National Drug Research Institute Preventing Harmful Drug Use

National Drug Research Institute Preventing Harmful Drug Use in Australia Steve Allsop Director National Drug Research Institute www. ndri. curtin. edu. au

What is a drug? • In this program we focus on psychoactive drugs – drugs that have effects on the central nervous system, perhaps affecting mood, thinking and behaviour. • This can include legal drugs (e. g. alcohol and caffeine) illegal drugs (e. g. cannabis and amphetamine) and prescribed or over-the-counter medicines (e. g. pain killers; benzodiazepines) • Depending on the context and nature of use, these drugs might have implications for safety and health in the workplace, and perhaps other factors such as team cohesion, productivity and risk of criminal activity

How do drugs affect you? • Drugs are usually categorised depending on the nature of the effect they have on the Central Nervous System (CNS) – Depressants (e. g. alcohol, heroin, solvents) depress the CNS – Stimulants (e. g. caffeine, amphetamine, cocaine) stimulate the CNS – Hallucinogens (e. g. LSD) can result in perceptual distortions and hallucinations • Some drugs (e. g. ‘ecstasy’) might have effects in more than one area (e. g. stimulant and hallucinogen) while heavy doses of some drugs might alter the types of effects (e. g. while cannabis is usually categorised as a depressant, in very heavy doses there might be hallucinogenic effects

How do drugs affect you • How a drug affects a person depends on several factors – the properties of the drug and how it is ingested(e. g. the potency or strength) – how much is used – risks vary depending on whether the drug is used via oral ingestion, smoking, inhaling, injecting) – Individual factors such as – the person’s sex (e. g. the same amount of alcohol affects men and women differently) – the person’s health – Environment or context in which the drug is used – Drinking alcohol on an empty stomach immediately prior to work or driving a car is a different risk to drinking at home with a meal

A simple model summarises this information • Drug use and drug related problems are influenced by things to do with: – The drug – The individual – The environment or context • And the relationship among these things

Individual e. g. Health Sex Age Drug e. g. Pharmacology Amount and How often Environment/context e. g. Time Place

Some background comments • Drug use can vary from time to time and region to region • Pressures of work make workplace more sensitive to risks of drug use • Is drug use getting worse – Not necessarily so • • • Alcohol Heroin Amphetamine Ecstasy Cannabis Pharmaceuticals • Heavier use among some people (young; some Indigenous communities) • Decrease in the age of onset of heavy use for some

How could you tell if alcohol and other drug use had relevance in your workplace? • You could engage in some sophisticated research, interviewing staff and key stakeholders – while some workplaces do undertake such research, it is timeconsuming and can be expensive • A simple approach is to understand what is going on in the broad community – if you lived in a region or country where, for example, heavy alcohol consumption was the norm, you might expect there to be higher workplace risks compared to a country with low alcohol consumption.

• The relationship between drug use and work is complex • Much opinion and rhetoric - little valid and reliable evidence • Prevalence of drug use in workforce likely to reflect general community – Biggest harms from alcohol, tobacco, followed by high prevalence illegal drug use such as cannabis and amphetamines (it might vary among diff industries)

• Some evidence that risk factors brought to work – community patterns of use • Some evidence that workplace factors contribute to hazardous and harmful drug use – – – stress/alienation work culture poor/low level supervision availability work conditions

Social and structural control factors • Costs or barriers to obtaining alcohol (Is it easy or hard? ) • Physical availability (Is it actually easily available) • Subjective availability (do people think it is easily available) • Perceptions of norms about use • Is there a cultural acceptance of use? Do I think everyone else does it? • Structural factors • Quality of supervision, Quality of policy implementation • Perceptions that use will lead to negative consequences (if caught there will be consequences)

Alienation and stress • Rewarding and supportive work improves wellbeing • Sense of lack of control and sense of powerlessness increases risk – (people who perceive they have no control over their environment are more at risk) • Monotonous and boring jobs increase risk • Shift work can increase risk (coping; separation from restraints) • Thus, alcohol may be used to cope with poor work conditions

Work culture • Work team attitudes • Alcohol norms (is it perceived as acceptable to use alcohol? ) • Isolation (physical, from culture, from family etc) • Low/Poor supervision • Low visibility (eg. people who work in isolation from workmates or good supervision) • Perceived availability and peer approval/disapproval • Peer accountability

Intoxication Regular use Dependence

Drug use • Drug use is an outcome of: – Individual resilience and vulnerability – Cultural and sub-cultural influences – Work structures, supervision and quality of working life

• Different patterns of drug use result in different kinds of problems • Different factors influence the development of problems • Specific problems require specific responses • As with any OSH problem, it is important to correctly “diagnose” the risk, identify contributing factors and develop specific responses • Avoid making things worse

Effective interventions- What works? What should we look for in the future? • Evidence on what works: ‘not a lot’! But – Recognise various factors that influence use and harm – Specific responses for specific problems and circumstances – conduct accurate diagnosis – Address occasional intoxication – Target all three domains of individual, environment and drug – Adopt quality processes for policy development and implementation – Consider timing of introduction – good policy=good timing – Use credible change agents – Invite and attract people to change with sensible evidence-based interventions that are subjectively relevant

Developing policy • Different problems will require specific responses • Effective responses are likely to involve strategies in the Drug, Individual and Environmental areas

Developing a policy • The first step will be to identify the risk factors in your workplace and to think of potential responses. Remember that effective responses are likely to involve strategies in areas of the – ‘Drug’ (what are you doing about availability? ), – Individual (what are the risk factors associated with your workforce) and – Environment/context (what are you doing to ensure a safe workplace; what workplace factors increase risky alcohol/drug use? ) • You will also need to be mindful of the legislative context – Is your policy consistent with relevant laws and OSH legislation?

• Attract stakeholders to change – how will you ensure that employees, unions, supervisors, community etc. support your activities? • Many people might resist alcohol/drug interventions but may be more responsive if attached to broader intervention (e. g. CVD) • Tailor interventions – each workplace (in fact each site) will have specific needs • Express policy in simple and clear language and communicate widely & regularly - ensure it is known & understood

Raising awareness about drug use • In order to gain support for a policy or strategy, or to encourage healthy choices, a company might invest in an education/awareness raising program. The aims might be to: – – – Educate about the risks of alcohol and drug use, especially in the context of the workplace Support healthy choices and behaviour Provide a rationale and build support for a workplace policy and procedures Challenge perceptions of risk and norms – e. g. if employees think alcohol use is a normal part of day to day work, they may be more inclined to drink more. Many young people think their peers are drinking more than they really are and their personal drinking choices are influenced by these perceptions Illustrate how other people’s drug use has relevance for the whole workforce Inform the workforce how to get further advice and help

Raising awareness about drug use • Different modes of delivery for raising awareness have been used such as online programs, face-to-face workshops, posters and so on • There is little evidence about the impact of such approaches, although there is some evidence that online delivery is attractive for some employees and has some small benefits in terms of knowledge. A key benefit is that they can be accessed anonymously, but then not all workplaces and employees have broad access to computers and the inter or intranet • Embedding alcohol and drug information in broader health programs (e. g. about diet or cardio-vascular disease) may enhance their attractiveness

Rehabilitation • Rehabilitation has been found to be cost effective and has been adopted by some of the most productive companies in the world • Supervisor’s role Performance management, not identification of drug symptoms Referral to services if indicated/available • If you use external services/expertise, they should • Have knowledge and skills (about counselling/treatment and about drug use) • Be confidential

Drug Testing What is it? Urine, blood, saliva, breath, sweat, hair. Contentious, but if it works then we might still justify its use

What does it measure? • Urine Testing – Exposure to drugs in recent past – No available evidence linking metabolites with performance eg “. . . Under no circumstances can impairment be diagnosed or even presumed from a urine test. . (It) does not provide any information about patterns of drug use, about abuse of or dependence on drugs or about mental or physical impairments that may result from drug use”

• Despite being around for a long time, NO strong evidence from controlled studies that it reduces drug problems • IT MIGHT – but no clear evidence to say it does • Unclear about unintended adverse consequences • Recent evidence POTENTIALLY raises concerns regarding cannabis testing

Oral fluid/Saliva testing • Less intrusive? • Measures presence of active drug – not how much nor how intoxicated but technically intoxicated • Weaknesses in relation to particular drugs? • Any screening test must be followed by confirmatory analysis

• No evidence yet that they reduce drug use and importantly reduce harm – doesn’t mean they don’t – just no evidence • Possibly have some unintended adverse outcomes – moves to use drugs with shorter detection window; binge use after site visit • They are NOT a magic bullet and should not be used alone – if you adopt, recognise risks as well as potential benefits

What does drug testing measure? • To summarise the debate on alcohol and breath testing: – It is important to be aware that there is not a strong body of evidence indicating that they reduce drug use and related harm. This does not mean they don’t do this. It means there is no strong evidence that they do – Equally – there is no evidence that they do not make things worse (e. g. people might move to using drugs that are not included in the drug testing program and which may be more harmful). This is not to say this does or does not happen – we simply do not have enough evidence to reach a firm conclusion – Drug testing does not identify someone who is impaired from the after- or hangover effects of drug use – Some people find drug testing intrusive, and question the right of the employer to test body fluids, especially in the absence of evidence about their effectiveness to reduce harm – Drug testing can be expensive and may undermine support for other approaches to prevent and reduce use. Its cost-efficiency has not been determined – A concluding comment is that drug testing approaches are often oversold and workplaces should be aware of risks and shortfalls as well as their potential

Performance Testing • Direct measure of ability, not an attempt to indirectly measure or attribute cause • In its “infancy” • Raises a number of other debates

Conclusion • What lessons can be learned from success in other areas of safety and health? • What lessons can be learned from success in reducing drug related problems – tobacco? • Identify existing factors that contribute to and prevent hazardous and harmful drug use in relation to work • Avoid ‘lure of masterstrokes’ • Be aware of limitations as well as strengths of strategies • Recognise role of broader community/government

Steve Allsop National Drug Research Institute s. allsop@curtin. edu. au www. ndri. curtin. edu. au