1. DRUG TESTING IN INDUSTRY THE OCCUPATIONAL MEDICINE PRACTITIONER’S ROLE Acknowledgement: Dr Peter Boogaard, Chief Toxicologist, Shell Health Services, SIPC, The Hague, Netherlands: Medical Review Officer Course

2. DRUG TESTING IN INDUSTRY Why test? Judgement errors HSE consequences Financial & reputational consequences OHS requirement

3. DRUG TESTING IN INDUSTRY Who to test? HSE-sensitive positions Heavy Plant Operators (vehicles, machinery etc) Maintenance staff Security staff Chauffeurs Company representatives Senior management

4. DRUG TESTING IN INDUSTRY When to test? Periodic medical surveillance examinations Post-illness Random Pre-employment/placement For-cause

5. DRUG TESTING IN INDUSTRY - OMP ROLE Receive test results from lab. Notify employee of confirmed pos. test result Review & interpret each confirmed pos. test result Provide opportunity for employee to discuss pos. test result Cont …….

6. DRUG TESTING IN INDUSTRY - OMP ROLE (2) Review employee’s medical history as appropriate Review medical records as appropriate Verify laboratory results Notify employer of verified positive result Cont …….

7. DRUG TESTING IN INDUSTRY - OMP ROLE (3) Process employee request for re-test Make decision-to-hire or return-to- duty recommendation Ensure decision-to-hire or return-to- duty requirements are accomplished Cont ……

8. DRUG TESTING IN INDUSTRY - OMP ROLE: SUMMARY All eleven steps! Nothing else! Provide a MEDICAL service – NOTHING ELSE!

9. DRUG TESTING IN INDUSTRY But Doc, he’s my best (driller/driver/ digger/etc)! AVOID THIS TRAP AT ALL COSTS!

10. DRUG TESTING IN INDUSTRY - POLICY DECISIONS Are taken in the boardroom, not the medical centre! Fall within overall A & D policy Concern: When to test Whom to test Outcome of positive test results Disciplinary and other decisions Confidentiality measures Must have no comeback on the OMP

11. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (1)

12. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (2)

13. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (3)

14. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (4)

15. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (5)

16. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (6)

17. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (7)

18. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (7a)

19. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (8)

20. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (9)

21. DRUG TESTING IN INDUSTRY -SAMPLING PROCEDURE (10)

22. DRUG TESTING IN INDUSTRY -PITFALLS

23. DRUG TESTING IN INDUSTRY - the last word? If you can’t do it properly, don’t do it at all!

24. DRUG TESTING IN INDUSTRY OTHER: Laboratory accreditation Screening vs confirmatory tests OVER TO PATHCARE!