Drug and Alcohol Policies at work

1. Drug and Alcohol Policies at work Dr Sally Pugh Williams MB BCh FRCP AFOM Occupational Physician

2. What is substance misuse? • Substance misuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. • Psychoactive substance use can lead to dependence syndrome = a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences • increased tolerance to a drug(s) • physical withdrawal state.

3. Managing substance misuse? • Policies which influence the levels and patterns of substance use and related harm can significantly reduce the public health problems attributable to substance use • interventions at the health care system level can work towards the restoration of health in affected individuals

6. WHY? UK Government information: • Between 2011 and 2012, an estimated 8.9% of adults used an illegal drug. • For young people aged between 16 and 24, the figure was 19.3%. • Crimes related to drugs cost the UK £13.3 billion every year.

7. Welsh data The health service cost in Wales of problem drug use has been estimated at £17.6 million per year There are estimated to be just under 20,000 problematic drug users in Wales The 2014 Welsh Health Survey (WHS) headline results show that 40% of adults reported drinking above the recommended guidelines on at least one day in the past week, including 24% who reported drinking more than twice the daily guidelines. WEDINOS – Welsh Emerging Drugs and identification of Novel Substances

9. The Chief Medical Officers (CMOs) guideline for both men and women states that: keep your intake to or reducing your intake to 14 units/week if you regularly drink as much as 14 units per week, it's best to spread your drinking evenly over three or more days. if you have one or two heavy drinking episodes a week, you increase your risk of death from long-term illness and injuries know that the risk of developing a range of health problems (including cancers of the mouth, throat and breast) increases the more you drink on a regular basis

10. “Safe” alcohol levels • Men and women 14 units a week , split over the week • 14 units=6 pints 4% beer • 14 Units =6 (175ml) glasses 13% wine • 14 Units= 14 ( 25ml)glasses of spirits 40% • Binge drinking = consuming • more than 8 units of alcohol in a single session for men, and more than 6 units for women • 8 units is just over three pints of 4% strength beer. • 6 units is just over two large glasses (175ml) of 13% strength wine.

11. Welsh data alcohol and drug overdose admissions

12. Note worthy information A significant minority of people who drink to excess do not consider that they have a significant drink problem that puts themselves and others at risk. Nearly 40 per cent of adults in Wales admit to consuming more than the recommended limits and 20 per cent admit to binge drinking. The comparison of alcohol sales with the reported alcohol use also suggests that people are consuming more alcohol than they think they are

14. Misuse of drugs Misuse of drugs, both legal and illegal, and other mind-altering substances, such as solvents, can damage health in a variety of ways: • Fatal overdoses • Addiction • Mental health problems • Infections caused by injecting • The toxic effects of the many substances that dealers mix (cut) with the active substance • The misuse of prescription only (POM)and over the counter medicines (OTC) causes serious health problems

15. Substance misusers : • Harm their own physical and mental health and well being • Inability to economically support themselves contribute to society. • As a secondary effect, they harm their families’ • Harm their childrens health • The long term effects on • Relationships suffer • Families suffer • and in some areas drug dealers and alcohol fueled anti-social behavior still take hold, causing misery for the surrounding community

16. Welsh Assembly approaches.. .. to implement a number of measures to reduce the harm caused by substance misuse including measures concerning- • alcohol • illegal drugs such as heroin, cocaine, ecstasy, amphetamines, LSD and cannabis • prescription only medicines (POM) such as anabolic steroids and benzodiazepines • over the counter medicines (OTC) such as preparations containing codeine • volatile substances such as aerosol propellants, butane, solvents and glues.

17. And finally… • 30,000 bed days were related to the consequence of alcohol consumption. • In 2006-07 there were 1600 hospital admissions in Wales with a primary diagnosis of alcoholic liver disease. • In addition, • The estimated health service cost in Wales of alcohol related chronic disease and alcohol related acute incidents is between £70 million and £85 million each year

19. Legal matters

20. The Misuse of Drugs Act 1971( amended 2001 and updates since then) The Act makes it illegal for people to: • possess illegal drugs • possess illegal drugs with intent to supply • supply or offer to supply illegal drugs (including giving them away for free or sharing with others) • produce illegal drugs • import or export illegal drugs • allow a house, flat or office to be used by people to undertake any of these unlawful activities

22. DVLA rules • https://www.gov.uk/drug-driving-law • Drug driving • Drunk driving

23. DVLA rules It’s illegal to drive if either: • you’re unfit to do so because you’re on legal or illegal drugs • you have certain levels of illegal drugs in your blood (even if they haven’t affected your driving) • Legal drugs are prescription or over-the-counter medicines. If you’re taking them and not sure if you should drive, talk to your doctor, pharmacist or healthcare professional. • The police can stop you and make you do a ‘field impairment assessment’ if they think you’re on drugs. This is a series of tests, eg asking you to walk in a straight line. They can also use a roadside drug kit to screen for cannabis and cocaine.

24. What makes a good policy

25. Substance misuse polices • Company philosophy • Corporate brand • What do you know about your communities? • Interlink with H&S policy and management systems and HR policies and practices • Employee engagement • Human rights issues • Testing and treatment or rehab can be “grey areas”

26. Substance misuse polices • Do you know what you are taking on? • Who owns the policy? • Who manages the policy? • A “helping hand” or a disciplinary approach • A health and well-being approach or a managerial matter- boundaries? • Costs v benefits

27. Content of a policy • Ethos • Why • How does it fit in • Who does it apply to • How does it work • Disciplinary or hand out • Zero tolerance? • Case management including Rehab • Data collection and the Review process

28. How matters come to light • Legal issues, e.g.driving licence penalties,employees on probation for offences • Absence issues • Accidents and incidents • Contraband • Whistle blower • “Hand-up”-self declaration

29. How do I look for substance misuse problems? Employee behaviours Drugs and alcohol may • cause mood changes • hallucinations • drowsiness • changes in alertness, perception in time and space Effects: Lateness Short term unpredictable absences from work Falling asleep on the job Incidents and accidents( not due to machinery problems) Relationship issues at work and or home Crime- driving bans, drug dealing

31. What to test for?

32. England, Wales and Northern Ireland Scotland 35ug/100ml breath 22 80mg/10ml blood 50 107mg/100ml urine 67 Alcohol testing There are strict alcohol limits for drivers, but it’s impossible to say exactly how many drinks this equals - it’s different for each person. The limits in Scotland are different to the rest of the UK.

33. Drug testing • What to test for? • Which medium to test- breath, blood, urine, saliva, hair? • When to test Pre-placement Random Post incident/”due cause” Other

34. Drug Screen-usual substances • Cannabis • Cocaine • Ketamine • Amphetamines • Barbiturates • Benzodiazepines • Methamphetamines( crystal met) • Opiates: morphine, codeine, dihydrocodeine, heroin • Methadone( withdrawal from heroin and painkiller) • Buprenorphine( similar to methadone) Key factors in drug detection: • Detection times • Rate of degradation • Drug interactions • Other factors • Other tests needed for e.g. other drugs -anabolic steroids

35. Pitfalls • Misuse of a substance causing the problem? • Drug metabolism problems • Chronic use v acute intoxication • Cheating on the test • False results • Is the test positive because of legitimate use of prescription drugs • Is there an underlying medical condition causing problems rather than a prescription drug? • Did the employee deliberately stop the drug before the test?

36. Is someone under the influence? • https://www.bing.com/videos/search?q=plice+fiut+to+drive+test&view=detail&mid=6670EF00AE0E302CE22D6670EF00AE0E302CE22D&FORM=VIRE

37. Summary • Substance misuse policies are not for the faint-hearted! • There is a Community issue. • Age is not a barrier or protection against misuse • Access to education and rehabilitation help is very advisable BEFORE you begin! • Some good success stories; some problems. • A policy and plan should fit with risk and ethos of the your business

38. Help?? ‘Healthy Working Wales’ (HWW), which includes the Corporate Health Standard (CHS) and Small Workplace Health Award, with the aim to provide free support and advice to employers in developing health and well-being policies and practices in the workplace (including alcohol and substance misuse). • 31% of the working population of Wales work for an employer engaged in HWW. To-date, 78 employers have achieved the Corporate Health Standard • 185 smallerbusinesses/organisations have achieved the Small Workplace Health Award. • A further 307 employers are engaged and working towards recognition through the quality frameworks. • The criteria of the CHS have been refreshed to reflect the latest developments in policies and practices. This includes the alcohol,drugs and other substance use module which is supported by Drug and Alcohol Charities Wales (DACW) and Alcohol Concern Cymru.

39. In terms of costs to the health service and the criminal justice system, where sustained behavioural improvements after treatment are maintained for two years, the evidence of the cost effectiveness of investing in treatment services is strong - £1 invested in drug treatment services can save £9.50 and in alcohol treatment services can save £5. DAN- Wales drug and alcohol service http://www.dan247.org.uk/Default.asp