Olympic tokers get a break

The Canadian Globe and Mail reports today that cannabis cut-off levels have been raised at the Winter Olympics:

“…in a nod to the growing relaxed attitude toward the drug around the world, the cut-off level for a positive test has been increased for the Sochi Games, allowing for some recreational use prior to the Olympics.

The new threshold for the active ingredient in marijuana, tetrahydrocannabinol or THC, has been increased from 15 nanograms per millilitre of urine to 150ng/mls. Officials say that means an athlete who smoked some weed before the Olympics, or inhaled second-hand smoke, wouldn’t likely test positive in Sochi. Someone who failed the new test would have to be “a pretty dedicated cannabis consumer,” WADA officials have said…”

And it’s fitting that it is a Canadian newspaper that brings us this story. This blogger remembers 12 years ago when challenged as a sample collector by the subject over passive smoking of marijuana causing a false positive.

His evidence was that a snowboarder was stripped of his gold medal but then had it re-instated when he challenged the result on the basis that he hung around with other boarders and that the community smoked a lot of dope.

Our client was witnessing this discussion, so when I returned to the office I checked it out. It turned out that there was a snow boarder, Ross Rebagliati, whose gold medal was re-instated after a failed drugs test…not, though, on the grounds of passive smoking, but mainly because THC wasn’t listed as a banned substance then – til snowboarding came in, the banned list focused on performance enhancing steroids! It has since been placed on WADA (the world anti-doping agency) list of banned substances.

That year, 1998, was the first time boarding was in the winter Olympics. I’ve just checked Mr Rebagliati’s Wiki page and the story doesn’t quite end there. In January 2013, he started a company called Ross’ Gold – a Canadian medical marijuana company. Fact can be way better than fiction.

Driving under the influence: is drug driving a serious issue in the UK?

How does drink and drug driving compare in the UK?

The risks of driving under the influence of alcohol have been well known, researched and promoted heavily for some decades now. Ever since the introduction of breathalysers, UK’s traffic police have had a simple piece of equipment that can determine if a driver has been drinking and whether they have exceeded the alcohol limit set down in law. That ability to test by the roadside has also helped raise the profile of the risks of drink driving in terms of the health and safety of the driver, passengers or pedestrians  and that facility also acts as a deterrent to drivers. There are few people in the country who could genuinely claim they are unaware of the risks of drinking alcohol with driving a vehicle.

But what about driving under the influence of drugs? The government runs campaigns against drug driving – some lamer than others (such as the dreadful ‘alien eyes’ poster campaign a few summers ago) – but essentially they have had very little impact.

Part of the problem is that the UK does not know the extent of drug driving in the country. The traffic police do not have the use of a simple device to test a driver to see if they have one of the common drugs of abuse in their system. The devices exist, and are used by police forces in other countries to great effect, but here in the UK, their introduction has been delayed for over a decade now.

Instead police have to use a ‘Field Impairment Test’ assessment – often referred to slightly tautologically as a FIT test. This is a roadside procedure based on a sobriety test with some additional elements, such as a card with holes in it of various sizes for the police to measure the driver’s pupil dilation. There’s a Romberg test (assessing the driver’s balance and ability to judge time), a walk and turn test, a one leg balancing test and a finger to nose test. Police officers have to undergo special training to be able to run and interpret the results of these exercises and as a result very few police officers have the qualification to execute the FIT. Also, even if an officer has that qualification, the 20 minutes or so required to complete the FIT along a roadside is anecdotally (from police) a deterrent to using it.

The result of this difficulty around FITs can be seen by the stark differences in the number of breathalyser tests for alcohol in comparison to the drug assessments: in December 2013, during their ‘Christmas campaign’, police forces in England and Wales carried out over 190,000 breathalyser tests. In the same month, they performed 513 FITs, an astonishing 370 times less drug driving tests than for drink driving.  

Equally striking – and perhaps of greater concern – was the difference between the positivity rate (the percentage of tests that drivers failed in either category for drugs or alcohol).  3.43% drivers failed the breathalyser tests, but 27.88% drivers failed the FIT drug assessment.

Now these figures are very likely to be skewed but other factors – firstly the size of the populations themselves (190,000 versus 513) means that the small drug driving figure is far more susceptible to statistical bias. Secondly, because breathalysers are so easy to use, police may use them during a Christmas campaign almost as a matter of course when they stop a driver. A FIT assessment though, because it is cumbersome to employ and it requires a trained officer, may (perhaps) only be used where there is already a suspicion the driver may be driving under the influence of drugs. Their pupils are dilated; they’re gabbling perhaps a bit too much. So the chances of a ‘positive’ may be higher.

However, we don’t know. There is simply not enough measurement of drug driving in the UK. You have to go back over a decade to find research that is still regarded as one of the best indicators of how serious the issue might be: then, 18% drivers in fatal accidents had illicit drugs in their system. There are 30 million drivers in the UK today. You do the math. It would be a brave commentator to suggest the UK’s drug driving will have dropped significantly since then.

The low-down on legal highs

 Following yesterday’s news that deaths related to the taking of legal highs in the UK had risen from 10 in 2009 to 68 in 2012, we publish this article by Matt Taylor, Managing Director of ScreenSafe, written last month for an occupational health clinic  

Legal Highs (Novel psychoactive substances) are often misrepresented as ‘safe’ for recreational use but can prove as harmful as controlled drugs

Novel (or new) psychoactive substances (NPS) are an ever-increasing group of synthetic, semi-synthetic or natural compounds, often advertised and sold as ‘legal’ alternatives to illicit drugs. Often misrepresented as ‘safe’ for recreational use, they can, however, prove as harmful as controlled drugs. Over the last decade, three European Commission funded projects have catalogued some 700 NPS and products allegedly containing them. Furthermore, the EU early-warning system, operated by the EMCDDA*, currently monitors over 300 new drugs.

The use of traditional drugs, such as heroin and cocaine, appears to be declining in some parts of the world, while the abuse of prescription drugs and new psychoactive substances is growing. This is according to the World Drug Report 2013, launched by UNODC on 26 June at a special high-level event of the Commission on Narcotic Drugs in Vienna.

For the first time, the number of substances reported exceeded the total number of substances under international control (234). The report describes how the international drug control system is now challenged by the speed and creativity of the NPS phenomenon.

 What are ‘legal highs’?

‘Legal highs’ are substances which try to produce similar effects to illegal drugs (such as cocaine, cannabis and ecstasy) but that are not controlled under the Misuse of Drugs Act 1971. These new substances are not yet controlled because there is not enough research about them to base a decision on. However, more and more ‘legal highs’ are being researched to see what the dangers are and if they should be made illegal.

‘Legal highs’ cannot be sold for human consumption so they are often sold as “research chemicals”, bath salts or plant food to get round the law.

The main effects of almost all ‘psychoactive’ drugs, including ‘legal highs’, can be described using three main categories:

  • stimulants
  • ‘downers’ or sedatives
  • psychedelics or hallucinogens.

Some drugs sold as ‘legal’ actually have been found to contain one or more substances that are, in fact, illegal.

What are the risks of ‘legal highs’?

Just the fact that a substance is sold as legal to possess, doesn’t mean that it’s safe – you can’t really be sure what’s in a ‘legal high’ that you’ve bought, or been given, or what effect it’s likely to have on you.  We know that the use of many current (and ex) ‘legal highs’, like mephedrone (meow-meow), Ivory Wave and 5-IT, have been directly linked to emergency hospital admissions and, in some cases, deaths.

Whilst drugs in each of the categories will have similarities in the kinds of effects they produce, they will have widely different strengths. Also, these three categories do not detail every reported risk of every ‘legal high’. In fact, for many ‘legal highs’, there has been little or no useful research into the short or long-term effects in people.

Stimulant ‘legal highs’ act like amphetamines (‘speed’), cocaine, or ecstasy, in that they can make you overconfident and disinhibited, and can induce feelings of anxiety, panic, confusion, paranoia and can even cause psychosis. They can put a strain on your heart and nervous system. They may give your immune system a battering so you might get more colds, flu and sore throats. You may feel quite low for a while after stopping using them.

‘Downer’ or sedative ‘legal highs’ act similar to benzodiazepines (drugs like diazepam or Valium), and like cannabis or GHB/GBL, in that they can make you feel relaxed or sleepy and reduce concentration and slow down your reactions. ‘Downers’ can make you feel lethargic, or forgetful, and can make you physically unsteady and at risk of accidents. They may cause unconsciousness, coma and death, particularly when mixed with alcohol and/or with other ‘downer’ drugs. Some people feel very anxious soon after they stop taking ‘downers’, and if a severe withdrawal syndrome develops in a heavy drug users, it can be particularly dangerous and may need medical treatment.

Psychedelic or hallucinogenic ‘legal highs’ act like LSD, magic mushrooms and ketamine. They create altered perceptions and can make you hallucinate (seeing and/or hearing things that aren’t there). Some strong hallucinatory reactions (‘bad trips’) can lead to the person acting erratically, sometimes without regard to their safety. Some psychedelic drugs create strong dissociative effects, which make you feel like your mind and body are separated. Both of which can interference with your judgement, which could put you at risk of acting carelessly or dangerously, and of hurting yourself, particularly in an unsafe environment.

Many of these risks are increased if the ‘legal high’ is combined with alcohol and/or with another psychoactive drug.

Are ‘legal highs’ illegal?

‘Legal highs’ are substances which produce similar effects to illegal drugs but that are not controlled under the Misuse of Drugs Act.

However, some drugs sold as ‘legal highs’ have been found to contain one or more substances that are, in fact, illegal. The truth is that you cannot be 100% sure what they will contain.

A number of substances previously referred to as “legal highs” have now been banned under the Misuse of Drugs Act, for example mephedrone. Being in possession of or supplying a controlled drug is an offence.

Like drinking and driving, driving while under the influence of drugs, including ‘legal highs’ is illegal – with some ‘legal highs’ you could still be unfit to drive the day after using. You can get a heavy fine, be disqualified from driving or even go to prison.

Why should we be concerned?

So what is this all about and should employers be concerned about their use and impact?

Any Drugs and Alcohol / Substance Abuse Policy should be an ever evolving document and process, and be reviewed regularly. It should address the issues of today. It should address the impact on the safety critical workforce from substances that can cause impairment.  This includes “over the counter” and prescription medication as well as illegal drugs, alcohol and solvents. However, there is a relatively new risk that should also be included. That is the massive increase in the use of so-called “legal highs”.

Not only do these “legal highs” pose a huge risk to the health and welfare to the user, but the effects they have on the user will cause impairment in the immediate, short, medium and long term.  This impairment may lead to fatal consequences. But the user may not be breaking the law.

So, how big is this emerging problem? Well, because these substances are currently classed as legal, it is a lot bigger than many might think. A simple search on the internet together with your credit card details and your “legal high” is delivered by Royal Mail the next day. Can’t wait until then? Not to worry, some websites will do a personal same day delivery. Failing that, pop into your local “headshop” and you can browse and get advice before making your purchase.

ScreenSafe has seen a dramatic rise in users of these “legal highs” with many enquiries asking about whether we can test for these substances, and whether they are covered under the “Drugs and Alcohol” policy.  “Yes” we can test for them and “Yes” they need to be included in the Policy.

Alarmingly, it is curious “law abiding” persons who would not think about taking illegal drugs as well as the “traditional” user that are being targeted. This includes children of 12-13 right up to 55-60 year olds. Financially, this market place is immense, with some online vendors now reporting profits of £100,000 per week.

These “legal highs” are here and now. This is not a “might be”. This is not fiction.  This is not an “underground” culture. This is mainstream, widely publicised and heavily marketed.

So what should we do now?

The Drug and Alcohol / Substance Abuse Policy is there to protect the employer, employees and members of the public who may come in contact with the company or its actions. While these “legal highs” remain legal, it can be slightly more complex and expensive to test employees for such substances. After all, there are other illegal substances that are often not included in the standard panel of drugs being tested for by employers either. However, ScreenSafe can offer a wide range of tests for a wide range of NPS (legal highs) including low-priced, simple to use urine “dip” tests for Synthetic Cannabis. An integral part to the Policy, testing is there as a tool to establish use and, where possible, at what level.

ScreenSafe also strongly believe that Training, Education and Awareness is key to the success of any Drug and Alcohol / Substance Abuse Policy. Our courses consistently receive very positive feedback, with many attendees citing the course as being invaluable not only as a manager, supervisor, contract head etc but also, and importantly, as a parent.

However, as stated above – policies need to be reviewed on a regular basis as the landscape is ever changing and evolving, to ensure they meet the current climate and requirements. Therefore, the training element is no exception.  ScreenSafe have recognised this and have included “legal highs” as part of our new and improved DandA© course. We also include the topic in employee awareness seminars and are developing further techniques to test for these substances as they evolve.

Any training should also be integral to C.P.D. and add value to the person’s role. Training and education also needs to be ongoing and regular where appropriate.

With the widespread use of “legal highs” and the increased use of alcohol and illegal drugs, there is no better time to raise employee awareness through training, education, updating handouts, literature, policies and induction “tool box talks” etc.

The bottom line is that impairment through drugs, alcohol, substance use or “legal highs” kills. It can kill the user. It can kill persons / employees who come into contact with the user.

Preventing use in the first place will make for happier, safer and healthier employees. If we can do this for just one person, we have made a difference to them, their family, their social community, their employment community and wider communities.

Investment in people / employees now, via training, education, awareness and routine testing is dramatically less than the cost of a compensation claim or even worse, that of a life.

Matt Taylor, ScreenSafe © Jan 2014

*EMCDDA is the European Monitoring Centre for Drugs and Drug Addiction

References: www.unodc.org  Drugnet Europe  www.talktofrank.com

 

Drug and alcohol control is a balancing act – but the scales are awry

“It’s time to have a rational debate”

The title of this blog comes directly from an article published by Westminster Briefing this week. It is written by James Morris, Director of The Alcohol Academy, a London-based voluntary organisation that promotes excellence in local alcohol harm reduction by working with and supporting local alcohol coordinators and strategic leads.

The article focuses on the debate between those who believe the war on drugs is best won by imposing stringent controls on the supply and use of drugs, and those who think that the decriminalisation of illicit drugs will do more to help solve problem drug use.

It’s an excellent article this blog author is happy to recommend, as it succinctly distils the arguments on both sides of this often polarised debate.

Currently, the UK government – and probably most of the UK political establishment – favour the drug controls side of the argument – in deeds at least. There are growing voices from the establishment, such as Chief Police Officers and academics like Professor David Nutt, who have expressed opinions that decriminalisation should be considered more readily. This also reflects a discernible trend across the globe where countries and US States are beginning to loosen controls on certain drugs such as cannabis. As Morris describes, the results are not clear cut, and the Portuguese experience is an example where the outcomes can be complex to determine.

ScreenSafe is part of the drug and alcohol testing sector that works with employers, public health organisations, occupational health professionals, government bodies and voluntary organisations to support their own policies on drug and alcohol use. As such, we can best inform the debate about controls vs. decriminalisation by providing expert knowledge on what we know most about – the ways and means of measuring drug and alcohol use, and of implementing good practice policies.

There’s an important role for the drug and alcohol testing industry whichever part of the debate becomes political reality, and the top organisations in the sector will be those that apply as much a scientific, evidential rigour and non-knee jerk reaction to each request for advice on testing and policy.

Generally, society does need to know who, through their substance misuse, may be a danger to themselves or others (to their children, to their colleagues or to the public for example).

In a ‘controlled drugs world’ it’s important to be able to help determine whether someone is a pusher or a user, for example. If there are laws being enforced that forbid the possession of Class A drugs such as heroin or cocaine, then materials testing is also used to support those measures. Where illegal drugs are risky and expensive to purchase, and where pushers (a combination of business entrepreneurship and criminality) encourage their use, then treatment centres and counsellors will use drug tests as part of addicts’ treatment.

That would be true too, if and when controls are relaxed.

If certain drugs are decriminalized there’s some evidence to suggest their use will increase, following the example set in countries when the prohibition on alcohol was lifted. So, for example, anti-drug-driving campaigns will need as high a profile as anti-drink driving campaigns, and both require a testing provision to support deterrence.

Many argue that testing is an integral part of health and safety education in preference to the control and enforcement sector, though it’s not always easy to separate the two (and it may be naive to try to). The overlap with law enforcement is inescapable, as a huge percentage of criminal acts such as burglaries and thefts are linked to drug addiction.

So can a ‘war on drugs’ be won by controls or by bringing drugs into the legal arena? The political discussions are so polarised progress has stagnated. But the debate about controls vs decriminalisation is too important for it to remain in the playpen – as Morris argues, it’s time to have a rational debate.

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Consultation on minimum price for alcohol “was a sham”, BMJ claims

  • Investigation comes as Government Health blog today emphasises that alcohol is the second largest cause of premature death in the UK after tobacco
  • 1 in 4 adults consuming alcohol are defined as heavy drinkers

Health experts have been angered by government ministers’ decision to scrap plans to introduce a minimum alcohol pricing, even after figures obtained by the British Medical Journal revealed the Dept. of Health had attended various meetings with industry representatives.

Minimum alcohol pricing refers to a policy whereby a minimum price is set for a unit of alcohol, and below which it cannot be sold.

Scholars such as those who conducted a series of related studies at the University of Sheffield, found evidence to support the argument that raising the price of alcohol would lead to a reduction in both crime and even deaths.

In a letter published last week in the Daily Telegraph, a group of 22 health professionals including Sir Ian Gilmore, special adviser on alcohol at the Royal College of Physicians wrote:

“Today, the public learns of the deplorable practices that were instrumental in the Government’s decision to reverse its commitment to save thousands of lives by implementing a minimum unit price for alcohol.

“We call on the Government to stop dancing to the tune of the drinks industry and prioritise public health.”

Today Public Health England published a blog on the Government’s website on alcohol-related hospital admissions that states alcohol is the second largest cause of premature death after tobacco.

Last month the Office for National Statistics released their latest available data on drinking alcohol in the UK:

  • In 2012 a quarter of adult drinkers were heavy drinkers[1]
  • Over 40% of adult drinkers in the 16-24 category were heavy drinkers
  • 58% of all adults drank alcohol in the week before the survey
  • Men formed the larger proportion of drinkers
  • 10% of women drank at least once a week during pregnancy

 

Drink driving and the legal alcohol limit

Previous research from road safety charity Brake has found that motorists remain ignorant about the dangers of driving the morning after drinking the previous night. According to their research half of young drivers and over a third of older motorists are driving in the morning not realising that they could still be over the limit.

The general rule is that alcohol is removed from the blood at the rate of about one unit per hour starting from one hour after a person stops drinking.  This is however dependent on a number of factors. Gender and weight and rate of metabolism, which will vary from person to person therefore must be taken into consideration.

In 2012 the Department of Transport (DoT) estimated that 290 people were killed in drink-drive accidents– an increase of 25% on the 2011 death toll of 230.

The legal alcohol limit for drivers in the UK is:

  • 35 microgrammes of alcohol per 100 millilitres of breath
  • 80 milligrammes of alcohol in 100 millilitres of blood
  • 107 milligrammes of alcohol per 100 millilitres of urine

So the question is, how much can the average person consume and still be able to drive? Depending on the type of drink consumed even one may put some over the limit. With the Christmas party season upon us we should all be making sure we have our local taxi number…

Should politicians in office be tested?

Toronto Mayor Rob Ford, who last week is widely reported for having admitted smoking crack cocaine, has proposed making drug and alcohol testing mandatory for Toronto city councillors. Should politicians in office be tested?

Workplace drug testing is something we know about – we support many organisations who have implemented drug and alcohol programmes at work. But should an organisation introduce a mandatory drug and alcohol programme as the Toronto Mayor is suggesting?

Organisations frequently approach us in circumstances where a drug related incident has occurred or where drug misuse is suspected – a driver was caught smoking a splif, an office worker turned up late behaving unusually, or an accident has occurred and someone has admitted to being under the influence. “Can we test them?” we get asked. “Do you have a policy which includes testing?” we ask back. Ahh….

Knee-jerk reactions are usually not the best times to implement policies, especially ones that could possibly touch on sensitive issues such as personal liberties. So a politician in a little local difficulty (with the world watching), is not the moment to quickly introduce a drug test programme almost on a whim. Such policies need to be considered carefully, discussed with all stakeholders (such as staff, human resources, management, occupational health, lawyers). That’s not to say that such an incident shouldn’t be the start of such a discussion. That can certainly help focus on the need.

But employers shouldn’t introduce drugs and alcohol testing without considering all the implications.  It’s essential for a robust workplace drug and alcohol policy to be in place first. Well considered, legally correct and properly implemented policies protect not only an employer but also their employees, and provide reassurance that the testing is being carried out fairly and legitimately. If done so, most importantly, it will stand the test of time. Something Rob Ford, Toronto Mayor, may be running out of.

Campaign group calls for alcohol workplace testing

An article has been published in the British Medical Journal which makes the recommendation that employees should be tested in the work place for signs of alcohol misuse.

Statistics show that 25% of the UK workforce drink alcohol to hazardous levels, which causes 40% of workplace accidents. It is estimated that 17 million work days are lost each year, costing Britain’s economy £7.3bn a year.

The author of the piece, Don Shenker was previously the CEO of leading national charity working on alcohol issues Alcohol Concern. He is now the director of the Alcohol Health Network, a new social enterprise, set up in 2012, which aims to support employers and employees to reduce alcohol harm by promoting alcohol awareness in the workplace.

In the article Mr Shenker recommended that employees should undergo a standardised test, such as the use of screening questionnaires to identify whether or not they are “risky” drinkers. He wrote “Offering staff confidential use of the alcohol use disorders identification test and brief advice as a self-awareness initiative at work, whether through face to face interactions or leaflets, may well help prevent problems with alcohol at an earlier stage,” He further added “In this way, staff, who may be concerned about their drinking or whose level of drinking is not yet apparent to them, can assess the risks their drinking poses to their health and take appropriate action.”

Substance misuse can be costly employers through absenteeism and reduced productivity. By having a robust clear policy it not only reduces the risk to them, but also allows them to assist those affected by substance misuse. ScreenSafe can help with all aspects of the implementing a workplace policy, from initial consultation to delivering all the required elements – including policy writing, training and education, testing and treatment services.

Rise in drink-drive fatalities in UK

The Department of Transport (DoT) estimate that 290 people were killed in drink-drive accidents in 2012 – an increase of 25% on the 2011 death toll of 230.

The legal alcohol limit for drivers in the UK is:

  • 35 microgrammes of alcohol per 100 millilitres of breath
  • 80 milligrammes of alcohol in 100 millilitres of blood
  • 107 milligrammes of alcohol per 100 millilitres of urine

Many motorists remain ignorant about the dangers of driving the morning after drinking the previous night. According to research by road safety charity Brake, half of young drivers and over a third of older motorists are driving in the morning not realising that they could still be over the limit.

Its important to be aware of the amount you take in and over what period of time. Thinking that sleeping it off can still leave you over the limit. Speaking on behalf of Drinkaware Chief Medical Adviser Dr Paul Wallace said “Imagine you’re drinking until three or four in the morning and you wake up at 8 am, if you’ve had six or seven units, you could still have several units of alcohol in your body when you start your day. This is because your body can only process around one unit an hour. With several units of alcohol still in your body you would still be over the drink drive limit.”

The general rule is that alcohol is removed from the blood at the rate of about one unit an hour however this is dependent on a number of factors. Gender and weight and rate of metabolism, which will vary from person to person must also be taken into consideration.

The silent epidemic of Hepatitis C

In the news this week was a story from Canada where experts are calling for a national strategy to diagnose and treat hepatitis C in their “baby-boomer” population. It is estimated that as many as estimated one in 33 from this age group in Canada are infected with hepatitis C.

Both Hepatitis B & C are blood-borne viruses that can infect and damage the liver and are often referred to as being a “silent epidemic” as many sufferers will not be aware they have the condition until the liver has been significantly damaged.

According to World Hepatitis Alliance the most common ways of contracting them are:

  • Blood transfusions and blood products using unscreened blood (in most developed countries blood has been screened since about 1990)
  • Medical or dental interventions without adequate sterilisation of equipment
  • Mother to infant during childbirth
  • Sharing equipment for injecting drugs
  • Sharing straws, notes etc. for snorting cocaine
  • Sharing razors, toothbrushes or other household articles
  • Tattooing and body piercing if done using unsterilised equipment

Hepatitis B is known to be more infectious than C and can also be transmitted via saliva, semen and vaginal fluid.

It is estimated that around 216,000 people in England have Hepatitis C.  Testing for it can be done quickly, easily and confidentially to provide peace of mind to those who may have been exposed. If caught at an early stage (within 6 months of infection) drug treatment has been found to have high success rates in eradicating the virus.