Sunday, June 07, 2009

Alcohol & Drug Free Workplace Part I

Last Friday, my friend who is a HR personnel from one company called my handphone to consult about urine testing for drug abused. Instead of just telling the name of the lab. I decided to give brief explanation on how important to have a proper Alcohol & Drug Free Workplace policy or/and program. I recalled handling one drug abused case in early 2008. Here is the story:
“Doc, can you please check the urine of one of my worker to rule out drug abused?”, asked a supervisor who walked into the clinic , during my relief duty at one of an in-house clinic in January 2008. I quickly asked back ,“Why?, why drug test?”.
Then the HR personnel of the company came in and interrupted, “ He is suspected of drug abused because he has odd behaviour lately. Just now, he switched off the machine unncessarily, causing interuption in our production.” “OK,OK! I said....Let me handle the case properly”. Then the mentioned worker came in with another personnel. I told the personnel that I will perform full medical checkup with general blood screening test including the urine test for drugs. They agreed and left the clinic.
I asked the nurse in-charge about the Alcohol & Drug-Free Workplace Policy. The nurse looked puzzle about the policy. I explained to her what I learned from The First Medical Review Officer (MRO) Course organised by SOEM-MMA in November, 2005. She understood.
I instructed the nurse to collect the urine and also to maintain a chain of custody (COC) when sending the urine to the private lab. The nurse called the security department and one of the guard came and went to the toilet with the worker to get his urine specimen. I sent his urine for a battery of tests for drug-abused and his blood for screening test to assess his baseline health. I did a full physical examinations to find out any signs of drug-abused.
The next morning, the nurse informed me that the urine test was positive for Amphetamines. I asked the nurse to instruct the lab. to do the confirmation test . The private lab. sent the urine specimen to their HQ in Australia to do the confirmation test. "The result will be only available in one week", informed the lab. personnel.
Meanwhile, I take detail history from the worker including questions about the latest medication he took which can cause False Positive screening test result for amphetamine. There are some agents contributing to positive (False Positive) result by immunoassay screening test such as ephedrine,pseudoephedrine which is the common ingredients of flu and cough medicine. He told me he took syrup sedilix prescibed by one of a panel clinic a night before. I asked him to bring the cough syrup bottle for my reference(See photo above- the bottle box he handed to me). I called the clinic and the doctor confirmed his prescription on the cough syrup.
Sedilix-DM Linctus contained Dextromethorphan,Promethazine,Psudoephedrine and parabens. As mentioned earlier, this cough syrup contained Pseudoephedrine which can cause False Positive for amphetamine.
So, I reserved my judgment as False Positive or Excused Positive urine test at this junction.

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