Methamphetamine in the Workplace
Mary F. Holley MD
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Only 25% of meth addicts are skid row bums shooting up in a dark alley somewhere. The
other 75% are working, driving trucks, operating heavy machinery, or operating on you.
They are found in health care, childcare, retail and construction, every industry and at
every level. College educated PhDs and 9th grade dropouts; all are equal in the eyes of
Drug impaired workers do not always conform to the stereotypes we have formed
regarding how addicts should appear or behave. The classic stereotype is of the lethargic,
apathetic, forgetful, and careless behavior that applies to users of alcohol and marijuana.
Methamphetamine abusers however often have the opposite presentation. In the early
stages of addiction they are energetic, productive, confident, sharp, and focused. As their
addiction worsens they become fidgety and restless, moody and irritable.
It is only in the later stages of addiction that methamphetamine addicts become
aggressive, agitated, confused and disorganized. End stage addicts have hallucinations
and delusions that are not always obvious. They may accuse people of spying on them,
following them or stealing from them, and may file harassment charges in the context of
a delusion. Their delusions often appear reasonable at first glance.
The impact of a workers drug addiction is felt throughout the company’s operations. An
addicted worker poses a safety threat to co-workers and to the pubic, depending on the
job particulars. Clearly an intoxicated nurse in a hospital can do a great deal of damage to
people’s lives. Identification of drug impaired workers is central to good risk
management on the part of any employer.
Signs of addiction in the workplace
Physical indicators of a methamphetamine addiction are distinct from those identifying
abusers of other drugs. Eyes are often bloodshot from lack of sleep and pupils are dilated
in the acutely intoxicated meth user. Later findings include tics and tremors that are often
disguised as intentional movements or gestures. Poor hygiene is sometimes evident with
body odor and tooth decay. Weight loss, frequent illness and chronic cough or throat
clearing can be indicators of meth abuse.
Performance indicators of meth use include frequent absenteeism and tardiness. Other
signs of meth abuse include poor quality, rushed and incomplete work, inconsistent
performance, disorganized work, indecisiveness, accidents breakdowns and mistakes,
missed appointments and customer complaints. Off duty drug use impairs the quality and
accuracy of work and contributes to liability issues for the company.
Behavioral indicators of meth use may include fidgety time wasting behavior and
frequent trips to the restroom, locker room or parking lot. Methamphetamine addicts may
have significant financial problems, frequently requesting an advance on their pay,
falsifying time sheets and pilfering job materials for resale. They make and receive a lot
of personal phone calls and use drug culture slang in their speech.
Clearly finding drug paraphernalia in the workplace is evidence of a worker’s drug
problem. You may find pipes, lighters, scales, and foil, or small baggies with powder
residue. Unknown substances found in the workplace can be sent for drug testing to the
same laboratories that do urine testing for identification. Law enforcement should
become involved if drugs or paraphernalia are encountered at the worksite.
The need for a drug free workplace policy
If your company does not have a drug policy, you become the employer of choice for
those who can’t handle a drug policy. Drug users are especially attracted to small firms
because of the likelihood of avoiding detection. But even small firms can have an
effective drug control policy with appropriate consultation and the use of outsourcing
employee assistance firms.
The perceived barriers to effective drug policies include the apparent cost of the program,
since employers must bear the cost of any drug test ordered. Ideally, the cost of the
program should be recouped more or less immediately in the form of lower absenteeism,
reduced workplace theft and improved productivity. The quality of workforce you can
attract should be enhanced by the promise that all co-workers are also being tested, and
no drug use will be tolerated. Non drug using employees value a workplace that is free of
The confidentiality laws have clearly recognized the employer’s right to have a drug free
workplace. Properly done and documented, no employee’s confidentiality need be
breached. Testing should be done discretely with only the minimum number of people
aware that it is taking place.
But often the major barrier to enacting a drug free workplace policy is the reluctance on
the part of the employer to initiate one. This reluctance may arise from concerns that
without drug using employees, the number of people in the workforce would be
inadequate. This is often the concern of fast food industry managers. Sometimes the
objection is one of denial that anyone working in a given industry or location could
possibly be using illegal drugs. Many hospitals and schools do not test their staff on the
grounds that educated professionals could not possibly be using drugs.
The deciding factor of whether to drug test or not should be the consequences of missing
a drug using employee and what kind of damage he or she could do both to the company
and to the pubic. The legal liability of a drug impaired worker is usually sufficient to
justify the costs of a drug free workplace policy. A drug impaired worker is more likely
to file a workman’s compensation or health care claim, more likely to injure another
worker, and more likely to cause an accident involving the public. The risk of damage to
expensive equipment and workplace theft also argues for establishment of a drug free
Establishing a drug free workplace policy
Ideally a drug free workplace policy would be initiated in a manner that involves worker
and management in the decision making process. A statement as to the necessity and
desirability of a drug free workplace policy should be written emphasizing the safety of
the worker and of the pubic. Clear goals of the program should be spelled out including
improved safety and productivity, prevention of crime, and preservation of a trained
There are two basic models for the drug free workplace policy, the law enforcement
model which emphasizes detection, apprehension, and discharge, and the performance
model which emphasizes prevention, deterrence and treatment. Ideally a drug free
workplace policy should encompass both philosophies as employees are seen as valued
assets to be preserved, and no drug use is tolerated in the workforce.
Program planning should include representatives of both employee and management to
determine such things as the frequency and type of testing done, facilities for collecting
specimens, identification of employee specimens, laboratory safeguards, supervisor
training and employee education. Penalties for positive test result should be spelled out in
advance of the first employee drug test and should be well publicized before the program
commences. Small companies can enlist the assistance of Employee Assistance Program
vendors who are familiar with local and state laws, allowable procedures and educational
materials appropriate for the workplace. Customized plans can be made available for an
industry or trade group, and many have already been developed. No need to reinvent the
Some workplaces fall under the Drug Free Workplace Act, a federal law concerning
companies with large federal contracts. Other employers are subject to specific
government agency rules such as the Dept of Transportation or Nuclear Energy
Commission. All employers however are subject to OSHA, the Occupational Health and
Safety Administration, and its general duty clause. Each employer shall furnish a place of
employment free from recognized hazards that are likely to cause death or serious harm
to his employees. This general clause empowers OSHA to fine any employer whose
employee is injured as a result of a drug using coworker who was not tested and removed
Employers are required to provide family and medical leave to employees requesting
drug or alcohol treatment, but are not required to offer such treatment to a person testing
positive on a employee drug test. Only self reporters are eligible for leave of this nature.
Components of a drug policy
The components of a drug policy include pre-employment investigation, post
employment education and training, and drug testing. Pre-employment investigation
should include a credit check, reference check, criminal background check and
professional licensing inquiry. Additional resources include workman’s comp history,
civil court records, and motor vehicle records. Drug testing of new hires is standard
procedure in many industries and turns up man positives even when the test is anticipated
Post employment education and training can include specific instruction regarding the
effects of alcohol and illicit drugs. Provision of such training is required by the Drug Free
Workplace Act, and often results in reduced workman’s compensation premiums for
employers not covered by the act. Training videos, paycheck inserts, instructional
courses, and posters can all serve as educational materials for employees.
Drug testing is used both as a deterrent to drug use and as an early detection method.
Drug testing can be done as a part of accident or incident investigation, or on a random
protocol. Existing employees are thus encouraged to remain drug free, and early detection
allows employers to intervene before a serious accident or incident occurs.
Non-specific drug testing examines a work area for evidence of drug use without
implicating any specific individual. Infrared testing devices and chemical residue tests
have been used to determine whether an area or piece of equipment, such as a vehicle or
computer, have been exposed to drugs of abuse. Even trace amounts of residue of drugs
of abuse are detected by these techniques, permitting directed testing of those individuals
with access to the equipment concerned. Drug detection dogs are also used to screen
locker rooms and vehicles. These practices allow companies to target drug testing to
individuals considered at risk for drug use.
Indicated Drug testing involves testing individuals with suspicious behavior as outlined
above. Indicated drug testing should follow the accident or suspicious behavior as closely
as possible as drug use may be intermittent. A positive test is most likely within 24 hours
of drug use in the case of urine testing. Random testing according to a prescribed protocol
is often used as an adjunct to indicated testing, ensuring that all employees are tested at
least annually. Random protocols help avoid charges of discrimination it the application
of drug testing.
Methods of drug testing
Urine drug testing is the most popular form of drug testing at the time of this writing
(2008) though alternative specimens are gaining popularity. Urine testing is inexpensive
and readily available from a variety of vendors. A cheap immunoassay drug test can be
done in about five minutes on site with immediate results. A confirmatory GC/MS (gas
chromatography / mass spectrometry) test of any positives is essential to avoid false
positives with the immunoassay. No permanent staffing decisions should be made just on
the basis of an immunoassay drug test.
Urine drug testing has the disadvantage in that it is easily adulterated or manipulated by
the drug abusing employee. Artificial urine is readily available on the internet and in
convenience stores. Food additives that acidify the urine also accelerate clearance of most
drugs of abuse avoiding detection by urine testing. For this reason, urine testing should be
completely unanticipated. Subjects should not be allowed to go to a locker or vehicle
prior to the administration of a drug test, nor should any other person be allowed to go
into the bathroom ahead of the person being tested.
The standard five panel urine drug screen tests for marijuana, cocaine, amphetamine,
PCP and morphine (the NIDA five). The window of detection for amphetamine and
cocaine extends from 8 hours post ingestion to 24-48 hours after last exposure. Marijuana
can be detected days, even weeks after last exposure, particularly in heavy users. Urine
collection should be done in a bathroom stall remote from other sources of water. Bluing
agents are put in the toilet water, and subjects are not allowed to bring purses or
briefcases into the toilet stall. Direct observation by same sex observers is advised only in
cases in which an individual has provided a cold or otherwise adulterated specimen in the
Hair and saliva drug testing are increasing popular because they avoid the bathroom
problem. Hair tests are accurate for all drugs except marijuana, in which only heavy use
is detected by the hair test. Hair testing offers the advantage of long term documentation
of drug use. If a result is contested, another specimen is readily available from exactly the
same time frame allowing confirmation of positives at a later date if necessary. Hair
testing also gives information on any drug use in the past several months. An inch and a
half of hair provides about 90 days worth of information on drug use in the past. The hair
test as usually administered - by clipping a lock of hair off at the hairline - does not give
information about the most previous seven days, since that section of hair is still beneath
Saliva testing also avoids the bathroom problem and is directly witnessed, eliminating
adulteration or substitution. Saliva testing can detect recent drug use, from immediately
after use to 24-48 hours after drug use, but is not reliable for more remote use. Its best
application is for detection of on the job use or for the parent suspicious of the activities
of a teenager arriving home after a night out with friends. Saliva testing is comparable to
blood testing in accuracy and duration of a positive.
For all types of drug testing, specimens should be labeled in the presence of the person
providing the sample, and their signature placed on the specimen label. A chain of
custody document should be completed including the positive identification of the person
providing the specimen.
Additional testing can be ordered for drugs other that the NIDA five, including
benzodiazepines (Valium etc), barbiturates, ecstasy, methadone, oxycodone, and various
adulterants. These are usually at additional cost. Positive screening tests should be
confirmed by GC/MS technology prior to taking any action.
Common excuses for a positive test include passive exposure – “my boyfriend uses.” The
cut off values for reporting a positive test are set sufficiently high that passive exposure is
not detected by clinical testing. It would take a van full of pot smokers to make a passive
occupant’s blood test transiently positive for 30 minutes (Neidbala 2005). Only direct
users will have sufficient levels in their body fluids to give a positive result on a random
drug test. A forensic lab (crime lab) is required for testing of children in which we are
looking for any detectible level of drug exposure.
Others with positive tests will claim remote use, “I used a long time ago, but I don’t use
drugs now.” Only marijuana can be detected longer than 36 hours in a urine test, and hair
tests can distinguish precisely when a given drug was used by segmental analysis.
Disputes over the timing of drug use are easily resolved by repeat hair testing with
careful segmental analysis.
Others will claim that their cold pills gave a positive test for amphetamine. A positive
result for methamphetamine requires the presence of both methamphetamine and its
primary metabolite amphetamine. High doses of cold preparations containing
pseudoephedrine will give a false positive on the immunoassay, but are easily
distinguished on GC/MS testing (Stout 2004).
Fall out from a positive test
An employer informing an employee of a positive drug test result can expect re receive
some resistance and an angry denial. The confirmatory GC/CM result should be the basis
for any disciplinary action, not the preliminary immunoassay. If the original test was
done on urine, a confirmatory hair test can be offered on the spot in cases of dispute.
Such an offer will usually be declined. Addicts know they can’t beat the hair test.
A medical review officer should be enlisted to validate positive results on a drug test. As
a physician, MRO’s are qualified to determine if legitimate use of a substance is a
reasonable explanation for a positive test. Documentation of such a review should be
maintained, as well as original documents and specimens in the event of legal action.
The manner in which positive results are conveyed is important to the eventual outcome
for an individual employee who tests positive for drug use. A firm but compassionate
presentation of the results, with concern expressed for the employee’s future and a list of
local rehabilitation resources is recommended. Two signatures should be on the
termination letter to diffuse potential anger and a feeling of being singled out for
vindictive reasons. The company’s protocol should be followed exactly in each and every
case, with any deviations carefully documented as to the variance in policy and the
reason for it.
Role of the workplace
Only a small minority of drug users, including methamphetamine users are back alley
derelicts. The vast majority of drug users are employed and are amenable to rehabilitation
if it is suggested by an employer. Early detection and effective intervention are most
likely to be efficacious when addiction is addressed in the work place, rather than in the
county jail. Employers have tremendous power to be a positive force in the battle to
defeat methamphetamine addiction.
Niedbala RS et al 2005 Passive cannabis smoke exposure and oral fluid testing II Two
studies of extreme cannabis smoke exposure in a motor vehicle. J Anal Toxicol 29:607-
Stout PR et al 2004 Evaluation of ephedrine, pseudoephedrine, and phenylpropanolamine
concentrations in human urine samples and a comparison of the specificity of DRI
amphetamine and Abuscreen online KIMS amphetamine screening immunoassays. J
Forensic Sci 49:160-4.