OSHA & Junk

Opiates vs Opioids

"-iates" are natural -Poppy, Codeine, Morphine, Heroin "-ioids" are synthetic -Hydromorphone, Oxycodone, Methadone, etc

English common law

"the honorable lord will care for his laborers" -framework for US worker's comp -during the Industrial revolution

Maximum possible worker's comp check per week

$1,000 -may be reduced if receiving other gov't help

Unholy Trinity of defense

(CAME OUT OF ENGLISH COMMON LAW) -Contributory negligence -Fellow Servant rule -Assumption of risk (death contracts) *TO PROTECT EMPLOYER*

How long do patients get to produce a urine sample

*4 min* -may be given 40 oz water if they still can't urinate after that time

Compliance EAP

*LEAST EXPENSIVE* method to comply with regulations -monitoring conditions set by: DRUG-FREE WORKPLACE ACT, DOT, & state regulations (drug/alcohol testing, counseling for abusers, MRO)

Alcohol lab screening

*Saliva test* 1st Confirmed with Breath screening -if result = 0.02 then *MUST REPEAT* in 15-30 min

Who pays for coverage of injuries in worker's comp

*THE EMPLOYER* - pays for premiums -even if the worker was harmed by another worker while on the job -employee is NEVER considered "at fault" for their injury -age is NOT an exemption

Leading cause of death in agriculture (4 most common)

-*Tractor rollovers* (transportation) -Run-overs -Stuck in machinery -Falls (from height or wet surfaces)

What services do EAPs provide?

-Assessments -Referrals -Short-term counseling (3-8 total sessions) -Legal advice -Financial counseling -Follow up (employees AND families) *ALL CONFIDENTIAL*

Who gets a drug test?

-Future employee Pre-employment screen -Someone suspected of impairment -Current employee for random testing -Driver who was cited or involved in accident -Employees returning to duty after being on leave -Those with a previous positive result

Deaths of teens on farms

-Machinery-related -Motor vehicle-related -Drowning

EAP counseling

-Marriage/family -Financial -Psych (stress, anxiety, depression) -Workplace conflict -Drug/Alcohol -Eating disorders -Coping with chronic illness/Bereavement

Medical care benefits for worker's comp includes

-Meds -Supplies -Hospital tx -Casts/Braces/Prosthetics

Permanent disfigurement covered by worker's comp

-Neck -Face -Head -Hand

Why are EAPs underutilized?

-Stigma ("mental health patient") -Fear of lack of confidentiality (getting fired) -Lack of motivation -Shame -Unaware of treatment options -Fear of commitment to treatment (skeptical that it helps)

Permanent losses covered by worker's comp

-Thumb, Finger, Hand, Arm -Foot, Toe -Sight, Hearing

Types of EAPs (KNOW THESE)

1. Full service 2. Integrated program 3. Wrap-around 4. Compliance 5. Peer-assistance programs

Age most affected by drug addiction

18-29 -frontal lobe not fully developed

Worker's accident insurance

1st modern system of worker's comp

How long can THC last in the system/urine?

30-90 days!

Normal urine temperature

90-100 deg F

False positives for Methamphetamines

ADHD meds Weight loss meds Vicks inhaler

ADA

Americans with Disabilities Act -protections for employees with physical or mental impairment that limits 1 or more activities *EMPLOYERS CANNOT DISCRIMINATE* -must be record of this disability

Monitoring of worker's comp

Big Brother is Always Watching + OSHA -Tracks # and severity of claims -Audits do occur -May get premium discounts (if low # of claims)

Downside to Employers utilizing EAPs

COST -many smaller businesses cannot afford it -BUT healthier workers = more efficient workers & better business

CEAP

Certified Employee Assistance Professional -trained (certified) person to deal with employee drug problems -helps employees thru hard times

Breath Alcohol Technician

Certified person who performs EtOH breath screenings

Possible outcomes from Pre-placement exams

Cleared. Pending clearance. Not cleared. Based on if patient is *healthy enough* to work +/- accommodations AND if patient does *not* represent a direct *threat* to self/others

Process for drug testing

Collect the specimen Test it Review it Report it

Checks for valid urine sample

Color Specific gravity (>1.003) Creatinine (>5) Chromium Nitrates Aldehydes

Critical element to the success of an employee assistance plan

Confidentiality -strict federal/state regulations -info must NOT be shared with employer

Outlook for EAP services

Continue to evolve & will likely provide many more services in the future (INCREASING marketplace competition, workplace demands, health reform, & lower cost with 3rd party EAPs)

Pennsylvania Worker's Comp Act

Covers: -medical expenses -wage-loss compensation -death benefits

DER

Designated Employer Representative -removes employee with + drug screen from duty

False positives for PCP

Dextromethorphan (OTC cold medicines) Tramadol

Regulated drug testing

Done by: -DOT -Nuclear Regulatory Commission -Dept of Defense *ALL SAMPLES MUST BE SENT TO HHS LAB* -collection must be monitored, 45 mL minimum Drugs: Pot, Cocaine, Opiates, Amphetamines, PCP

False positives for Marijuanna

Dronabinol (Marinol) Hemp-containing foods (CBD) *Patients cannot use Medical Marijuanna and still pass the DOT screening*

Occupational Alcohol Programs

EAP from 1940s -addressed ALCOHOL abuse only -referred by coworkers

False positives for Cocaine

ENT, Ophthalmic, Dentist treatments Bromptons' solution

Integrated program EAP

Emphasis on BEHAVIORAL HEALTH -*COMBO* of in-program service + referrals -more common with LARGE companies/unions

EAPs

Employee Assistance Programs -address employee substance abuse (& other psych health issues) -a form of employee paid benefit

Farmers & worker's comp

Employees NOT covered if: -Farmer pays <$1,200 in wages per yr OR -employee works <30 man-work-days per yr

Negligent infliction of emotional stress

Employer cannot use a drug test in order to invade an employee's personal privacy

Invasion of privacy

Employers cannot go around telling others about the results of an employee's drug screen

Reasonable accommodation for disability

Ex: scheduling, station modified, training, interpreters -so employee enjoys equal employment opportunity -info must be stored in SEPARATE medical file -managers can know accommodation but NOT the Dx

Documentation for Worker's comp

FULL NAME OF PATIENT & EMPLOYER Mailing address Location of work Payroll info Classification of job held Type of benefits

Wrap-around EAP

Focused on Mental Health Services -used by *SMALLER* business employers -uses 3rd party contracts

Managed behavioral heath care/EAPs

From 1990s on -EAP that addresses WIDE variety of personal concerns (not just drugs/alcohol) -SELF referral

How well do physicians recover from drug abuse?

Great! They have high recovery rates with Physician Health Programs

Alternatives to URINE for drug screening

Hair/nails Saliva

What have company managers found to improve the "bottom line"?

Helping troubled employees, rather than punishing them -these companies use EAPs!

ADA & drug use

I don't really get it but... ADA probs can't protect you from a failed drug screen if you ARE NOT yet an employee

DOT Disqualifications

IDDM Seizure disorder Uncontrolled HTN Implanted defibrillator Monocular vision Hearing loss (40+ db in both ears) On Methadone, Chantix, or Recreationals Loss of limb Sleep disorder

Designated provider's list

If a worker becomes injured, there is a list of WHO they can go see in order to have care that is covered in the first 90 days -6 options must be given (3/6 must be physicians) -Employer cannot mandate who the employee sees -Employee entitled to 2nd opinion (for surgeries) -Employee match switch provider's on the list

Instant drug screen results

If negative = can tell employee If positive = must be confirmed by HHS lab -*NEVER TELL EMPLOYEE OF POSITIVE RESULT*

Worker's comp covers...

Illness Injury Disease

Goal of EAP

Improve workplace environment Maximize employee work performance by affecting health

Positive drug screen with deemed reasonable explanation

In the record it is recorded as a NEGATIVE result

IME

Independent medical examination -the insurance company mandates a second opinion from an unbiased physician -EMPLOYER MUST COMPLY (jail time!)

Occupational disease list

KNOW THESE: -Name of disease -Agent causing it -Source of the agent -Disease syndrome -Prevention

Entitlements for Worker's comp *(KNOW THESE)*

Lost wages (total vs partial) Death benefits Specific loss benefits (fingers, toes, etc) Medical care

How many follow-up drug screens for an employee who previously tested positive?

MINIMUM *6* over the course of a year -always performed randomly -always with DIRECT observation

MRO

Medical Review Officer -must be a PHYSICIAN -confirms positive results for drug testing -reviews potential reasons for false positives *FOR POSITIVES - must offer employee another chance ON THE SAME SAMPLE*

Timing of Pre-placement exams

Must be conducted POST-OFFER -an exam cannot affect the decision on whether or not to hire

Alcohol screening result of 0.040

Must be removed from duty & undergo SAP evaluation -per DOT rules

Can you add on testing for cancer or TB during pre-placement screening?

NO - the employer is paying -must be relevant to the job -if you find something, let the patient know to go get it checked out!

Blood testing for alcohol

NOT permitted for work screenings -use other tests

NIOSH

National Institute for Occupational Safety and Health -part of CDC -provides guidance on hazardous chemicals & exposures -has a subset devoted to AGRICULTURAL hazards

NLRA

National Labor Relations Act -rights for unions -employer cannot demand a new drug screening without going thru the union first

NCCI

National counsel on compensation insurance -helps determine compensation & classification (Pennsylvania does NOT use them)

Findings during pre-placement exam

No legal obligation to inform the patient -but ETHICAL obligation still exists

High risk workers according to worker's comp

Oil/gas workers Healthcare works

Public Pension Insurance

Origins of Disability compensation

Who isn't covered by worker's comp?

Owners & Family members Farm hands Independent contractors Railroad workers Some federal government employees

False positive for Opiates

Poppy seeds

Most common exam performed in occupational medicine

Pre-placement exam -common for Department of Transportation

Types of worker's comp that the employer chooses

Private State-run Self insurance (usually too costly)

Peer assistance EAP

Program based on *MEMBERSHIP*, not set by employer -for workers of small businesses, contractors, or those geographically dispersed *ASSURES CONFIDENTIALITY* - not an in-house work service

Social insurance

Programs to APPEASE THE MASSES

Full service EAP

Provides everything from crisis management to child care assistance -internal (company-run) or external (3rd party) *EXPENSIVE*

False positives for Amphetamines

Pseudophedrine/Ephedrine Propranolol/Atenolol Levodopa/Carbidopa ADHD medications Didrex (for obesity)

ADA Mental impairment includes

Psych disorder Intellectual disability Seizure disorder Organic brain syndrome Learning disability (Dyslexia)

Types of drug panels

SAMHSA - 5 drugs (Regulated) Others are not regulated

Pre-placement exam format

Self-assessment questionnaire (Hx) Physical exam Labs (urine drug screen)

SEAP

State Employee Assistance Program -free service for PA state employees/families -includes *4* face to face sessions -discounted legal services

SAMHSA

Substance Abuse and Mental Health Services Administration -defines drug testing procedures

SAP evaluation

Substance abuse professional evaluation -if an employee has + drug screen, must see professional before returning to any duties -develops a remediation plan -in charge of post-monitoring of employee upon return

Low risk workers according to worker's comp

Teachers

Reasons for urine sample rejection

Temperature out of normal range Specimen ID mismatch No collector name & signature Tamper seal broken Insufficient volume (<45 mL)

If you're not an approved provider for worker's comp...

Their visit will not be covered -warn them of this 1st! -do initial assessment only

If employer uses "Unregulated" drug testing

Then employer must have clear policy & inform employees what would happen if they had a positive drug screen -they cannot use gov't forms for testing!

GOAL of pre-placement exams

To help people perform their duties safely -NOT to exclude people from working

Ways to prevent fake urine collection

Turn off water to sink & toilet Bluing dye in toilet Check for adulterants Direct observation (DOT requires this)

Exceptions to pre-offer pre-placement testing rule

Urine drug screens Functional capacity screening (strength/agility)

Pre-placement exam testing

Vision, Hearing, Toxicology, Infection titers, CXR, Spirometry -consider exposures -must be relevant to job

When should employee seek EAP help?

WHENEVER THEY HAVE A PROBLEM (you name it) -also to prevent things from becoming a problem

Does an injury in the parking lot count for worker's comp?

YES -so do CME conferences, seminars, & site vists

Muck-rakers

journalists or writers who alerted the public to wrongdoings in politics and business Helped establishment of: -FDA (1906) -Meat Inspection Act (1906) *ULTIMATELY PUT IN STATE'S CONTROL*

State Worker's Insurance Fund

state-run insurance carrier