Transcript Italy

Work Place Drug Test
Drug-testing in the work place
Giovanni Serpelloni
Elisabetta Simeoni
Department of Anti Drug Policies
Presidency of the Council of Ministers
Work place drugs test and general antidrug strategies
PET
THC e Working Memory
Alteration and impairment of procedural memory
( memorize operational sequences,
automatisms and contemporaneity)
Alteration of coordination
Alteration of stability
Consumo di marijuana
Volontario sano
N=6
4,22 mm
ADDICTION NEUROSCIENCE Verona Group 2010
Emisfero sinistro laterale
0,52 mm
0,57 mm
Emisfero sinistro mesiale
 Riduzione dello spessore corticale nelle aree temporo-mesiali e
nella corteccia cingolata anteriore (in blu)
 Associazione con deficit neuropsicologici (attenzione e memoria)
Effects of Marijuana - SPECT
In our experience, the effects of marijuana use typically cause decreased activity in the posterior temporal lobes
bilaterally. The damage can be mild or severe, depending on how long a person used, how much use occurred,
what other substances were used (nicotine is a powerful vasoconstrictor) and how vulnerable a particular brain is.
For more information see Dr. Amen's article High Resolution Brain SPECT Imaging in Marijuana Smokers with
AD/HD, Journal of Psychoactive Drugs, Volume 30, No. 2 April-June 1998. Pgs 1-13.
18 y/o - 3 year history of 4 x week use
underside surface view
decreased pfc and temporal lobe activity
16 y/o -- 2 year history of daily abuse
underside surface view
prefrontal and temporal lobe activity
38 y/o -- 12 years of daily use
underside surface view
decreased pfc and temporal lobe activity
28 y/o -- 10 years of mostly weekend use
underside surface view
decreased pfc and temporal lobe activity
Alterazione funzionale del cervello
nell’alcolismo
Normal
Alcoholic
Healthy levels of brain
activity
Darker Colouring indicates
depressed brain activity
Strategie e politiche antidroga
10
The 4 elements of the National Drug Action Plan
ItalyAction Plan
National Drug
5 intervention areas 2009-12
1
2
Prevention
Treatment
Monitoring of
Early contact
Acceptance
Diagnosis and
appropriate therapies
and prevention of
related
pathologies
phenomenon
and Assessment
information
early
warning
universal
and selective
early detection
and educational
approach
3
Rehabilitation
and
Reintegration
social
and employment
4
of results
(criterion of
financability)
5
Combatting
and reducing
supply
of illegal drugs:
On territory
On Internet
An Italian “matrix”
on European indications
INTERNVETION AREAS
1
Prevention
Priority actions

Earlier and more explicit information on the damage caused by drugs and
alcohol abuse

Universal prevention through permanent media communication

Selective prevention for high-risk groups in places of entertainment

Early detection of young consumers to reduce lag time before start of treatment

Drug tests on workers with at-risk duties

Specific interventions to prevent drug and alcohol-related traffic accidents
(information, education, on site drug and alcohol tests)

Educative approach in schools with support available for families
Work place
Drug test
Early detection
of young
policy drug use
(SIANN 2009)
Certification for
beginner driving
On site
Drivers test
DRUGS TEST
NO TEST
Drug test
In the school
“Self-applied”
Drug test
Legislative sources
• Pres. Decree
309/1990
Art. 125 (Checks for drug addiction)
Order no. 99/CU of 30 October 2007
•
State/Regions MoU
•
State/Regions Agreement
•
Leg. Decree 81/2008
Rep. Acts no. 178 of 18 September 2008
Art. 41, para. 4 and 4 bis (as modified by article
26, para. 5, of Leg. Decree no. 106 of 3 August
2009)
•
Pres. Decree no. 309/90
Article 124
Drug-addicted workers
1.
Workers who are confirmed to be drug addicts, who intend to start therapy and rehabilitation programs
at the healthcare services of local health services or other therapeutic-rehabilitation and socioassistance structures, if employed on a permanent basis have the right to keep their work position for
the time in which the suspension of their work is due to undertaking rehabilitation and, in any case, for
no more than three years.
2.
Collective labour contracts and work agreements for the public sector may establish specific means for
exercising the right in para. 1. Without prejudice to any more favourable contractual arrangement,
long-term absence for therapy-rehabilitation is considered, for regulatory, economic and social security
purposes, as unpaid leave of State employees and similar. Workers who are relatives of a drug addict
may, in their turn, be put on unpaid leave, on request, to contribute to the therapy and rehabilitation
program of the drug addict should the drug addiction service declare such a need.
3.
For the substitution of the workers as set out in para. 1, it is allowed to recruit on a fixed-term basis,
pursuant to article 1, para. 2, letter b), of Law no. 230 of 18 April 1962. As part of public employment
fixed-term contracts cannot last more than one year.
4.
There is no prejudice to the provisions in force which require the possession of particular
psychophysical and attitudinal requisites for access to employment, as well as those for staff of the
armed forces and police, those who act as security personnel and those to which the limits envisaged
by article 2 of Law no. 874 of 13 December 1986 apply, and which regulate suspension and removal
from service.
Pres. Decree no. 309/90
• Article 125
Checks for drug addiction
1. Those belonging to categories of workers destined to duties which entail risks for the
safety, security and health of third parties, as identified with the Decree of the Ministry of
Labour and Social Security, together with the Minister of Health, are subject to care in
public structures under the national health service and, at the cost of the employer, to a
check on the absence of drug addiction before being recruited and, subsequently, to
periodic checks.
2. The Decree as set out in para. 1 also establishes the frequency and means of carrying
out such tests.
3. In the case of ascertaining a state of drug addiction during the employment relationship,
the employer is required to remove the worker from carrying out the duty which entails
risks for the safety, security and health of third parties.
4. In the case of failure to observe the provisions as set out in paras 1 and 3, the employer
is punished with arrest from two to four months or with a fine from ten to fifty million lire.
Unified Conference Agreement
30 October 2007
Procedures for healthcare checks on absence of drug
addiction or taking of drugs on workers with duties which
entail particular risks for the security, safety, and health of
third parties in application of provision no. 99/cu of 30 October
2007
PERMANENT CONFERENCE FOR RELATIONS BETWEEN
THE STATE, REGIONS AND AUTONOMOUS PROVINCES OF
TRENTO AND BOLZANO
PROVISION of 18 September 2008
Agreement between the Government, Regions,
and the autonomous Provinces of Trento and Bolzano
Procedures for healthcare checks on absence of use
of drugs on workers with duties which entail
particular risks for the security, safety, and health of
third parties
Technical-scientific group
Italian Railways (FRI.) – State Railway Group – Healthcare Division
Contracting body
National Association of Company Doctors (ANMA)
Italian society of Work Medicine and Industrial Hygiene (SIMLII)
Transport Association (ASSTRA)
Institutional Group
Ministry of Infrastructure and Transport – Legislative Office
Presidency of the Council of Ministers –Secretarial Office – State Regions Conference - Service for
healthcare and social policies
Minister of Labour and Social Policies – Legislative Office
Ministry of Defence- Legislative Office – Head of human rights section
Ministry of Health – Healthcare Prevention Directorate
Ministry of the Interior – Police Department - Healthcare Directorate – Central healthcare operating centre –
Research Centre for forensic laboratory work and toxicology
Ombudsman for the protection of personal data
Ministry of the Interior – Healthcare Office Fire Brigade, for public assistance and civil defence
Enav Spa
PROBLEMS TO BE ADDRESSED

Lack of centralised and standardised data to allow analysis of the
outcome of investigations that quantify the use of drugs by workers with
at-risk duties;

Need to have available constantly updated information in order to
support any actions to combat the phenomenon and to regulate the
sector;

Need to finalise a standard form for the transmission of clinical and
toxicological data (case history, objective examination, toxicological
history, laboratory examination, diagnostic therapies) from the drug
addiction services to competent doctors;

Verify the case for introducing forms of randomisation to check the
absence of drug addiction and the taking of drugs;

Reassess the model by which this check must happen at least annually as
envisaged by the specific procedures, with periodic and timely updating
in reference to new recruits and to subjects who have accepted at-risk
duties.
GENERAL OBJECTIVE
Establishment of a network among operative units
that exist to develop systems for monitoring and
standardised assessment of tests carried out at
companies in order to record the use of drugs in
workers with duties which entail particular risks for
the security, safety and health of third parties
Creation of a constant and periodically updated flow
of data regarding cases relating to toxicological and
analytical checks (level I) and diagnostic and
verification checks (level II)
SPECIFIC SUB-OBJECTIVES
1. Establishment by the DPA of a permanent technical-scientific
group to assess the impact of the Drug Test program for
workers with at-risk duties
2. Realise, in collaboration with the support of the DPA
3.
4.
5.
6.
Observatory, a permanent data flow which is centralised at
the DPA of the exams carried out (levels I and II) and the
outcomes of these tests (aggregate data) through a specific
website;
Realise periodic reports on the trend in the tests;
Analyse and propose additions and changes to the relevant
institutional acts;
Set up proposals for technical-scientific guidelines, specific
training and study and research;
Promote international activities and cooperation for the
purposes of scientific and operative discussion.
A basic principle

Not only drug addiction but
also the occasional use of
drugs must be considered
incompatible with undertaking
at-risk duties

For prevention purposes, UseAbuse-Addiction are to be
considered as at-risk conduct
and conditions which are
incompatible with undertaking
at-risk duties or driving
Areas of application
for healthcare checks
1.
Pre-engagement check for at-risk duty;
2.
Periodic check, normally annually;
3.
Reasonable doubt check, i.e. when there are
sufficient indications or evidence of possible taking of
illegal substances;
4.
Post-accident check;
5.
Follow-up check (precautionary monitoring) at
least monthly for 6 months;
6.
Return to work check for at-risk duties, after a
period of suspension due to a previous positive
result for drug-taking.
Procedures for checks
1. First-level checking procedures by
the competent doctor:



Clinical checks by means of a medical
visit
Screening tests (biological matrix: urine)
Confirmation test
2. Second-level diagnostic – checking
procedures done by competent
healthcare structures:

Clinical checks through medical checkups

Toxicological-analytical checks
(biological matrix: urine and hair)
General procedure for checking workers with at-risk duties
Legitimate
impediment
means
suitability
recovery
exemption
Case studies
The use of drugs in Italy in
workers with at-risk duties
Categories of people tested
 Railway staff
 City and regional bus staff
 Air transport staff
 Air traffic controllers
 Goods movement staff
 Military personnel
First-level checks
2010
86,987
people examined
+60.7% compared to
2009 (54,138 people)
First-level checks
2010
People examined by gender
First-level checks
2010
People examined by drug
551
positives with
confirmation test
(0.63% of those
tested)
- 11.7%
compared to
2009
(624 people)
First-level checks
2009 - 2010
People examined by type of substance
Substance
2009
2010
Diff. %
Cocaine
13%
19.6%
+6.6%
Opiates
9%
4.2%
-4.8%
Codeine
4%
4.5%
+0.5%
Methadone
6%
3.8%
-2,2%
64%
64.6%
+0.6%
4%
3.3%
-0.7%
Cannabis
Other substances
Second-level checks
2010
122 occasional
drug-users
-59.2%
compared to 2009
23 drug addicts
-66.7%
compared to 2009
Second-level checks
2010
People examined by type of substance
Armed forces
2006 - 2010
Italian army (*)
2006
2007
2008
2009
2010
Tests carried
out
47,993
39,523
48,306
42,417
57,034
Positive tests
625
340
54
446
204
% Positives
1.30
0.86
0.11
1.05
0.36
+ 34.5%
Navy (*)
2006
2007
2008
2009
2010
Tests carried
out
50,525
43,747
41,476
43,958
43,752
Positive tests
26
19
15
7
4
0.05
0.04
0.04
0.02
0.01
% Positives
(*) on average a person undergoes 4 to 7 tests
Forze Armate
Anni 2006 - 2010
Airforce (*)
2006
2007
2008
2009
2010
Tests carried
out
63,378
43,617
64,108
70,258
82,805
Positive tests
57
42
41
27
0
0.09
0.10
0.06
0.04
0.00
% Positives
+ 17.9%
Total (Army, Navy, Airforce) (*)
2006
2007
2008
2009
2010
Tests carried
out
161,896
126,887
153,890
156,633
183,591
Positive tests
708
401
110
480
208
% Positives
0.44
0.32
0.07
0.31
0.11
(*) on average a person undergoes 4 to 7 tests
- 56.7%
Carabinieri
2006 - 2010
Carabinieri
2006
2007
2008
2009
2010
Tests carried
out
1,670
249
1,632
638
810
Positive tests
5
6
14
6
2
0.30
2.41
0.86
0.94
0.25
% Positives
+ 27%
(*) on average a person undergoes 4 to 7 tests
- 66.7%
Conclusions
Three commitments for the future
1. The application of the protocol will be subject to
monitoring and checking for effectiveness,
efficiency and financial sustainability
2. The classes of workers undergoing checks must be
redefined with a realignment to those envisaged for
alcohol
3. Redefinition of competent second level
structures, introducing, besides drug addiction
treatment services, also other structures which
undertake such work for air and rail traffic
controllers.
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