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Health care to health
12/13/2013
Is Your Company Ready For The State Legalization of Marijuana?

Is your company ready for the state legalization of marijuana?

By Dr. John Charbonneau, MD, MPH, FACOEM
University of Colorado Health

In accordance with the newly passed ballot initiative, the possession and use of limited quantities of marijuana is legal under Colorado state law. The statistics regarding current marijuana usage suggest that there is potential for significant impact on Colorado workplaces. Our anecdotal experience in Medical Review Officer work is that the frequency of urine drug screens positive for marijuana is increasing.

The time to consider your company’s alcohol and drug usage policy and testing procedures, is now. Marijuana usage is already common and will likely increase in prevalence. We strongly urge you to seek appropriate legal guidance in the development and implementation of your policies and procedures, and the consistent application of those guidelines to all employees. Nothing in this article is intended to, nor should be taken as, providing legal advice.

According to The National Institute of Drug Abuse 2010 National Survey on Drug Use and Health, “marijuana is the most commonly used illicit drug,” with 17.4 million past-month users. In 2011, among 12th-graders, 32.8 per cent had used marijuana in the last year, and 20.6 per cent were current users. As such, nearly 1 in 3 new entrants to the workforce will have used marijuana in the last 1 year, and 1 in 5 will be a current user.

The State of Colorado Medical Marijuana Patient Registry has been kept since June of 2001. According to The Colorado Department of Health and Environment, as of Aug. 13, 2013 there are:

  • 109,622 registered medical marijuana patients in Colorado, with 4,769 in Larimer County and 3,470 in Weld County.
  • Sixty-seven per cent are male, and the average age is 42 years old.
  • The most common condition is severe pain, with this diagnosis listed for 94% of all such patients.

Marijuana’s effects last from one to three hours after it is inhaled, and possibly longer if it is eaten. While there are both beneficial and adverse effects of marijuana usage, some of them can have an impact on workplace health and safety, including:

  • Euphoria, hallucinations, sleepiness, depression, anxiety, fear, distrust or panic.
  • Difficulty learning new material.
  • Disturbance of balance, posture, coordination and reaction time.

It is easy to see that if employees come to work with such impairments, there is potential for adverse workplace events, including:

  • Impaired performance at work with productivity losses.
  • Personal injuries to employees, coworkers, customers or the general public.
  • Public Health risks, particularly in the transportation industry.
  • Liability exposure due to accidents, whether or not the involved worker is impaired
  • Product and property damage.

Implications of Urine Drug Screen Testing

According to The Medical Review Officer’s Manual, Fourth Edition, “THCA [the primary active ingredient in marijuana] is the metabolite that usually appears in the greatest concentration in urine and is the target for both screening and confirmation tests. A non-user who takes one dose of THC can test positive in urine for approximately three days using a GC/MS cutoff of 15ng/mL. After multiple high doses, and if low cutoffs are used, THCA can be detected in urine for up to several weeks and perhaps longer after last use. There are, however, extreme case reports of THCA detected in urine for 36-95 days after cessation of intake.” The ability to detect the use of marijuana far outlasts its physiologic effects. As a result, companies must also consider the potential impact of a positive urine drug screen result even if the worker was not impaired at the time of the testing or accident. A positive post-accident urine drug demonstrates use or exposure, not impairment.

Applying an Occupational Medicine approach to this potential workplace safety issue may be illustrative:

Primary Prevention
Company policies and procedures regarding the use of marijuana and any other potentially impairing substances, including prescription medications, must be clearly communicated. Employees and Managers must be educated regarding the physiologic effects of marijuana usage, adverse and beneficial, and the potential for impact on workplace safety and productivity.

Secondary Prevention
Frequent reminders regarding company policies and procedures regarding this issue. Consideration of a consistently applied Urine Drug Screen testing program for safety-critical positions, with a predetermined process for the evaluation and management of workers with positive tests.

Tertiary Prevention   
Ensure availability of and access to high quality Chemical Dependency treatment resources in the community. There must be consistent application of company policies and procedures, including discipline, so that the consequences of unsafe workplace behaviors are clearly understood, and enforced.

“A little neglect may breed great mischief; for want of a nail a shoe was lost; for want of a shoe the horse was lost; and for want of a horse the rider was lost; being overtaken and slain by the enemy; all for want of a little care about a horse shoe nail.”  -Benjamin Franklin, The Way to Wealth, 1758

 

 

 

 

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