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PA Restaurant & Lodging AssociationSupervisor Training

Gina RiordanProgram Supervisor

griordan@dfwpa.orgOffice: (717) 454-3100

Cell: (717) 724-7315

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Who We AreDrug Free Workplace PA

Nonprofit organization funded by PA Commission on Crime & Delinquency

Established to create and implement Drug Free Workplace programs for PA businesses and educate all community members

Provides tools, resources, and expertise in-person and online training

All services provided FREE OF CHARGE due to state grant funding

Have worked with over 1,000 organizations, assisting with policy development, conducting workplace and family education trainings

Five Components of a

Drug Free Workplace

Based on the US Department

of Labor Guidelines

1. Establishing a Drug Free Workplace Policy

2. Supervisor Training

3. Employee Education

4. Employee Assistance Program (EAP)

5. Alcohol and Drug Testing

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OverviewSupervisor Training

• Introduction

• The Cost of Substance Abuse to Society

• The Cost of Substance Abuse to the Workplace

• Substance Use Disorder 101

• Drug Classifications & Signs and Symptoms of Misuse

• What a Supervisor Should and Should Not Do

• When an Incidence Occurs

• Resources

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The Cost of Substance Use to Society

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When Will the Death Toll Stop Rising?

Source: CBS News, 2017.Graphics: CBS News; Huffington Post; and YouTube.

More Americans died of drug overdoses in 2017 than died in the Iraq, Afghanistan, and Vietnam wars combined.

• 55,000 Americans died of car crashes at the peak of such deaths in 1972

• 50,628 HIV/AIDS-related deaths occurred at its peak in 1995

• Over 40,000 died from guns during the peak of those deaths in 1993; 24,703 were murdered in 1991, the deadliest homicide year

• Suicide—which has been on the rise for nearly 30 years—claimed 44,193 deaths in 2015

• 2016 with over 64,070 overdose deaths in U.S. • 2017 with 69,400 overdose deaths across our

nation

8Credit: Haeyoun Park and Matthew Bloch/The New York Times

Overdose Deaths Ripple Across the US

Sources: Centers for Disease Control and Prevention, 2018. Ford Turner, Reading Eagle. February 28, 2018.

According to the U.S. Centers for Disease Control and Prevention, Pennsylvania has the fastest growing rate of drug overdose deaths among the 50 states. Map shows change in number of drug deaths for 12 moths ending July 2017 compared to the preceding 12 months.

Pennsylvania Drug Overdose Deaths Outpacing ALL Other States

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• Over prescribing physicians wrote over 240 million prescriptions for opioids in 2014.

• Substances are often laced with other more powerful substances.

• The introduction of more and more synthetic substances.

• Earlier onset of substance use among teen 12–13-years-old versus 17–18 as was the average age for first-time experimentation 15 years ago.

• An increase in the “self-medicating” concept.

• The Internet provides access and resources for many more substances than ever before.

• Philadelphia has the largest eastern importation of heroin that is extremelypure and has not yet been cut with other drugs.

• More and more drugs are being cut with fentanyl, which is 30-50 times stronger than heroin—or carfentanil, which is approximately 100-500 times more potent than fentanyl.

• It only takes a very small amount of fentanyl or carfentanil to cause a severe or deadly reaction.

Why Such an Increase in Overdose Deaths?

Drug Enforcement Administration, 2018. FAQ’s-Fentanyl and Fentanyl-Related Substances

Why Such an Increase in Overdose Deaths In Pennsylvania?

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Pennsylvania Overdose Deaths Deaths over a 12 month period

2015-2016: 3,7972016-2017: 5,443

43.4% increase—largest increase among all statesPA emergency rooms saw an 81% increase in opioid-related visits

PA Governor Tom Wolf signed a statewide disaster declaration in January 2018 to establish the following criteria:

Declaration will enhance state response, increase access to treatment, and save lives

It is the first of its kind designated toward a public health emergency in PA

It will utilize a command center at the Pennsylvania Emergency Management Agency to track progress and enhance coordination of health and public safety agencies

Declaration clearly outlines 13 initial initiatives organized by three areas of focus: prevention, rescue, and treatment

Source: Centers for Disease Control & Prevention—March 2018

Graphics: Waismann Method Advanced Treatment for Opioid Addiction, 2018.

13Source: Pennsylvania Coroner/Medical Examiner Data 2016

Drug Related Overdose Deaths per 100,000 by Pennsylvania County

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The Cost of Substance Use to the Workplace

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The Cost of Drug Abuse to the Employer

The Working Partners report found that the loss of money connected to employee drug abuse costs the workplace money in the following areas:

Workers’ Compensation (WC): 38%–50% of all WC claims are due to substance abuse in the workplace. Employees who abuse substances file 3–5 times as many WC claims as those who do not use.

Medical Costs: Substance abusers incur 3x higher medical costs than non-abusers.

Absenteeism: Substance abusers are 2.5x more likely to be absent eight or more days a year.

Employee Turnover: It costs a business an average of $7,000 to replace a salaried worker.

Productivity: Drug impaired employees function at approx. 67% of their working potential.

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All Drug Users

77%

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FYI: Small and medium-sized organizations, where drug testing policies and programs are generally not in place, employ approximately 80% of the US workforce.

Source: Working Partners for an Alcohol and Drug-Free Workplace and U.S. Department of Labor

Many Small & Medium Size Organization with No Policy

17Source: Tomo Drug Testing, “Effects of Substance Abuse in the Workplace,” June 27, 2016.

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Where Does Your Industry Fall?

Source: Most recent available data gathered from SAMHSA The CBHSQ Report, April 16, 2015.

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1 in 3 Adults Report Drug Abuse or Addiction within their Family

Pew Research Center, U.S. Politics and Policies, October 24, 2017

46% of those employees touched by drug abuse or addiction report being distracted or less productive at work

due to substance abuse in their families.

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Let Your Employees Know You Conduct Drug Testing

100 = The number of people employed at your company

12% = The percentage of your actual workforce that abuses drugs (national average)

$15,000 = The average cost per year your company spends for each drug abuser in your employment

$180,000 = The yearly cost of substance abuse for your company

General Workplace Drug Testing Categories

New Hires Post Accident

Random Return to Duty

Cause/Suspicion

A Drug Free Workplace Program & Policy Provides an 800% Return on Investment.

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Substance Use Disorder

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What is Addiction?

Source: Addiction Policy Forum.

https://www.addictionpolicy.org/what-is-addiction

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Substance Use Disorder Does Not Discriminate: It Touches Us All

Source: The New York State Office of Alcoholism & Substance Abuse Services; Closing the Addiction Treatment Gap-Open Society Foundations.

Photo credit: Sunrisehouse.comPhoto credit: Sunrisehouse.com

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An estimated 20 million people in the United States have alcohol or other substance use disorder, yet only about one in 10 receives needed treatment. The stigma around addiction can be a major barrier to people seeking treatment.

Research has found that people with substance use disorders are viewed more negatively than people with other mental illness or physical illness. The language we use about addiction can contribute to the stigma, which ultimately can lead to those who suffer not seeking the help they so desperately need.

Words Can Hurt—Worse Yet—

Words Can Delay Treatment

Source: American Psychiatric Association, 2017

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Drug Classifications & Signs and Symptoms of Substance Misuse

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The Classifications of Drugs

CNS STIMULANTS• Cocaine

• Methamphetamine

HALLUCINOGENS• LSD, PCP, Peyote

CANNABIS• Marijuana, Weed, Hash

CNS DEPRESSANTS• OPIATE / OPIOID ANALGESICS – Heroin, Oxycodone

CNS DEPRESSANTS• SEDATIVE-HYPNOTICS – Ethanol, Xanax, Barbiturates

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• More than 80,000 people die from alcohol-related deaths each year in the United States.

• Several million more people engage in risky, binge drinking patterns, which could ultimately lead to alcohol problems, eventual addiction, and death.

• Only 6.7 percent of adults who had reported an alcohol abuse disorder in the past year received treatment.

• Up to 40% of all hospital beds in the US (except for those being used by maternity and intensive care patients) are being used to treat health conditions directly related to alcohol consumption.

Still the Most Widely Used and Accepted Substance of all: ALCOHOL

Resource: National Council on Drug and Alcohol Abuse (NCADD) - 2016

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Alcohol Comes in a Variety of Forms

Liquor, cocktails, spirits, booze, wine, beer, shooters, shots, homemade, moonshine, the list goes on. All are considered alcohol, and, in excess, all do the same amount of damage. Alcohol continues to be the most widely used and misused drug across the country.

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Source: Centers for Disease Control and Prevention (CDC), 2015

Numbers do not Reflect the BIG Picture Related to Alcohol Abuse

CDC Experts are quick to point out that while on average, six people die from alcohol poisoning each day in the United States these numbers do not show the full societal cost of excessive drinking. These statistics do not include deaths in which alcohol poisoning is a secondary factor, such as strokes, liver and kidney failure, or car collisions brought on by consumption of alcohol.

Alcohol Remains in the Bloodstream Up to 12 Hours after the last drink.

Affects the body by slowing down the central nervous system—depressant.

Initially acts as a stimulant, invigorating thought and activity; as more is consumed, body slow down drastically.

Produces feelings of relaxation, reduced anxiety, lowered inhibitions, and mild euphoria.

Dependency, both physical and physiological

Toxic damage to the esophagus, liver, pancreas, heart, kidneys, and the gastrointestinal tract.

Fatal respiratory or heart failure following excessive use or alcohol poisoning.

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Chronic Consumption of Alcohol—3 or More Servings Per Day—Drastically Impacts Health: Sometimes Quickly, Sometime Slowly

Increased susceptibility to disease and cancers

Spontaneous abortion and higher neonatal mortality rate, prematurity, and birth defectsIt is estimated that 54% of birth defects are alcohol related.

Physical symptoms may include: shakiness, lightheadedness, puffiness, bloating, broken blood vessels, large middle section, poor skin color, dry itchy skin, constricted pupils, vomiting, diarrhea.

Dulled mental processes

Impairs the brain’s ability for self control

Lack of coordination and reflex action

Slurred speech

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The annual cost of beer. If you buy a 6 pack of beer three (3) times per week—that costs you about $4.40. Over the course of 20 years that would be $12,672 spent on beer.

The annual cost of wine. If you consume a bottle of wine a day—that costs you $8 on average. Within 1 year, you would have spent around $3,000 on wine.

The annual cost of liquor. If you drink a bottle of vodka a day—that is around $15. Over the course of 1 year you spend more than $5,000 on vodka.

Very likely that you may experience many other alcohol-related health problems and economic difficulties, such as: hospital visits, unintentional injuries, job loss, unpaid bills, car accidents, DUI fines and costs, etc.

How Much Does Drinking Cost You?

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Barbiturates

Common Brand Names: Amaytal®, Butisol®, Nembutal®, Luminal®, Seconal®

Common Street Names: yellow jackets, yellows, blockbusters, goof balls, red birds, reds, barbs, tooies and phennies

Classification: sedative, depressant, sleep inducing drug

Duration: Barbiturates effects remain in your system for 2-3 days after the last use

Legally used to treat anxiety, headaches, insomnia and seizures

Peaked in 70’s; making comeback with youth

Side Effects: Lightheadedness, dizziness, nausea, vomiting, abdominal pain, sedation

Physical Signs of Misuse (taken orally or injected): Extreme sleepiness, lethargy, sedated low, shallow breathing, poor coordination, poor judgment, confusion, mood swings, risk taking behaviors

Abuse in Large Doses:Memory problems, impaired judgment, coordination, breathing problems

High percentage of deaths associated with use from suicide because of drastic mental effects of the drug.

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Benzodiazepines (Benzos)

Common Brand Names: Ativan®, Halcion®, Klonopin®, Tranxene®, Valium®, Xanax®

Common Street Names: bennies, downers

Classification: depressant, calming effect

Duration: Benzodiazepines effects stay in the system for 2-3 days or up to 8 days.

Legally used to treat anxiety, and for sedation; also used as an anticonvulsant .

Current abuse popularity is high among teens and young adults.

More commonly misused by people who also abuse cocaine, heroin, and methamphetamines.

Signs of Misuse (orally or crushed and snorted):Slows down central nervous system, amnesia, hostility, irritability, drowsiness, vivid or disturbing dreams

Graphic: American Addiction Centers

Benzodiazepines were first introduced to the medical community to replace highly addictive and dangerous barbiturates. However, from 1998 to 2008, addiction treatment admissions involving benzoabuse nearly tripled, reflecting the addictive potential that benzos also presented.

Although benzodiazepines are legally prescribed medications, they are highly addictive and their misuse or abuse can have detrimental results, particularly when combined with other substances.

The following statistics provide a picture of benzodiazepine abuse and the associated risks.

➢ Klonopin is one of the most widely available benzos on the illicit market.

➢ Polysubstance abuse is present in 95% of people seeking treatment for benzos.

➢ In about 82% of benzo-related treatment admissions, another drug is the primary substance of abuse.

➢ Benzos accounted for an estimated 8,000 deaths in 2014 in the United States alone.

The Truth about Benzos

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Source: American Addiction Centers

Benzo Addiction

Common Brand Names: Heroin, Hydrocodone, Oxycodone®, Morphine®, Codeine®, Fentanyl®, Hydromorphine®, Oxymorphine®, Methadone®, Buprenorphine®, Vicodin®, Percodan®, and Demerol®

Common Street Names: Heroin, smack, horse, mud, Junk, H, dope, downtown, montega, hillybillyheroin, OC, Oxy, perks, vikes, erks, ox, cotton, ops, kickers

Classification: Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone, hydrocodone , morphine, and many others.

Duration: Opioids effects remain in your system for 1-3 days after the last use.

Trends: All poppy plant derivatives, Opioid misuse in the U.S. dates back to before even the Civil War and the use of opium. Any method of use can lead to fast addiction and opioids enter the brain quickly-affecting areas responsible for producing physical dependence. Opioids and are highly addictiveThose who inject are at high risk for HIV/AIDS, Hepatitis B &C, heart. and other diseases.

Physical Signs of Misuse (swallowed, snorted, smoked, or injected): Euphoria, drowsiness & “nodding off,” impaired mental function, slow respiration, pinpoint or constricted pupils, lack of motivation, lack of appetite, poor hygiene, track marks, and loss of interest in life.

Consequences reach beyond users: Severe fetal effects , violence and crime, spread of disease. Opioids are the most frequently reported drugs in overdose deaths by the coronersoffice. Opioids become even more dangerous when mixed with other substances.

Opioids

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Common Street Names: aunt mary, BC bud, blunts, boom, chronic, dope, gangster, ganja, grass, hash, herb, hydro, indo, joint, kif, mary jane, mota, pot, reefer, sinsemilla, skunk, smoke, weed, yerba

Duration: Marijuana effects last for 1-24 hours after last use.

Facts: Marijuana is a dry, shredded green/brown mix of flowers, stems, seeds, and leaves from the Cannabis sativa plant. The mixture typically is green, brown, or gray in color and may resemble tobacco.

Methods of Misuse: Marijuana is smoked as a cigarette (called a joint), in a pipe, or in a bong. It is also smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, sometimes in combination with another drug. Marijuana is also mixed with foods or brewed as a tea.

Short-term Effects: problems with memory and learning, distorted perception, difficulty in thinking and problem-solving, loss of coordination, dry mouth, increased appetite, damage to lungs and pulmonary system. The effect of marijuana on perception and coordination are responsible for serious impairments in driving abilities.

Long-term Effects: apathy; impairment of judgment, memory and concentration; loss of motivation, ambition and interest in the pursuit of personal goals. High doses of marijuana can result in mental confusion, panic reactions and hallucinations.

Cannibus; Marijuana (dry leaf)Depressant, Stimulant, and Hallucinogenic

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Marijuana

It is a greenish-gray mixture of dried flowers of cannabis sativa.

Medical marijuana is legal in 30 states—including PA—and D.C.

Recreational marijuana is legal in 9 states and D.C.—not including PA.

Under federal law, marijuana remains a Schedule I controlled substance.

Under Federal law it is considered to have no medicinal value.

THC–produces the “high,” and is legal in PA with a doctor’s recommendation.

Combining alcohol or other depressants/stimulants with marijuana can quadruple the effect, increasing the impairing consequences of both.

Graphic: Illinois Marijuana Industry 2018.

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Common Side Effects of Marijuana

Smoking three or more joints per weeks means the smoker is never free from the effects of marijuana on the brain.

Because today’s marijuana has a 500-800% higher potency years past, smoking 3-5 joints a week is the equivalent of what would have been 15-40 joints per week 15 years ago.

Marijuana over-activates parts of the brain that contain the highest number of these receptors. This causes the "high" that people feel. Other effects include:

altered senses (for example, seeing brighter colors)

altered sense of time

changes in mood

impaired body movement

difficulty with thinking and problem-solving

impaired memory

hallucinations (when taken in high doses)

delusions (when taken in high doses)

psychosis (when taken in high doses)

Graphic: AddictionBlog.org

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Methods of Recreational Marijuana Use

Generally smoked by means of a joint or rolled cigarettes; can be smoked with a pipe or bong

It can be ingested through food (brownies, candy, soft drinks)

Vaping, “dabbing,” or JUULing contains 80-90% THC concentration

Graphic: www.JUUL.com

Graphic: www.AgateDreams.com

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The Impact of the Legalization Marijuana in Colorado

• A 32% increase in marijuana related traffic deaths from 2013-14.

• DUI related cases with active THC as the primary offense increased 45%.

• Colorado’s youth drug usage rate (12–17-year-olds) ranked 56% higher than the national average.

• There was a 38% increase in number of marijuana-related hospitalizations

• Poison Control’s involvement increased 72% with marijuana-only related exposures

Source: Smart Approaches to Marijuana (SAM)

Colorado’s 2015 Report regarding the legalization

of marijuana resulted in the following statistics:

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Pennsylvania’s Medical Marijuana Act and the Employer

• Employers must recognize the new risks the MMA presents for their workplace.

• As a preliminary matter, federal law still governs in many instances.

• Marijuana is a federally controlled substance illegal to sell, possess, or use.

• Federally, marijuana is classified as a controlled schedule I drug.

• Medical marijuana is currently legal in 30 states and D.C. despite the federal ban on the substance.

• There are no known cases of the federal government prosecuting individuals who abide by their state’s marijuana laws.

• The PA Medical Marijuana Act refers specifically to marijuana obtained through a licensed dispensary for a serious medical condition limited by statute to the following forms: pills, oil, tincture, liquid, topical (gels & creams), and vaporization or nebulization

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The Workplace and Act 16

Discrimination against an employee certified to use medical marijuana is prohibited.

MMA provides that no employer “may discharge, threaten, refuse to hire or otherwise discriminate or retaliate” against an employee solely on the basis of that employee’s status as an individual who is certified to use medical marijuana.

MMA states that an employer is not required to accommodate the use ofmedical marijuana “on the property or premises of any place of employment.”

Graphic: Pennsylvania Safe Access

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The Workplace and Act 16

Under the MMA, an employer can discipline an employee for the following reasons:

1) Being under the influence of medical marijuana in the workplace

2) Working while under the influence of medical marijuana when the employee’s conduct and/or performance falls below the standard considered normally acceptable for their position.

In order to discipline an employee pursuant to this provision, the employee must both be under the influence of medical marijuana while at work and have their job performance fall below an acceptable level.

Graphic: Thomson Reuters Legal Solutions

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The Workplace and Act 16

If your business is subject to federal laws or regulations mandating a marijuana-free workplace, continue to abide by those requirements.

MMA does not require employers to violate federal law that prohibits marijuana use by employees.

Certain safety-sensitive duties and positions are specifically addressed.

The MMA provides that no one under the influence of medical marijuana may engage in the following job tasks: control of chemicals, which require a permit issued by federal/state government operation; control of high voltage electricity; any other public utility employment duties at heights or in confined spaces including mining.

Under the federal law, some healthcare, all transportation, and all federally regulated employees, are banned from the use of medical marijuana.

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The Workplace and Act 16

What EXACTLY qualifies an employee as falling below expected job performance or the standard of care for their position?

The standard of care for a particular position is unclear. MMA is new, so PA employers should anticipate this issue to be raised as a defense by employees facing disciplinary action for being under the influence of MM.

The ability to prove the facts of medical marijuana use while on duty is difficult.

Because of this—and to protect employersfrom possible lawsuits—in some cases it may be advisable to discipline the employee solely on poor job performance until there are steadfast decisions made by the PA courts.

Graphic: Express Expertise

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Common Street Names: Cocaine, Crystal, Crack, coke, candy, flake, whitecaoat, yayyo, dust, toot, snow, blow, sneeze, powder, lines, rock

Duration: Cocaine remain in your system for 1-2 days after the last use.

Facts: Cocaine interferes with the part of the brain that controls pleasure—more and more is needed to maintain pleasure. Crack causes a short lived high, immediately followed by opposite intense feelings of depression and craving.

Methods of Use: Usually snorted, can be converted to liquid for injection. Crystal crack form is smoked. Freebasing is mixing and smoking powered cocaine with sodium bicarbonate.

Side Effects: Paranoia, angry/hostile, irritability, anxiety, increased heart rate, muscle spasms

Physical Signs of Misuse: Red blood shot eyes, runny nose, sniffling, loss of interest in normal activities, irregular sleeping and eating patterns, loss of interest in normal activities, frequently needing money

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Cocaine

Amphetamines

Common Street Names: addy, candy, hearts, crosses, black beauties, speed, fast, up, uppers

Duration: Amphetamine effects remain in your system for 1-2 days after the last use.

Facts: Commonly prescribed as ADD/ADHD and narcolepsy medications. Speed is produced illegally, less potent form of methamphetamine, may be powder tablet or crystal form, ranges in color from brown to white. Can be swallowed, smoked, injected or snorted. High doses and frequent heavy use can also create an “amphetamine psychosis” characterized by paranoid delusions, hallucinations and out of character aggressive or violent behavior. Produces feelings of alertness, euphoria. Allows user to go for long periods of time without sleep.

Side Effects: Racing heartbeat, heart attack, blurred vision, dizziness , headaches, high blood pressure, stroke, anxiety, paranoia, depression, distorted thinking

Physical Signs of Misuse: Euphoria and over confidence, talking more and feeling energetic, repeating simple things like itching and scratching, large pupils and dry mouth, fast heart beat and breathing, teeth grinding, reduced appetite, excessive sweating, increased sex drive, drastic mood swings, hallucinations.

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Common Brand & Street Names: Loperamide, Imodium A-D, Poor Man’s Methadone, . Currently, there are no drugs tests available to detect.

Facts: Anti-diarrheal medication that contains opioid agent that binds the same receptors in brain.

71% increase in abuse over the past 5 years, used on street to minimize withdrawal symptoms from stronger opioids. There is no high, and Imodium does not relieve pain. It can just alleviate the severe gastrointestinal symptoms of opiate withdrawal.

Since Imodium is an opiate, many people mistakenly assume that it will act as an opiate replacement medication. Since it does not activate receptors in the same way as replacement medications it will not work in the same manner. At-home detox attempts using Imodium or other methods should be avoided as complications can occur.

Side Effects: Dizziness, drowsiness, dry mouth, vomiting, constipation, fatigue, stomach pain, discomfort, or enlargement

Side Effects when taken in large doses: Irregular heartbeat, seizures, death

Signs of Misuse: Empty packaging

Be on the Lookout: Imodium A-D and Trending Misuse

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Creating Drug Free WorkplaceSupervisory Skills

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When an Incident Occurs

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Resources & Links

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Phone: (717) 454-3100

LinkedIn: Drug Free Workplace PA

Twitter: @DFWPA

FB: Facebook.com/DrugFreeWorkplacePA

Please visit our website for additional resources and training sessions as well as treatment option in your area.

www.drugfreeworkplace.org

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Questions and Answers