Shed more light in the Drug/Alcohol Testing Business
ELSSI Ltd has compiled information on a number of the most common questions, for a better understanding of the drug/alcohol testing concept.
Below there is an assortment of such questions with their respective answers, courtesy of ELSSI Drug Testing Ltd to our customers base worldwide:
Drug and Alcohol test is primarily an instrumental chemical analysis of a human biological specimen – for example urine, hair, blood, sweat, or saliva – performed to detect the presence of drugs or their metabolites. It is used in the shipping community, to conform to international safety regulations, to control Drug and Alcohol use on board ship. Its purpose is to make the ship a safer and cleaner working environment. Urine is the most common body fluid used.
Perhaps the answer will shock most of us, it is alcohol. Alcohol is indeed a very strong drug. The abuse of alcohol causes more damage vs. all the other drugs combined.
Based on a study conducted in the US showed that when airline pilots had to perform routine tasks in a simulator under three alcohol test conditions.
The following results were obtained:
1st test: before any alcohol ingestion, where 10% could not perform all tasks correctly
2nd test: after reaching a blood alcohol concentration of 0.10/100ml, where 89% could not perform all tasks correctly, and
3rd test: fourteen hours later, after all alcohol had left their systems, where 68% could not perform all tasks correctly
Note: There is no reason not to believe that the above findings also apply to the ships working environment!
To begin with, it is the most frequently used illegal drug. It is similar to alcohol and habit forming (addictive) and does negatively affect job performance, operating machinery, driving skills, etc. Long term use will cause brain damage. The negative effect on users lasts well after the «high» wears off, making the users dangerous to the ship and the sea environment. Marijuana is a very «sneaky» drug. A study using air line pilots was conducted and financed in 1985 by NIDA. Ten experienced pilots were examined in a flight simulator before and after smoking a marijuana cigarette. On the repeated test after 24 hours, the entire group showed a substantial decline of their performance: a tendency of deterioration on all variables, a substantial disturbance – reduction in their capability. However of most importance, no one in the group felt that he had reduced capability.
Let’s begin by defining the term «Substance Abuse». This appears seemingly an easy thing to do, but it is a rather difficult task, because in essence it involves several things or practices:
• The use of legal drugs
o Prescribed for medicinal purposes by a doctor and misused by others for other purposes, i.e. to satisfy their «craving». This also involves and includes over the counter medications, i.e., cough syrups, dietary pills, etc.
o The over consumption of Alcohol, in quantities that impair one’s ability and judgment. Alcohol in our society is legal and «socially accepted». For this reason people do not realize that alcohol is a drug.
• The use of illegal narcotics, prohibited by law such as, heroin cocaine, marijuana, etc.
Benzene (a.k.a. benzol), is a very dangerous chemical and exposure to it has serious health effects. It is an organic chemical compound and a known carcinogen. Its chemical formula is: C6H6. And it is a colorless and highly flammable liquid with a sweet smell.
The short term breathing of high levels of benzene can result in death, while low levels can cause drowsiness, dizziness, rapid heart rate, headaches, tremors, confusion, and unconsciousness. Eating or drinking foods containing high levels of benzene can cause vomiting, irritation of the stomach, dizziness, sleepiness, convulsions, and death.
The major effects of benzene are chronic (long-term) exposure through the blood. Benzene damages the bone marrow and can cause a decrease in red blood cells, leading to anaemia. It can also cause excessive bleeding and depress the immune system, increasing the chance of infection. Benzene causes leukemia and is associated with other blood cancers and pre-cancers of the blood.
The United States Environmental Protection Agency has set the maximum permissible level of benzene in drinking water at 0.005 milligrams per liter (0.005 mg/L). The EPA requires that spills or accidental releases into the environment of 10 pounds (4.5 kg) or more of benzene be reported to the EPA.
Drug & Alcohol testing process has the following three steps:
- Collection of the urine sample
- Analysis at the lab
- Reporting of test results
Find out more information for each one step, below:
Step 1: Collection of the urine sample
Collection is done on board ship, by trained collectors that realize the significance of obtaining a valid, un-adulterated urine sample. The required facility is a cabin with a WC and a table with two chairs. Precautions can be taken, such as putting blue dye in the toilet and turning off the water supply, to prevent adulteration or substitution of specimens so that collection can be completed in privacy without any direct visual observation by the collector.
The donor must have an id card with his photograph. The sample is collected and a special form, the Chain of Custody Form (COC) is filled, the sample is sealed, signed and sent by courier to the lab for analysis.
Step 2: Analysis at the lab
The laboratory analysis requires three stages:
- Screening based on Enzyme Multiplied Immunoassay technique (EMIT).
- Verification of the positive results from the EMIT process, by Gas Chromatography /Mass Spectrometry (GC/MS). This test is also known as the gold standard and is similar to «fingerprinting» the drug. It is accurate and reliable and gives both, quantitative and qualitative findings. The positive results are sent to an MRO for further diagnosis.
- The final diagnosis is done by a physician, a registered expert on drug abuse, Medical Review Officer (MRO). He must justify his diagnosis and if necessary he can contact the donor. A positive result from the GC/MS can be reported as negative by the MRO. Sometimes the positive results are justified, if in fact the donor is on medication .The MRO diagnosis is final.
(Note: If the donor disagrees with the result, he has a legal right to challenge it in court, using the other split sample).
ELSSI uses split sample sampling in all urine collections.
Step 3: Reporting of the test results
The drug test result, which actually is the final diagnosis of the MRO, is reported to a designated and appointed officer in the shipping company; typically this is a doctor, or the health and safety officer. Test results are strictly confidential and should be handled as such with strictly limited access, on a «need to know basis» only.
Chain of custody is a legal term that refers to the ability to guarantee the identity and integrity of the sample (or data) from collection through reporting of the test results
The COC procedure safeguards the identity and integrity of the sample. A specially designed form (COC) accompanies the urine sample and each step in the overall procedure is recorded on this form. Among other, this procedure ensures that your specimen will not get mixed up with someone else’s.
In the D/A analysis the cut-off value is a minimum measurement, a set value for each type of drug. A test result lower than this set value is reported as negative, a higher test result can be regarded as a positive indication of its presence. The cut off values for each drug using the EMIT test methods are set higher. The GC/MS method is very sensitive and can detect very minute quantities; therefore the cut-off levels for each drug are much lower. The unit of measurement used is nanograms per millilitre (ng/ml).
The setting of cut-off levels involves understanding the expected results of testing and determining the needs of the employer’s drug-free workplace program, based on his companies D/A policy. If a cut-off level is set too low, test results will come back with more «false positives» as some «passive users» (passive exposure to non-users) could test positive. Conversely, a high cut-off level will result in more «false negatives» and thus some users could go undetected. However, a high cut-off level lessens the likelihood of taking action against someone based on passive exposure. For this reason SAMHSA’s guidelines set cut-off levels on the high side.
There are a number of different body fluids that can be chemically tested to detect drug use. Urine is the most commonly used fluid for abused drugs, based on SAMHSA’s guidelines. Breath is the most common for alcohol, based on the US Department of Transportation (DOT’s) guidelines.
Results of a urine test show the presence or absence of drug metabolites in a person’s urine. Metabolites are the active chemical substances, after the drug is broken down by the liver that remain in the body for some time after the effects of a drug have worn off. It is important to note that a positive urine test does not necessarily mean a person was under the influence of drugs at the time of the test. Rather, it detects and measures the use of a particular drug within the previous few days and has become «the de–facto evidence of current use».
A breath-alcohol test is the most common test for finding out how much alcohol is currently in the blood. The person being tested blows into a breath-alcohol device, and the results are given as a number, known as the Blood Alcohol Concentration (BAC), which shows the level of alcohol in the blood at the time the test was taken.
A blood test measures the actual amount of alcohol or other drugs in the blood at the time of the test. Blood samples provide an accurate measure of the physiologically active drug present in a person at the time the blood sample is drawn. Although blood samples are a better indicator of recent consumption than urine samples, there is a lack of published data correlating blood levels for drugs and impairment with the same degree of certainty that has been established for alcohol.
In cases of serious injury or death as the result of an accident, the only way to determine legal intoxication is through a blood specimen. There is also a very short detection period, as most drugs are quickly cleared from the blood and deposited into the urine.
Analysis of hair provides a much longer «detection period» giving a more complete drug-use history going back as far as 90 days. Like urine testing, hair testing does not provide evidence of current impairment, but rather only past use of a specific drug.
- Oral fluids (Saliva):
Saliva is collected from the mouth also can be used to detect traces of drugs and alcohol. It is easy to collect (a swab of the inner cheek is the most common collection method), harder to adulterate or substitute, and may be better at detecting specific substances, including marijuana, cocaine and amphetamines/methamphetamines. Because drugs do not remain in oral fluids as long as they do in urine, this method shows promise in determining current use and impairment.
Another type of drug test consists of a skin patch that measures drugs in sweat. The patch, which looks like a large adhesive bandage, is applied to the skin and worn for some length of time. A gas-permeable membrane on the patch protects the tested area from dirt and other contaminants. Although relatively easy to administer, this method has not been widely used in the workplace.
He is a specially licensed physician trained and certified to diagnose drug test results. He reviews the positive test results to determine if it is due to the misuse /abuse of drugs. The MRO will contact the donor who tested positive and interview him to ascertain if there is another probable explanation for his positive result. Is he on medication? Does he have a prescription? If necessary the MRO will contact the donor’s physician. If his findings conclude that the positive result is due to abuse, only then will he diagnose the test result as positive.
For the past 35 years, since the 1980’s, drug testing opponents have challenged the science as lacking and have questioned the results, through debates, court trials, etc. Since then, science and technology have made tremendous advances. Today, with the use of a certified laboratory by SAMHSA and its guidelines, the use of the gold standard the GC/MS and the review of an MRO, drug testing has indeed become very accurate. As mentioned above, in this business we must not make mistakes.
In order to test the reliability and the conformance of the lab to the SAMHSA guidelines, blind samples are sent as part of the daily routine analysis. Blind samples are urine specimens for which the results are known, but not to the lab. In this way, the testing quality of the lab is determined.
It is interesting to note that between 1982 and 1990, the US Navy sent through their testing system 50,000 blind urine samples, unknown to the labs. The false positives were none.
This is a most dangerous situation; the worst thing one can do is to ignore it! Yes, he is your mate and friend, but by ignoring it, you are endangering the safety of the entire ship. You must report it. The company’s drug/alcohol policy should cover appropriately such events and lay down the course of action to be taken. To avoid bad feelings between ships personnel, a practical suggestion would be, to run an unannounced random test and to include this sick person.
Yes! Actually the adulteration of urine samples has become a very profitable business.
It is the tampering of a urine sample for the purpose of giving a false negative test result.
Urine sample adulteration has become a serious problem to the laboratories performing drug analysis.
There are many ways for a urine sample to be adulterated and become invalidated if the donor is given the opportunity:
- Individuals have placed various chemical substances under their fingernails and released them into the urine sample to affect the subsequent analysis.
- Placing a pinhole in the bottom of the urine sampling vile. This would result in a leak that would not be detected at the collection site. During shipping, most or all of the urine could leak out.
- Ordinary table salt, detergent, or other commonly available household chemicals, such as vinegar, bleach, can destroy the drugs and give a false negative result.
- Frequently, soap dispensers or cleansers in the WC offer the opportunity to add effective adulterants to the sample.
- Use of a fluid-filled bulb placed under the arm, with a tube leading to the genital area, is another method. The subject can squeeze the bulb and release water or other substance that would dilute or contaminate his/her own urine.
- The donor can obtain urine from friends not using drugs.
- The subject can scoop water from the toilet basin into the collection container and dilute the urine.
It is therefore important that specimen collection be directly witnessed if possible by the collector, who is by definition a reliable individual to prevent this sort of intentional adulteration. While direct-observation collections provide the greatest credibility to a drug deterrent program, the procedure can be embarrassing to both parties.
There are other means by which adulteration of samples can be minimized:
- The temperature of the specimen should be close to body temperature (37°C) if the sample has not been diluted with water. This can be checked by thermometer.
- Collection facilities can be set up with no soap dispensers or cleaning agents available that can be used to adulterate the sample. The water in the toilet can be dyed.
- A pH check would indicate an attempt to acidify (vinegar) or alkalize (soap, detergent) the specimen to invalidate the screening assays. The laboratory checks on the validity of the sample by performing a creatinine analysis. Creatinine is normally present in a urine sample and will be detected by the test if the sample is urine. In addition, the concentration of creatinine can be used to determine if the sample has been diluted (by adulteration or by drinking excessive quantities of liquid).
Other means of influencing the outcome of a urine analysis that are more difficult to detect involve the drinking of large quantities of water before providing a sample, which will dilute the urine produced. Drinking large volumes of water or other liquid several hours prior to the urine collection could easily result in a tenfold dilution of urine. This dilution would lower the concentration of drug sufficiently so that it could not be detected by the laboratory analysis.
There is a belief that drinking vinegar can produce negative urine results. While it is theoretically possible that sufficient vinegar ingestion could alter urinary pH, it is unlikely that such a quantity could be drunk without toxic consequences. Even if pH were altered slightly, the effects on different drugs would be variable -the excretion rate of some might be increased slightly and for others it might be decreased.
Typically a company’s policy should allow for a multitude of situations where Drug & Alcohol Testing should be exercised. Such as:
Pre-employment drug/alcohol testing has become an important segment in many shipping companies hiring policy because it prevents seafarers who abuse drugs from joining the company. Its role is that of prevention, playing an important role to ensure a safe and clean ship working environment.
Prevention, is taking action before health or safety problems relating to alcohol or drug use develop. It helps in making effective hiring decisions.
For pre-employment drug testing, every attempt should be made to provide only several hours’ notification before the donor must report for the test.
Although in the shipping business this would be difficult to arrange, ideally prospective employees can be given a 2-3 days «time window» during which they will report for the test. Then, notification can be given several hours in advance of the test. If they know a collection, or a test is forthcoming, they can take steps to adulterate the results.
It is highly recommended for shipping.
It is the most effective type of testing because it is un-predicable and very frequently used in shipping. It is also the most objected to type of testing in all businesses by certain employees, those that have something to hide. Un-announced testing is a process whereby urine samples are collected in a manner that the employees cannot predict when the collection will be requested. The frequency of testing is determined by the company’s policy and its emphasis on safety. Sensitive working environments -such as in shipping- requires more frequent testing. A normal practice is to test the entire crew and the officers.
Another form of un-announced collection is the «random testing». It is a game of chance like a lottery ticket. As an example, instead of testing the entire crew, test half the crew, etc. Random testing is important to increase the overall «sensitivity» of a drug detection program. It is possible for individuals to tailor their drug use to conform to the pattern of urine collection used. If they know a collection is forthcoming, they can discontinue use of the drug, long enough prior to the urine analysis so the drug use will not be detected.
After an accident (Post-Accident):
This has now become a regulatory requirement, by the US Coast Guard, (SMI) Serious Marine Incident. Since property damage, pollution, personal injury or even death can result from accidents, testing following an incident /accident can help determine whether drugs and/or alcohol were a factor.
The Coast Guard’s Chemical Testing Requirements following a Serious Marine Incident (SMI) are the following:
- Alcohol testing is required within 2 hours of a SMI.
- Collection of samples for drug testing is required not later than 32 hours.
A solution is to equip ships with DOT approved saliva tests and sampling kits.
Reasonable suspicion testing, or sometimes referred to as «due cause» testing, is conducted when there are observable signs and symptoms to suspect drug use or a drug policy violation.
It is important to have clear, consistent definitions of what behaviour justifies drug and alcohol testing and any suspicion should be corroborated, by an officer and/or the captain. Additionally, it is advised that employees who are suspected of drug use or a policy violation, be removed from duty work while awaiting the test results. This should be part of the company’s Drug & Alcohol policy.
Periodic testing is usually scheduled in advance and combined with check-ups and uniformly administered to all the employees. Some employers use it on an annual basis, especially if physicals are required for the job. Such tests generally are more accepted by employees than unannounced tests, but employees can prepare themselves by stopping their drug use several days beforehand.
Return-to-duty testing involves a one-time, announced test when an employee who has tested positive has completed the required treatment for substance abuse and is ready to return to the workplace. Some shipping employers also use this type of testing for any employee who has been absent for an extended period of time.
Note: ELSSI uses split sample testing for all its shipping collections.
This is a form of testing required by all Department Of Transportation testing sites. The Department of Transportation (or DOT) regulations for drug testing are also often used by employers to determine if their employees are drug free when conducting their work. This is because these regulations are fair both to the employer and the employee facing testing.
Split specimen urine drug testing is only slightly different from regular testing. In this process, the urine sample is split into two vials and sent to the SAMHSA certified lab for urine testing. One of these vials is tested upon arrival at the lab and the other is stored frozen for litigation purposes. If the first vial is tested as positive, for any reason the person who submitted the sample can request that the other vial be tested. If this happens the 2nd vial is sent to a Medical Review Office.