This is Part 3 of the blog series, Drug-Free Workplace - A Human Resources Guide. If you want to read the full guide, use the nav below to start from the beginning. 

• Drug-Free Workplace - A Human Resources Guide (intro, start here)
• Overview Of Key Regulations
• Five Steps To Creating A Successful Program (you are here)

This post is a little lengthy so, use the bookmarks below to jump to a specific section:

• What to include in your drug and alcohol policy
• Drug and alcohol supervisor training
• Drug and alcohol employee training, aka employee awareness training
• Employee Assistance Programs and how they add value to your drug-free workplace
• Drug and Alcohol Testing: How it's done, when to do it, and your options for administration.   

1. Draft a Drug and Alcohol Policy

A drug and alcohol policy forms the foundation for a drug and alcohol program. A policy is not the same as a drug and alcohol program rather, it is one of the five components. As you're drafting your drug and alcohol policy, be sure to involve everyone. You should have input from your executives as well as employee advocates for fairness. 

13 sections your policy should address:

1. What is the purpose and goal of your policy?
2. Who does your policy cover?
3. When will your policy apply?
4. What behavior will be prohibited?
5. Will employees notify you of drug-related convictions?
6. Will your policy include searches?
7. Will your program include drug testing?
8. What are the consequences of a policy violation?
9. Will there be Return-to-Work Agreements?
10. What type of addiction treatment will be available to employees?
11. How is employee confidentiality protected?
12. Who will be responsible for enforcing your policy?
13. How is your policy communicated to employees?

We recommend that you have your final draft reviewed. Hire a legal consultant such as a labor or employment attorney. Do this before distribution and implementation. 

2. Train Your Supervisors

Next, your business should train those individuals closest to the workforce: supervisors. Training supervisors is an integral part of every drug and alcohol program. Provide supervisors with basic information about your drug and alcohol program. Make sure they understand their role in its implementation.

At least, supervisor training should include a review of:

• Your drug and alcohol policy;
• The supervisor's specific responsibilities in implementing the policy; and
• Ways to recognize employees who have job performance problems.
• Ways to deal with employee problems related to alcohol and other drugs.

3. Train Your Employees

Employee training and education is often overlooked by most businesses. This is also known as employee awareness training. You should include this in your implementation process. After implementation, include it in the onboarding process. Without employee awareness training, you aren't completely deterring drug or alcohol abuse. At least, promoting your drug and alcohol program is a deterrent in itself. 

Employee awareness training should: 

• Describe the impact that alcohol abuse and drug use has on the workplace.  
• Give factual information about addiction and the major drugs of abuse. 

4. Start An Employee Assistance Program (EAP)

Employee assistance is also an overlooked component by most businesses. An EAP can be a valuable resource for both employees and managers and can play an important role in your drug-free workplace program. 

What is an Employee Assistance Program?

An EAP is a worksite-focused program. It's designed to assist in the identification and resolution of productivity problems. The problems that associate with personal problems, such as alcohol or drug abuse. EAP services mirror the components of a drug-free workplace program. Putting an EAP in place can go a long way towards building your drug-free workplace. 

The EAP supports three important ideas in a drug-free workplace:

• Employees are a vital part of a business and valuable members of the team.
• It is better to offer assistance to employees than to fire them.
• Recovering employees can, once again, become productive and effective members of the workforce.

An EAP offers other valuable services to your business. These go beyond those of a drug-free workplace program. An EAP can complement and support your drug-free workplace program in a unique way. It encourages employees to seek help with emotional issues and day-to-day problems. Employee assistance professionals are in a better position to identify employees. They can identify problems with drugs or alcohol before there are problems at work. 

Furthermore, an EAP gives supervisors tools for dealing with troubled employees. Supervisors can remain focused on employees' work performance, rather than on employees' personal lives. 

What are the goals of an EAP?

Employers put in place EAPs to do a variety of goals:

• Identify employee personal problems at an early stage before there is a serious impact on the job
• Motivate employees to seek help through easy access to assessment and referral
• Direct employees to the best source of help and high-quality providers
• Limit health insurance costs through early intervention
• Reduce workers' compensation claims by encouraging easy access to treatment programs
• Decrease employee turnover
• Offer an alternative to firing valuable employees
• Provide employees with support and prove that a company is a caring employer

What are the essential components of an EAP?

An EAP should include these essential components:

• A policy statement that defines how employees access the EAP. The statement should also explain the services provided and how to protect confidentiality.
• Consultation and training services for supervisors and managers. How to manage and refer troubled employees to the EAP.
• Promotional activities to ensure the EAP is visible and accessible to employees.
• Educational programs for employees on relevant issues such as alcohol and drug addiction.
• Problem identification and referral services. Provide these to individual employees (and often to family members).
• An up-to-date list of qualified providers of treatment or help. This will enable prompt referral of employees to appropriate resources.

Some EAPs also offer short-term counseling by licensed professionals.

How does an EAP work?

Employees can access the EAP voluntarily or supervisors can refer them. Supervisors can refer the EAP in cases of job-performance problems. When an employee uses EAP services voluntarily, supervisor involvement isn't necessary. However, when a supervisor refers an employee, combine the offer with progressive discipline. The supervisor will need to continue to track the employee's performance. 

More than 10,000 EAPs are in operation under various types of service arrangements. Labor unions, management or labor-management cooperation may provide EAPs. Likewise, union or employers may pay for the services. Other options are to fund through negotiations or joint labor-management health funds.

To learn more about choosing an EAP vendor, contact the Employee Assistance Professionals Association or the Employee Assistance Society of North America.

5. Drug and Alcohol Test Your Employees

Drug testing is one action you can take to determine if employees or job applicants are using drugs. It can identify evidence of recent use of alcohol, prescription drugs, and illicit drugs.    

How is drug testing conducted and how accurate is it?

Generally, private sector employers have a fair amount of latitude in implementing drug testing. Private sector employers are not required to follow federal guidelines. Although, we recommend doing so to help you stay on the safe legal ground. Court decisions have supported following the Federal guidelines. As a result, many employers choose to follow them.  

The most common method of drug testing is urinalysis. A drug test can take place at the workplace, a clinic, or any other site selected by the employer.

Under the Federal guidelines, an employee provides a sample. Then, they send the sample to a certified laboratory. The accuracy of drug tests done by certified laboratories is high. This certification applies only to the five substances tested in the Federal drug testing programs. These five drugs or classes of drugs are marijuana, cocaine, amphetamines, opioids, and phencyclidine (PCP).

Below are certain procedures required by the DOT's guidelines. These procedures ensure the accuracy and validity of the testing process:

• Custody and Control Form: A custody and control form documents the handling and storage of a sample. "CCF" for short. It's documented from the collected time until the time of disposal.  It links an individual to his or her sample. It's a written proof of what happens to the specimen. This includes at the collection site and the laboratory.
• Initial Screen: The first analysis done on a sample is an initial screen.  This one test alone is not always accurate or reliable; there is a possibility of a false positive.  When the initial screen is positive, they perform a second confirmatory test.
• Confirmation Test:  A second, confirmation test (GC/MS) is accurate. It provides specificity to help rule out any false positives from the initial screen. GC/MS stands for Gas Chromatography/Mass Spectrometry. For a positive result, the initial screen and confirmation test results must agree. 
• Split Sample:  A split sample is when an initial urine sample is split into two bottles. The collector separates the urine sample during the collection process. These are "bottle A" and "bottle B". If there is a positive result from bottle A, the individual tested may request a second confirmation test using bottle B. The second confirmation test is done at a different laboratory. DOT's alcohol and drug testing regulations need all tests performed using a split sample collection.

When the initial screen and confirmation test are both positive, the MRO reviews the results. MRO stands for Medical Review Officer. They are a licensed medical doctor who has special training in the area of substance abuse. The MRO also makes sure the custody and control form procedures are followed. Next, the MRO contacts the individual to make sure there are no medical or other reasons for the result. It is only at this point that the MRO may report a positive test result to the employer.  Certain medications can sometimes cause a positive result. A doctor may have prescribed the medicine and the employee used it in the proper amount. In this case, the test is a negative report.

Good to know>> Never take action against an employee until the MRO has reviewed the positive drug test results. 

When are employees drug tested?

There are a variety of circumstances under which an organization may need a drug test. The following are the most common:

Pre-Employment 

To prevent hiring employees who use illegal drugs, have them take a pre-employment test. A pre-employment test takes place after a conditional offer of employment is made.  Applicants agree to test as a condition of employment. If they fail to produce a negative test, they are not hired. It's possible for employees to prepare for a pre-employment test. They do this by stopping their drug use several days before they expect to be tested. Some employers test probationary employees on an unannounced basis but, some states restrict this process.  

Reasonable Suspicion

Reasonable suspicion testing is sometimes referred to as "probable cause". Others call it or "for cause" testing. It's conducted when supervisors document observable signs and symptoms of drug use. Also, if a supervisor witnesses a drug-free workplace policy violation.  It's important to have clear definitions of what behavior justifies drug or alcohol testing. It's a best practice for two supervisors or managers to help decide when to test. Since management decides, it requires comprehensive supervisor training. 

Post-Accident 

Property damage or personal injury may result from accidents. Testing following an accident can help determine whether drugs or alcohol were a factor. It's important to establish criteria that will trigger a post-accident test. Determine how to document the criteria. Determine who will make a determination and document. Some criteria are fatalities, injuries that cause medical care, and damage to vehicles. Also, property above a specified monetary amount and citations issued by the police. The results of a post-accident test determine drug use. Although, a positive test result in and of itself can not prove that drug use caused an accident.

Employers also need to have guidelines. They should specify how soon following an accident testing must occur. This will make sure results are relevant. Substances remain in a person's system for various amounts of time. It's usually recommended to do post-accident testing within 8 hours. Some employers expand the test trigger to incidents or a near miss. Refer to these as "post-incident."

Random  

Random testing is unannounced and unpredictable. Place employee identifying information in a testing pool. ID information could include social security numbers or employee numbers. Then, make a scientifically arbitrary selection. Because random testing is unpredictable, it's the best deterrent against drug use! The selection is computer generated. This ensures that it's a true random. In other words, each person of the workforce population has an equal chance of selection. It doesn't matter if that person was recently tested or not.  

Periodic   

Periodic testing is usually scheduled in advance and uniformly administered.  Some employers use it on an annual basis, especially when requiring physicals. Such tests generally are more accepted by employees than unannounced tests but, employees can prepare for them by stopping their drug use several days beforehand.

Return-to-Duty 

Return-to-duty testing involves a one-time, announced test. It takes place after an employee tested positive and then received substance abuse treatment. Some employers use this type of testing for any employee who has been absent for an extended period of time.

Follow-up 

Conduct follow-up testing or post-rehabilitation testing periodically. This takes place after an employee returns to the workplace upon completing rehabilitation. Administer testing on an unannounced, unpredictable basis. The period is usually specified by the SAP. SAP is short for Substance Abuse Professional.  

Other types of tests are also used by some employers. For example, blanket testing is like random testing. It's unannounced and not based on individual suspicion but, everyone at a worksite tests rather than a randomly selected percentage. Other types of testing include voluntary, probationary, pre-promotion and return-after-illness testing.

What are the different sample types used for drug testing?

There are many different sample types laboratories can test to detect recent drug use. Although, some state laws dictate which ones are acceptable. Many options are technologically feasible. Urine is the most used sample type for illicit drugs reflecting DOT's guidelines. Breath is the most common for alcohol also reflecting DOT's guidelines.

Urine

Results of a urine test show the presence or absence of drug metabolites in a person's urine.  Metabolites are drug residues that remain in the body for some time after the effects of a drug have worn off. A positive urine drug test does not 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. It has become the de facto evidence of current drug use.

Alcohol passes rapidly through the system. Because of this, conduct urine tests quickly after alcohol consumption. This is to ensure any degree of accuracy.  For this reason, urine tests are generally not helpful in detecting alcohol. Illicit and prescription drug use is more easily traced in urine.   

Breath 

A breath-alcohol test is the most common test for finding out how much alcohol is currently in the blood.  The person blows into a breath-alcohol device and the results are quantitative. Breath alcohol results quantify the Breath Alcohol Concentration (BrAC). It shows the concentration of alcohol in the breath at the time of taking the test. BrAC levels correlate with impairment, and the legal limit of 0.08 for driving has been set in all states. Under DOT regulations, a BrAC of 0.02 is high enough to stop someone from performing a job. They can be stood down for a specific amount of time (usually between 8 and 24 hours). A BrAC reading of 0.04 or higher is a positive alcohol test under DOT regulations. A positive test requires immediate removal from safety-sensitive functions. Under DOT regulations, a person who tests at the 0.04 BrAC level may not resume job duties. In order for them to perform safety-sensitive duties, they must complete the return-to-duty process.

Under the DOT regulations, a BrAC of 0.02 is high enough to stop someone from performing a job. They can be stood down for a specific amount of time (usually between 8 and 24 hours). A BrAC reading of 0.04 or higher is a positive alcohol test under DOT regulations. A positive test requires immediate removal from safety-sensitive functions. Under DOT regulations, a person who tests at the 0.04 BrAC level may not resume job duties. In order for them to perform safety-sensitive duties, they must complete the return-to-duty process.

Blood

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. At the time of the sample draw, it's measured in a person. Blood samples are a better indicator of recent consumption than urine samples. But, there is a lack of published data correlating blood levels for drugs and impairment. The data doesn't have the same degree of certainty that's established for alcohol. The only way to determine legal intoxication at the time of an accident is a blood specimen. There's also a short detection period. Most drugs clear from the blood and deposit into the urine.

Hair 

Hair drug testing analysis provides a much longer "testing window". It gives a complete drug-use history going back as far as 90 days. Like urine, hair testing does not provide evidence of current impairment. Rather, only past use of a specific drug. Hair testing is the least invasive form of drug testing. This decreases any privacy issues that an employee may have conducting other sample types of drug testing. 

Oral Fluid 

Saliva, or oral fluids, collected from the mouth detects traces of drugs and alcohol. Oral fluids are easy to collect (a swab of the inner cheek is the most common collection method). They're also harder to adulterate or substitute. Research data have argued that oral fluid drug testing may be better at detecting specific substances. These include marijuana, cocaine and amphetamines/methamphetamines. Drugs don't remain in oral fluids as long as they do in urine. Thus, this method shows promise in determining current use and impairment. 

Alternative Rapid Samples

There are also rapid drug testing methods for in vitro specimen which includes urine and oral fluid. Rapid tests are conducted on-site when the employee provides their sample and the result is usually available within minutes. With rapid drug testing methodologies, you’re sacrificing laboratory accuracy for speed. 

Here’s a chart to sum up the different sample types:

What drugs are detected in a drug test?

Testing conducted according to the Federal guidelines checks for five illicit drugs plus, in some cases, alcohol (ethanol, ethyl alcohol, booze).  

The five illicit drugs are: 

• Amphetamines (meth, speed, crank, ecstasy)
• THC (cannabinoids, marijuana, hash)
• Cocaine (coke, crack)
• Opiates (heroin, opium, codeine, morphine)
• Phencyclidine (PCP, angel dust)  

But, most private sector employers are not limited to these five. They may include drugs that individuals therapeutically take based on a physician's prescription. Most private sector employers can test for any combination of drugs. Common drugs of abuse are grouped together to form testing "panels".  

The typical 8-panel drug test includes the above-mentioned substances plus:

• Barbiturates (phenobarbital, butalbital, secobarbital, downers)
• Benzodiazepines (tranquilizers like Valium, Librium, Xanax)
• Methaqualone (Quaaludes)

The typical 10-panel drug test includes the 8-panel test plus:

• Methadone (often used to treat heroin addiction)
• Propoxyphene (Darvon compounds)

Testing can also be done for:

• Hallucinogens (LSD, mushrooms, mescaline, peyote)
• Inhalants (paint, glue, hairspray)
• Anabolic steroids (synthesized, muscle-building hormones)
• Hydrocodone (prescription medication known as Lortab, Vicodin, Oxycodone)
• MDMA (known as Ecstasy)

How does a drug test determine if a person has been using substances?  

Besides a blood test, drug testing does not determine impairment or current drug use. Rather, drug testing determines a specified amount or presence of a drug. There is a small measurement applied to drug testing. Only traces of a drug or its metabolite above a specified level is a positive report. This measure is a "cut-off level" and it varies for each drug. Setting cut-off levels involve understanding the expected results of testing. You should also understand the needs of the employer's drug-free workplace program. For instance, if a cut-off level is set low, test results will come back with more "false positives". In this case, some "passive" users could test positive. A low cut-off level could cause a positive result from consuming poppy seeds. A high cut-off level will result in more "false negatives," and thus some users may go undetected. Yet, a high cut-off level lessens the likelihood of taking action against someone based on "passive" exposure. For this reason, the Federal guidelines set cut-off levels on the high side.

Setting cut-off levels involve understanding the expected results of testing. You should also understand the needs of the employer's drug-free workplace program. For instance, if a cut-off level is set low, test results will come back with more "false positives". In this case, some "passive" users could test positive. A low cut-off level could cause a positive result from consuming poppy seeds. A high cut-off level will result in more "false negatives," and thus some users may go undetected. Yet, a high cut-off level lessens the likelihood of taking action against someone based on "passive" exposure. For this reason, the Federal guidelines set cut-off levels on the high side.

What are the different ways to administer drug and alcohol testing?

Throughout the testing process, you will interact with many service providers. These include laboratories, collection sites, and Medical Review Officers (MROs). You may choose to administer your program with your existing staff or with a C/TPA. C/TPA stands for a Consortium/Third-Party Administrator. When you partner with a C/TPA, you're outsourcing your drug and alcohol testing program which has its advantages. 

Are you planning on having direct relationships with service providers? If so, you should dedicate enough resources and staff for education and program administration. This can be challenging as you grow your business. You may find yourself dedicating a whole department to administration. 

A valuable option is to share your administration with a C/TPA. A C/TPA will bundle services and share the majority of the administrative work. They have an experienced staff. They will help answer a lot of questions and guide you. This will get you through the implementation and monitoring process. 

You should have a much better grasp on where you need to go from here. Consider the five steps of a successful drug-free workplace program and apply them to your business. 

Before implementation, you should be able to answer these questions:

• What laws apply to my business?
• Is our drug and alcohol policy drafted and distributed?
• Are my supervisors trained?
• Are my employees trained?
• Do we have an EAP in place?
• Do we have contracts in place with service providers?