SUBSTANCE ABUSE Source Warning signs for abusing drugs Drug tests - PDF document

4/15/2019 Objectives • Risk factors for drug abuse • Statistics • Trafficking flows SUBSTANCE ABUSE • Source • Warning signs for abusing drugs • Drug tests Dr. Basim A. Baragaba, MD, MPH, AME • Substance Abuse Prevention Program Occupational Medicine Specialist Health Safety and Environment Department Johns Hopkins Aramco Healthcare What is drug or Questions substance abuse or misuse? Substance abuse , also known as drug abuse , is a • Have you ever knowingly or patterned use of a drug in which the user consumes the unknowingly taken recreational drugs? substance in amounts or with methods which are harmful • Do you know how to recognize to themselves or others, and is a form of substance- whether someone is using recreational related disorder. drugs? • Have you ever witnessed, suspected or encountered a drug abuser or trafficker? http://cdn.atforum.com/wp-content/uploads/overdose-drug-abuse.jpg 1

4/15/2019 Substance use may cause Why is Addiction a Problem? issues at work • Rates of alcohol, tobacco and drug use is increasing! • Impacts judgment, alertness, perception, motor coordination, emotional state • Consequences of alcohol, tobacco and drug use are countless! • Impacts working safely or making safety sensitive decisions • Addiction affects all strata of society! • Affects job performance • Cost of addiction is high including death, lost • Pre-occupation with obtaining and using substances while at work productivity, cost to employers, society and families! • Can lead to illegal activities at work including selling illicit drugs to other employees • Has psychological or stress-related effects. The Impact of What are the Risk Factors Substance Abuse for drug abuse? • Environmental factors 2007 Cosco Busan oil spill - largest in San Francisco bay since 1988. The Hong Kong owners of Regal Stone Ltd • Individual factors and Fleet Management Ltd agreed to a $44 million settlement. • Genetic factors Capt. John Coto tried to get his Mariner’s license back. • Occupational factors The Coast Guard denied renewal and found Cota "did not meet the medical standards and professional • All the above qualifications requirements for renewal’. 2

4/15/2019 Risk Factors for Drug Abuse Risk Factors for Drug Abuse Conflict and stress! Availability! Ref: Google images Risk Factors for Drug Abuse Risk Factors for Drug Abuse Genetic predisposition https://anaheimlighthouse.com/wp-content/uploads/2018/03/anaheimlighthouse-how-drug-addiction-affects-children-article-photo-parents-sit-on-sofa-with- children-taking-drugs-and-drinking-193822439.jpg 3

4/15/2019 Risk Factors for Drug Abuse Risk Factors for Drug Abuse Poverty neighborhoods Other occupational risk factors for drug abuse Substance Use Disorders • High demand/low control situations Substance dependence : A strong desire to take drugs, difficulties in controlling its use, persisting in its use, • Working in remote areas despite harmful consequences • low job satisfaction • long hours or shift work Withdrawal : A group of symptoms which occur on • Lack of career development cessation or reduction of use of a psychoactive substance that has been taken repeatedly, usually for a prolonged period and/ or in high doses. Tolerance : Diminished response to a drug that is the result of repeated use 4

4/15/2019 Population of current World Health Organization illicit drug users in the US (WHO) 2010 A: 9.4% ATLAS of Substance Use Disorders Resources for the Prevention and Treatment of B: 8.6% substance Use Disorders (SUD) Country Profile: SAUDI ARABIA C: 5.5% D: 4.1% E: 3.9% The Substance Abuse and Mental Health Services Administration (SAMHSA): https://www.drugabuse.gov/publications/drugfacts/nationwide-trends Substance Abuse Statistics in Saudi Arabia • Study published in 2016 showed the prevalence of substance abuse among male • There was an increase in the use of cannabis secondary school students in Abha City is high! and amphetamines • 8.8% male secondary school students were • Decrease in the use of heroin and volatile substance abusers substances • Prevalence of substance abuse increases with • Peer pressure and psychosocial stresses were students' age risk factors for initiation Bassiony, M. (2013). Substance use disorders in Saudi Arabia. Journal of Substance use , 18 (6), 450-466. http://www.alliedacademies.org/articles/substance-abuse-among-male-secondary-school-students-in-abha-city-saudi-arabia-prevalence-and-associated-factors.html 5

4/15/2019 What is the most common Global trends in estimated prevalence of drug use and prevalence of people with abused substance drug use problems (2006-2015) A. Marijuana B. Amphetamine C. Cocaine D. Hallucinogen E. Inhalant Ref: ” World Drug Report 2017, UNDOC “United Nation Office of Drug and Crime”, Reponses to annual report questionnaire. Why is marijuana the most ILLICIT DRUG USE IMPACTS MILLIONS: commonly used drug? MARIJUANA MOST WIDELY USED DRUG • Jokes • No social stigma • Relieves stress, anxiety, fear, pain or anger-related to personal, psychological or family issues • Marijuana, as medicine • Availability • Popular culture endorses marijuana use • Low perception of harm • Legalized in other countries Reports and Detailed Tables From the 2016 National Survey on Drug Use and Health (NSDUH) https://www.samhsa.gov/sites/default/files/topics/data_outcomes_quality/nsduh-ppt-09-2017.pdf 6

4/15/2019 Marijuana use among people aged Drug Related Deaths 12 years or older by % (2002-2016) Key Substance Use and Mental Health Indicators in the United States:Results from the 2016 National Survey on Drug Use and Health (https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#fig15) Main Opiate trafficking flows Drug Related Deaths (2011-2015) Heroin use among people aged 12 or older, by age group/by percentage % (2002-2016) Reports and Detailed Tables From the 2016 National Survey on Drug Use and Health (NSDUH) https://www.samhsa.gov/sites/default/files/topics/data_outcomes_quality/nsduh-ppt-09-2017.pdf source: UNDOC elaboration, based on responses to annually report questionnaire and individual drug database 7

4/15/2019 Main Cocaine trafficking flows Main Methamphetamine trafficking (2011-2015) flows (2011-2015) source: UNDOC elaboration, based on responses to annually report questionnaire and individual drug database source: UNDOC elaboration, based on responses to annually report questionnaire and individual drug database * among 12th Source of Marijuana Amphetamines seized worldwide Graders (2012-2015) by State Policy 100 80 60 40 20 0 Medical Marijuana States Non-Medical Marijuana States source: UNDOC elaboration, based on responses to annually report questionnaire and individual drug database SOURCE: University of Michigan, 2015 Monitoring the Future Study 8

4/15/2019 Drug Abuse: Drug Abuse: Behavioral Warning Signs Physical Warning Signs • Red eyes, pupils larger or smaller than usual • Drop in attendance/performance at work or school • Changes in appetite or sleep patterns • Unexplained financial problems; borrowing or stealing • Sudden weight loss or weight gain • Engaging in secretive or suspicious behaviors • Deterioration of physical appearance, personal • Sudden change in friends, favorite hangouts, and/or grooming habits hobbies • Unusual smells on breath, body, or clothing • Frequently getting into trouble (fights, accidents, illegal activities, etc) • Tremors, slurred speech, or impaired coordination Drug Abuse: Psychological Warning Signs • Unexplained change in personality or attitude • Sudden mood swings, irritability or angry outbursts • Periods of unusual hyperactivity, agitation or giddiness • Lack of motivation; appears lethargic or ‘spaced out’ • Appears fearful, anxious, or paranoid Source: Blume, S.B., Alcohol and Drug Abuse in the Encyclopedia of Occupational Health and Safety 4th edition, International Labor Office, 1998 9

4/15/2019 Does your company have Components of a Comprehensive a Drug Policy? Substance Abuse Prevention Program ☑ Yes RISK ASSESSMENT ☑ No DOCUMENTED POLICY AND PROCEDURES ☑ I don ’ t know Employee Supervisor Drug Employee Education Training Screening Assistance Are Drug Tests Accurate? TYPES OF DRUG TESTS  Urine sample : the most commonly used  Breath alcohol : the most common test for impairment by alcohol  Other types of tests are blood , saliva , and hair 10

4/15/2019 Are Drug Tests Accurate? Indications for Drug Testing • Chain of custody • Pre-Employment testing • Pre-shift testing • Initial test • Periodic testing • Confirmation test • Reasonable suspicion testing (for cause) • Random testing • Medical Review Officer (MRO) • Post-incident testing • Post-treatment testing http://i.huffpost.com/gen/1321171/images/o-WELFARE-DRUG-TEST-facebook.jpg DESPITE CONSEQUENCES AND DISEASE BURDEN, MANY DO NOT GET TREATMENT Reports and Detailed Tables From the 2016 National Survey on Drug Use and Health (NSDUH) https://www.samhsa.gov/sites/default/files/topics/data_outcomes_quality/nsduh-ppt-09-2017.pdf 11

4/15/2019 QUESTIONS??? 12