1 Emerging Safety Issues: Addressing Addiction in the WorkplaceA Monster Hiding in the Shadows

2 Substance Abuse 47,000 Canadian deaths are linked to substanceabuse annually Statistics: Every 7 hours, there is a death related to substance abuse… 1 in 4 deaths are due to the effects of drug addiction © Nadine Wentzell Consulting Inc 2017

3 Substance Abuse AlcoholAlcohol average lifespan: years years 20 years less than the general population Statistics: © Nadine Wentzell Consulting Inc 2017

4 Most Used Drugs in Canada:Marijuana Prescription Opioids Fentanyl - Duragesic Oxycodone - Percocet Hydromorphone - Dilaudid Hydrocodone – Tussionex Morphine – MS Contin Codeine – Tylenol #4 Cocaine Amphetamine & Methamphetamine Heroin Refs: © Nadine Wentzell Consulting Inc 2017

5 Opioids Opioids Natural (Opiates) Morphine Codeine Synthetic OxycodoneOpium Morphine Codeine Synthetic Hydrocodone Oxycodone Fentanyl Hydromorphone Merperidine What are Opiates? Opiates are a group of drugs that are used for treating pain. They are derived from opium which comes from the poppy plant. Opiates go by a variety of names including opiates, opioids, and narcotics. The term opiates is sometimes used for close relatives of opium such as codeine, morphine and heroin, while the term opioids is used for the entire class of drugs including synthetic opiates such as Oxycontin. But the most commonly used term is opiates. Natural Opiates vs. Synthetic Opioids: What are They? Opiates are named after the substance opium, stated by the DEA as being “extracted from the poppy plant, Papaver somniferum” in order to be used as “the key source for many narcotics.” These drugs which are taken from the dried milk within the naturally growing poppy plant include: Opium Morphine Codeine Thebaine All of these drugs can be found inside the plant and are not man-made. Synthetic opioids, however, might include any narcotics that are either fully or partly manmade (IE semi-synthetics). Some synthetic and semi-synthetic opioids include: Hydrocodone Oxycodone Fentanyl Methadone Oxymorphone Meperidine The entire class of drugs, either natural or synthetic, may be referred to as opioids, but the term opiate refers only to naturally-occurring substances. Understanding whether or not an opioid is organic allows you to better assess a situation of narcotic drug use. Especially if an individual is abusing an opiate because they believe it is safer, you can more easily help them if you know exactly what drug they are using and how much. When comparing the levels of potential harm in natural opiates and synthetic opioids, it is important to remember that both types of drugs can be incredibly dangerous and one should not be considered less so by any means. © Nadine Wentzell Consulting Inc 2017

6 Canada’s Prescription Opioid EpidemicAs of 2013, the number of pharmaceutical related deaths in BC far exceeded the number of deaths from MVAs involving alcohol. Distribution of recent publication: BC’s Node of the Canadian Research Initiative on Substance Misuse has taken an initiative to distribute (to healthcare professionals, members of the public, etc.) their most recent November 2015 publication on Strategies to Address British Columbia’s Rx Opioid Crisis (“Together, We Can Do This”) to aid in the education in addressing the public health harms related to the current pharmaceutical opioid/other addictive pharmaceuticals crisis currently sweeping the province. MATRIX—Expanded Notes: Bubble #1: The rate of pharmaceutical opioid use in Canada has tripled over the last decade Bubble #2: Canada has the second highest opioid consumption rate among developed countries. Bubble #3: Within only 2 years, there has been a 7-fold increase in fentanyl detected deaths in BC, representing 25% of all illicit drug related deaths in the province. Alarming Increase in Deaths by Drug Overdose in Canada Drug overdose is the leading cause of accidental death in Canada. A major part of the problem is due to our massive addiction to “opioids” which are being over-prescribed by physicians for pain relief.  Doctors prescribed pain relief prescriptions to one out of every two Canadians in   The opioid, fentanyl, is at the forefront of Canada’s overdose epidemic.  Fentanyl patches are 100 times stronger than morphine.  Medical guidelines provide that no one should be put on fentanyl without doctors first trying a less potent opioid.  Yet, many doctors write prescriptions for fentanyl for first time users with no previous exposure to opioids.  According to Dr. David Juurlink, Head of Clinical Pharmacology and Toxicology at Toronto’s Sunnybrook Health Sciences Centre, “the idea that we’re just starting people on fentanyl is mind-boggling”.   This is a public health catastrophe. The deaths from illicit drug overdose in BC has increased in the first four months of 2016 by 75%.   As a result, in April, 2016, British Columbia declared a public health emergency in response to the surge in both fatal and non-fatal overdoses.  The declaration allows health officials to collect data on overdoses which will ideally result in a more timely response with the drug naloxone by emergency crews: this drug can reverse the effects of the opioids within minutes.  Health Services statistics indicate a 44% increase in the use of naloxone in 2015.  In the US, 49 states have effectively used a data base to collect data on overdoses.  This allows physicians and pharmacists to review a person’s history with prescription narcotics and look for signs of abuse. Refs: . © Nadine Wentzell Consulting Inc 2017

7 Who is Responsible? Regulators Health Care ProvidersEmployers/Employees Health Care Providers Regulators Medical Marijuana in the Workplace: Risks for Employers  Employment and Labor Legislation 1.    Introduction As the use of medical marijuana continues to increase across Canada, employers will be encouraged to place a high priority on making changes to their workplace policies. With the passing of new Medical Marihuana Access Regulations, Canadians who require medical marijuana for a variety of health reasons will no longer need a license from Health Canada to obtain it, and a simple doctor's prescription will do. As such, medical marijuana must be treated like any other prescription medication, and this may relax the traditional taboos associated with the drug. Much like other medical drugs, a prescription for marijuana does not give the employee a green light to use it in the workplace. Both the employee and employer are subject to certain obligations with regards to the use of medical marijuana in the workplace. In order for both employers and employees to properly understand their rights and responsibilities, and to avoid unnecessary litigation, it is important to identify the various ways that the use of medical marijuana impacts the employer-employee relationship. 2.    Accommodating Medical Marijuana under the Ontario Human Rights Code – Vapourize the Stigma Medical marijuana engages the same principles of accommodation as any other doctor prescribed drug. An employee's need to consume medical marijuana triggers an employer's statutory obligations. Section 5.1 of the Code mandates that an individual has the right to equal treatment with respect to their employment without discrimination on the grounds of "disability". Employees may be prescribed medical marijuana to cope with a number of conditions such as arthritis, cancer, chronic pain, or sleeping disorders.  The Code imposes a duty on employers to accommodate employees' disabilities to the point of "undue hardship". There are three different factors when determining whether or not the request for accommodation meets the threshold of undue hardship to the employer. First, the court looks to the cost of accommodation. Second, the court looks to whether or not there is any outside funding to help subsidize the costs of accommodation. Third, and perhaps most pertinent to medical marijuana, the court looks to any health and safety concerns the accommodation may pose. While second-hand smoke may pose a hazard to other employees, the employer would have to demonstrate that the individual could not be isolated, or that the issuance of a vaporizer would bring undue hardship to the employer. To date, no employer has been able to successfully establish undue hardship based on the health and safety risks posed by marijuana. 3.    Accommodating Medical Marijuana under the Occupational Health & Safety Act The use of medical marijuana in the workplace is also governed by Ontario's Occupational Health and Safety Act(OHSA). Under section 25 of the OHSA, employers have the duty to "take every precaution reasonable in the circumstances for the protection of a worker." Thus, employees do not have a right to be impaired in the workplace where their impairment may endanger their own safety or the safety of co-workers. In order to appropriately gauge the employee's capacity to continue to perform their job safely, the employer should request medical documentation from the employee that speaks to the ability to safely carry out assigned duties. If the inquiry discloses a meaningful impairment in the employee's capacity to carry out their job, then the employer is not necessarily required to accommodate the employee's request to use medical marijuana, particularly where the position involves the use of safety-sensitive equipment. Employees in safety-sensitive positions must inform their employers if they are going to be using medical marijuana. The employer's obligation to accommodate does not end when a meaningful impairment of the employee's ability to perform their current job becomes apparent. The employer will likely be obligated to accommodate the employee in other ways such as allowing the employee a leave of absence while undergoing marijuana treatment, or providing the employee with alternative forms of work that do not engage safety concerns. Employers should be wary that termination of an employee, without first asking whether the medication the employee was taking was affecting job performance, will likely be found to be inappropriate. It is important for employers to understand that they have a broad obligation to investigate and make efforts to accommodate employees using prescription medications, including medical marijuana. 4.    Creating Policy for Medical Marijuana in the Workplace – A Joint Effort Workplace policies dealing with medical marijuana should largely reflect policies created to address any other use of prescription medication in the workplace. However, it is important for employers to effectively and precisely communicate the employee's entitlements and obligations with regards to using, or being under the influence of, medical marijuana. For instance, terms such as "impairment" and "under the influence" should be specifically defined so employees understand whether or not they fall under the scope of the policy. Employers should communicate what, if any, uses of medical marijuana will be considered acceptable in the workplace, and the appropriate procedure for reporting the use of medical marijuana. Employers should also address the disciplinary consequences of breaching the use or reporting protocols. Engaging with employees at an early stage may work to reduce uncertainty and prevent future incidents or litigation. Employers would be wise to consult with their workplace health and safety committees in the development of policy regarding medical marijuana. Further, employers ought to consult with employees seeking accommodation when establishing the appropriate adjustments to the employee's work duties, schedule or work arrangements. 5.    Drug Testing Despite developing clear and transparent policies regarding the use of medical marijuana in the workplace, employers often wish to subject employees to drug testing to ensure compliance. The restrictions on the employer's power to conduct these investigations, though, is worthy of exploration. First, the onus lies on the employer to demonstrate reasonable cause to subject the employee to drug testing. The employer must be able to point to evidence sufficient to form a reasonable opinion that the employee is impaired. It is important for employers to note that the smell of marijuana, independent of any other indications that the employee is under the influence of marijuana, is not a reasonable basis for dismissal of the employee, even where the employee occupies a safety sensitive-position. Evidence of a general problem with marijuana or other drug abuse in the workplace, for instance, may be sufficient to subject employees to random drug testing. However, the employer is granted greater leeway in subjecting employees to drug testing in certain prescribed circumstances, alleviating them of the burden to establish reasonable cause. For instance, drug testing can be mandated after an incident, as a requirement of an agreed upon rehabilitation program, or as a precondition to employment, promotion or transfer. Also, employers may not necessarily be allowed to draw adverse inferences from an employee's refusal to submit to a drug test. Drawing such inferences could amount to discriminating against the employee. However, where the employer had reasonable grounds for requesting the test, the drawing of an adverse inference will not likely be held to be discriminatory. Again, the onus lies on the employer to establish reasonable cause to test the employee, then shifts to the employee to refute that evidence by subjecting themselves to a drug test. 6.    Reimbursement Pursuant to the Ontario Workplace Safety and Insurance Act, employers may be responsible for reimbursing an injured employee for all or part of the cost of his/her medical marijuana treatment. For example, the employer will likely be obligated to reimburse the employee for an amount of marijuana that is "necessary and sufficient" to the employee's treatment. The employer may also be obligated to cover the cost of the injured employee's vaporizer. Specific guidance should be sought on how these issues interact with the accommodation issues renewed earlier. 7.    Conclusion While medical marijuana engages similar protocols for accommodation as any other prescription drug, employers would be wise to review their workplace policies to ensure they are complying with their obligations. Employers should also strive to effectively communicate the responsibilities of employees seeking to use medical marijuana. Employers are encouraged to engage with employees and employee health and safety committees when deciding on accommodation plans and workplace policy addressing the appropriate use and disclosure protocols for medical marijuana. Consultation and effective communication with employees becomes particularly acute where employees are working in safety-sensitive positions. Employers are encouraged to fully understand their obligations with regards to accommodation, the appropriate circumstances for drug testing, and the degree of reimbursement they must provide employees who require medical marijuana. Ref: © Nadine Wentzell Consulting Inc 2017

8 Employer: Human Rights LegislationAsk the question, “What does ‘Duty to Accommodate’ mean?”. Allow for discussion before proceeding to next slide. Duty to Accommodate © Nadine Wentzell Consulting Inc 2017

9 Human Rights Legislation: Substance AbuseFederal & Provincial: Current or former dependence on drugs or alcohol is considered a disability under the federal act Legislation prohibits discrimination based on a disability © Nadine Wentzell Consulting Inc 2017

10 Responsibility of Employer: LegislationOccupational Health & Safety Act Responsible for health, safety and welfare of employees Required to minimize or eliminate all safety risks Westray Bill C-45 = Criminal Code 271.1 Duty for organizations and their representatives to take every precaution to protect their workers as well as general public Employers Occupational Health & Safety Acts Responsible for health, safety and welfare of employees Must minimize or eliminate all safety risks that have the potential to harm employees Can be found liable for irresponsible and negligent actions of employees who may be under the influence of a substance – Metron case Liable for negligent actions of employees © Nadine Wentzell Consulting Inc 2017

11 Responsibility of Employee: LegislationOccupational Health & Safety Act Fitness for duty Responsibility for own and co-workers safety Application of training Cooperation with employer Employees Occupational Health & Safety Acts Shared responsibility for a safe workplace Fitness for duty requirement Individual responsibility for own safety and that of co-workers Cooperation with employer Application of education & training provided by employer Ref (JPEG): © Nadine Wentzell Consulting Inc 2017

12 Responsibility of Employee: Medication UsePrescribed or as directed by manufacturer (OTC) Used for intended purpose within appropriate dose range Responsibility to ask re: safety concerns Report safety concerns to supervisor Consequence for not reporting Employee © Nadine Wentzell Consulting Inc 2017

13 Taking Action on Employer ResponsibilityProblems Responsibility Solutions How do we translate into actions? © Nadine Wentzell Consulting Inc 2017

14 Nadine Wentzell BSc(Pharm) MAdEd Workplace Drug & Alcohol Consultant Fostering Safe Workplaces& Healthy People Lacewood Drive Halifax, NS B3S 1K6 (office) (cell)