes. Only 17 percent believe that steroid use is a significant concern among student athletes in high school.

Don Hooton, Founder of the Taylor Hooton Foundation, says the latest findings should serve as a wakeup call for America to address the problem of steroid abuse. “We must realize that the solution to this problem begins with raising the awareness level of this drug problem,” he added.

Hooton is urging the federal government to launch an educational effort because even though 75 percent of the polled Americans were okay with drug testing student athletes, 55 percent would choose education if only this option is available and only 44 percent would submit to a drug screening, The Associated Press reports.

A case study presented Tuesday at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists showed that pregnant women who use synthetic marijuana may experience dangerous symptoms harmful for both the mother and the unborn child.

Dr. Cindy S. Lee and Dr. Sally Nalesnik, from Kern Medical Center in Bakersfield, CA, conducted research involving a pregnant woman who came to the labor and delivery floor agitated and had a seizure. The woman was approximately 35 weeks pregnant and did not previously have prenatal care. She was found to have elevated blood pressure and protein in her urine which are common symptoms of preeclampsia. After being resuscitated, the patient underwent emergency cesarean delivery in response to fetal distress.

The woman’s physicians successfully delivered a 28-week female baby who screened negative for drugs. Typically, eclampsia is cured with the delivery of the baby, but this particular patient did not  get better following delivery.

“This was an interesting, yet confusing presentation,” Dr. Lee said in a news release. “We wanted to report it so in the future if something similar came up, it would be in the literature and physicians could refer to it.”

The woman’s lab results showed very low potassium levels and her urine drug test returned negative. Her physicians later received information from an anonymous caller who said the patient was regularly smoking Spice Gold, one of the many street names for synthetic marijuana.

“This was not a pregnancy problem but a drug problem,” Dr. Lee added. She said it is important for ob-gyns to realize that emerging drugs represent growing challenges to medical practitioners because synthetic marijuana, for instance, cannot be detected in standard drug tests.

Synthetic marijuana is a mixture of herbs and spices that is typically sprayed with a synthetic compound that mimics the effect of THC, the psychoactive element in marijuana. Among the most popular compounds that illegal drug makers are using to create synthetic marijuana include JWH-018, JWH-073, and JWH-200, and HU-211. Although these chemical compounds are banned under federal and several state laws, drug makers are getting smart enough to  use other available synthetic cannabinoids that are not yet banned in order to avoid existing drug laws.

Law enforcement officials  and public health practitioners are concerned about the potential side effects of synthetic marijuana and bath salts, saying they don’t really know what those products can do to people.