Work Place Drug Test

1. Work Place Drug Test Drug-testing in the work place Giovanni Serpelloni Elisabetta Simeoni Department of Anti Drug Policies Presidency of the Council of Ministers

2. Work place drugs test and general anti-drug strategies

4. PET

6. THC e Working Memory Alteration and impairment of procedural memory ( memorize operational sequences, automatisms and contemporaneity) Alteration of  coordination Alteration of stability

7. Volontario sano Consumo di marijuana N = 6 4,22 mm ADDICTION NEUROSCIENCE Verona Group 2010 Emisfero sinistro laterale 0,57 mm Emisfero sinistro mesiale 0,52 mm • Riduzione dello spessore corticale nelle aree temporo-mesiali e nella corteccia cingolata anteriore (in blu) • Associazione con deficit neuropsicologici (attenzione e memoria)

8. Effects of Marijuana - SPECT In our experience, the effects of marijuana use typically cause decreased activity in the posterior temporal lobes bilaterally. The damage can be mild or severe, depending on how long a person used, how much use occurred, what other substances were used (nicotine is a powerful vasoconstrictor) and how vulnerable a particular brain is. For more information see Dr. Amen's article High Resolution Brain SPECT Imaging in Marijuana Smokers with AD/HD, Journal of Psychoactive Drugs, Volume 30, No. 2 April-June 1998. Pgs 1-13. 18 y/o - 3 year history of 4 x week useunderside surface viewdecreased pfc and temporal lobe activity 16 y/o -- 2 year history of daily abuseunderside surface viewprefrontal and temporal lobe activity 38 y/o -- 12 years of daily useunderside surface viewdecreased pfc and temporal lobe activity 28 y/o -- 10 years of mostly weekend useunderside surface viewdecreased pfc and temporal lobe activity

9. Alterazione funzionale del cervello nell’alcolismo Alcoholic Darker Colouring indicates depressed brain activity Normal Healthy levels of brain activity

10. Strategie e politiche antidroga

11. The 4 elementsof the National DrugActionPlan

12. Italy National Drug Action Plan5 intervention areas 2009-12 1 2 3 4 5 Prevention information early warning universal and selective early detection and educational approach Treatment Early contact Acceptance Diagnosis and appropriate therapies and prevention of related pathologies Rehabilitation and Reintegration social and employment • Monitoring of • phenomenon • and Assessment • of results • (criterion of • financability) Combatting and reducing supply of illegal drugs: On territory On Internet

13. An Italian “matrix” on European indications INTERNVETION AREAS 1 Priority actions Prevention • Earlier and more explicit information on the damage caused by drugs and alcohol abuse • Universal prevention through permanent media communication • Selective prevention for high-risk groups in places of entertainment • Early detection of young consumers to reduce lag time before start of treatment • Drug tests on workers with at-risk duties • Specific interventions to prevent drug and alcohol-related traffic accidents (information, education, on site drug and alcohol tests) • Educative approach in schools with support available for families

14. Work place Early detection of young drug use Drug test policy(SIANN 2009) DRUGS TEST Certification for beginner driving On site Drivers test NO TEST Drug test In the school “Self-applied” Drug test

15. Legislative sources Pres. Decree 309/1990 State/Regions MoU State/Regions Agreement Leg. Decree 81/2008 Art. 125 (Checks for drug addiction) Order no. 99/CU of 30 October 2007 Rep. Acts no. 178 of 18 September 2008 Art. 41, para. 4 and 4 bis (as modified by article 26, para. 5, of Leg. Decree no. 106 of 3 August 2009)

16. Pres. Decree no. 309/90 Article 124 Drug-addicted workers Workers who are confirmed to be drug addicts, who intend to start therapy and rehabilitation programs at the healthcare services of local health services or other therapeutic-rehabilitation and socio-assistance structures, if employed on a permanent basis have the right to keep their work position for the time in which the suspension of their work is due to undertaking rehabilitation and, in any case, for no more than three years. Collective labour contracts and work agreements for the public sector may establish specific means for exercising the right in para. 1. Without prejudice to any more favourable contractual arrangement, long-term absence for therapy-rehabilitation is considered, for regulatory, economic and social security purposes, as unpaid leave of State employees and similar. Workers who are relatives of a drug addict may, in their turn, be put on unpaid leave, on request, to contribute to the therapy and rehabilitation program of the drug addict should the drug addiction service declare such a need. For the substitution of the workers as set out in para. 1, it is allowed to recruit on a fixed-term basis, pursuant to article 1, para. 2, letter b), of Law no. 230 of 18 April 1962. As part of public employment fixed-term contracts cannot last more than one year. There is no prejudice to the provisions in force which require the possession of particular psychophysical and attitudinal requisites for access to employment, as well as those for staff of the armed forces and police, those who act as security personnel and those to which the limits envisaged by article 2 of Law no. 874 of 13 December 1986 apply, and which regulate suspension and removal from service.

17. Pres. Decree no. 309/90 Article 125 Checks for drug addiction Those belonging to categories of workers destined to duties which entail risks for the safety, security and health of third parties, as identified with the Decree of the Ministry of Labour and Social Security, together with the Minister of Health, are subject to care in public structures under the national health service and, at the cost of the employer, to a check on the absence of drug addiction before being recruited and, subsequently, to periodic checks. The Decree as set out in para. 1 also establishes the frequency and means of carrying out such tests. In the case of ascertaining a state of drug addiction during the employment relationship, the employer is required to remove the worker from carrying out the duty which entails risks for the safety, security and health of third parties. In the case of failure to observe the provisions as set out in paras 1 and 3, the employer is punished with arrest from two to four months or with a fine from ten to fifty million lire.

18. Unified Conference Agreement30 October 2007 Procedures for healthcare checks on absence of drug addiction or taking of drugs on workers with duties which entail particular risks for the security, safety, and health of third parties in application of provision no. 99/cu of 30 October 2007

19. PERMANENT CONFERENCE FOR RELATIONS BETWEEN THE STATE, REGIONS AND AUTONOMOUS PROVINCES OF TRENTO AND BOLZANOPROVISION of 18 September 2008Agreement between the Government, Regions, and the autonomous Provinces of Trento and Bolzano Procedures for healthcare checks on absence of use of drugs on workers with duties which entail particular risks for the security, safety, and health of third parties

21. Technical-scientific group Italian Railways (FRI.) – State Railway Group – Healthcare Division Contracting body National Association of Company Doctors (ANMA) Italian society of Work Medicine and Industrial Hygiene (SIMLII) Transport Association (ASSTRA) Institutional Group Ministry of Infrastructure and Transport – Legislative Office Presidency of the Council of Ministers –Secretarial Office – State Regions Conference - Service for healthcare and social policies Minister of Labour and Social Policies – Legislative Office Ministry of Defence- Legislative Office – Head of human rights section Ministry of Health – Healthcare Prevention Directorate Ministry of the Interior – Police Department - Healthcare Directorate – Central healthcare operating centre – Research Centre for forensic laboratory work and toxicology Ombudsman for the protection of personal data Ministry of the Interior – Healthcare Office Fire Brigade, for public assistance and civil defence Enav Spa

22. PROBLEMS TO BE ADDRESSED • Lack of centralised and standardised data to allow analysis of the outcome of investigations that quantify the use of drugs by workers with at-risk duties; • Need to have available constantly updated information in order to support any actions to combat the phenomenon and to regulate the sector; • Need to finalise a standard form for the transmission of clinical and toxicological data (case history, objective examination, toxicological history, laboratory examination, diagnostic therapies) from the drug addiction services to competent doctors; • Verify the case for introducing forms of randomisation to check the absence of drug addiction and the taking of drugs; • Reassess the model by which this check must happen at least annually as envisaged by the specific procedures, with periodic and timely updating in reference to new recruits and to subjects who have accepted at-risk duties.

23. GENERAL OBJECTIVE Establishment of a network among operative units that exist to develop systems for monitoring and standardised assessment of tests carried out at companies in order to record the use of drugs in workers with duties which entail particular risks for the security, safety and health of third parties Creation of a constant and periodically updated flow of data regarding cases relating to toxicological and analytical checks (level I) and diagnostic and verification checks (level II)

24. SPECIFIC SUB-OBJECTIVES Establishment by the DPA of a permanent technical-scientific group to assess the impact of the Drug Test program for workers with at-risk duties Realise, in collaboration with the support of the DPA Observatory, a permanent data flow which is centralised at the DPA of the exams carried out (levels I and II) and the outcomes of these tests (aggregate data) through a specific website; Realise periodic reports on the trend in the tests; Analyse and propose additions and changes to the relevant institutional acts; Set up proposals for technical-scientific guidelines, specific training and study and research; Promote international activities and cooperation for the purposes of scientific and operative discussion.

25. A basic principle • Not only drug addiction but also the occasional use of drugs must be considered incompatible with undertaking at-risk duties • For prevention purposes, Use-Abuse-Addiction are to be considered as at-risk conduct and conditions which are incompatible with undertaking at-risk duties or driving

26. Areas of application for healthcare checks Pre-engagement check for at-risk duty; Periodic check, normally annually; Reasonable doubt check, i.e. when there are sufficient indications or evidence of possible taking of illegal substances; Post-accident check; Follow-up check (precautionary monitoring) at least monthly for 6 months; Return to work check for at-risk duties, after a period of suspension due to a previous positive result for drug-taking.

27. Procedures for checks • First-level checking procedures by the competent doctor: • Clinical checks by means of a medical visit • Screening tests (biological matrix: urine) • Confirmation test • Second-level diagnostic – checking procedures done by competent healthcare structures: • Clinical checks through medical check-ups • Toxicological-analytical checks (biological matrix: urine and hair)

28. General procedure for checking workers with at-risk duties Legitimate impediment means suitability recovery exemption

29. Case studies The use of drugs in Italy in workers with at-risk duties

30. Categories of people tested • Railway staff • City and regional bus staff • Air transport staff • Air traffic controllers • Goods movement staff • Military personnel

31. First-level checks2010 86,987 people examined +60.7% compared to 2009 (54,138 people)

34. First-level checks2010 People examined by gender

35. First-level checks2010 People examined by drug 551positives with confirmation test (0.63% of those tested) - 11.7% compared to 2009 (624 people)

36. First-level checks2009 - 2010 People examined by type of substance

37. Second-level checks2010 122 occasional drug-users -59.2% compared to 2009 23 drug addicts -66.7% compared to 2009

38. Second-level checks2010 People examined by type of substance

39. Armed forces2006 - 2010 + 34.5% (*) on average a person undergoes 4 to 7 tests

40. Forze ArmateAnni 2006 - 2010 + 17.9% - 56.7% (*) on average a person undergoes 4 to 7 tests

41. Carabinieri2006 - 2010 - 66.7% + 27% (*) on average a person undergoes 4 to 7 tests

43. Conclusions

44. Three commitments for the future The application of the protocol will be subject to monitoring and checking for effectiveness, efficiency and financial sustainability The classes of workers undergoing checks must be redefined with a realignment to those envisaged for alcohol Redefinition of competent second level structures, introducing, besides drug addiction treatment services, also other structures which undertake such work for air and rail traffic controllers.

45. Thankyouforyourattention 46