Prescription medicinal cannabis

Leanne Summers

Hi all

After receiving a request from a team member to use medicinal prescription cannabis for health management purposes, we've been reviewing our D&A policy. We are aiming to include approval of the use of this as long as it is one that is approved by the MoH (including those that have low doses of THC) and prescription conditions are followed. We will manage it within our policy in the same way we do other prescription medications that may have safety related risks associated with them (e.g. some pain relief medications etc).

The journey so far has been interesting after opening up this massive can of worms and I’ve learnt that there are many other businesses who will be in the same situation as us as the legal use of cannabis for medicinal purposes increases. We have multiple critical safety hazards on site, so obviously although we want to support our team's health management choices, we need to make sure that safety comes first.

We've done extensive research (the Canadians have walked this path before us) and received specific advice from a range of sources including the NZ Drug Foundation, the GP from the Cannabis Clinic, our lawyer and various other organisation over the last few months. It has been challenging to be able to make decisions on our policy changes due to limited precedence in this area. However, where we've landed from a H&S perspective is we don't believe THC is a reliable indication of potential impairment due to most of this guidance telling us that cannabis has an impairment time of around eight hours.

What I'm trying to figure out now is if we change our testing method in our current policy from urine to saliva testing, would that help us to ascertain if a person who has been prescribed medicinal cannabis (which comes with the condition of not operating heavy machinery for eight hours after using due to impairment) had taken the medication in less than the eight-hour impairment period, or taken unprescribed cannabis within that eight-hour period?

None of the above sources of information have been able to give advice around this, other than the GP from the Cannabis clinic saying she didn't know the answer and that we would be best to consult with an occupational health specialist - but that she didn't know anyone that was experienced in this area. She also asked that if we did find someone to let her know because she was receiving similar requests for this information from other companies and she would like someone to be able to refer them to.

Does anyone have any similar experiences around this? Thoughts, advice, ideas or other contacts who may be able to give more direction?

Thanks
Leanne

Andrew

I've had one person advised they are prescribed MC.

Great. And that was about it.

Usual "impairment" requirements apply.

No change in policy (actually no policy). No busy bodying in a person private life. Still no Testing being done - not forming judgements on what people do outside work - its impairment that counts.

Done and dusted in about 60 seconds.

Matthew Bennett

Hi @Leanne Summers. I commend the thorough and open approach you are taking to this. I also aspire to the view that @Andrew is taking.

Traditional drug and alcohol policies take a moralistic stance in my opinion: 'drugs are illegal, therefore anyone using them is bad', where in actual fact 'illegal' is merely a statement made on a piece of paper that changes with social opinion. Illegal is rarely based on data, more likely lobbying. The actual issue is impairment, as Andrew rightly states. Impairment can be from a huge number of things - playing PlayStation till 3am, prolonged high mental demand or has been kept awake till 4am by a newborn!

I'm sorry I can't help with your question on urine vs. saliva testing, however the most valuable assessment is on cognitive capacity - is this worker up to this task right now?

I'll be interested in where you land on this; your work so far is helpful.

Thanks
M@

Andrew

The other point I'd make is the more we bury ourselves in policies and procedures the more we are going to get tangled in them when an issue arises.

We ought not treat everyone same same. We need to be flexible and fleet enough to rise to a one off occasion and tailor make a solution for that situation - without having it apply everywhere else.

Leanne Summers

Thanks Matthew and Andrew for your thoughts :)

Correct, impairment can be from a wide range of things, and we already have processes in place to monitor and support our team through things like life crisis events, mental health, secondary work or the tiring experience that comes with caring for newborn children.

We're not looking at changing our policy from any angle of judgement or 'busy bodying' at all. I do feel that organisations do need to have some form of 'impairment policy' to manage that risk, but totally agree with you @Matthew where traditional D&A policies take that moralistic stance. This is why we've been reviewing our existing archaic one. As part of our review, we've canned random testing and will focus any testing on reasonable grounds and post incident testing as a more effective way to manage potential impairment risk related to D&A use. Personally, I think gone are the days where cannabis = Bob Marley, and I for one voted yes in the last referendum - for a number of reasons, personally using it not being one of them.

From the research I've done so far though, I think a lot of businesses will be looking at reviewing their policy in relation to the use of medicinal cannabis. However feedback from people like the GP at the Cannabis Clinic, the NZ Drug Foundation and our lawyer has been that a lot have just put it in the too hard basket. So I'm really interested in sharing and hearing about experiences and thoughts with others here who may have already gone down this path. And any advice specifically around the saliva testing question would be really helpful.

Thanks
Leanne :)

Candis Hawkins

Interesting discussion, have been through similar experience. No definitive answer. Gathered expert medical and legal advice, still no definitive course of action.

Janene Magson

@Leanne
I agree, it is all about impairment and our random tests pick-up 5 different drugs(prescript/ over the counter) which cause impairment and we also test post incident. Random testing is needed not just for Cannabis but over the counter as well as prescribed medication(drugs). We have just had a month of awareness of prescribed drugs and what the effects are and letting our staff understand that when prescribed medication, to make sure that the doctor knows what their job is and to either prescribe alternative or state if they can actually perform their duties while taking this medication. We all know that a range of over the counter medication(drugs) cause more harm as this is not regulated and therefore random testing is still essential.

Chayne Zinsli

Previously, when considering a request to use medicinal cannabis for chronic back pain, I also sought advice from similar sources with a similar outcome. The position we ultimately took was to treat medicinal cannabis just the same as any other prescribed medication that presents a risk of impairment. If the "side effects" of a prescription medicine include impairment, then that risk needs to be managed regardless of what the medicine is.

Andy Huntley

↪Matthew Bennett

I'm not sure I would aspire to any position 'done in 60 seconds' but which could have enormous ramifications, particularly where the science is fairly tenuous and not exactly apolitical. Having been a front line police officer for 25 years dealing first hand with the devastation drugs cause (legal and illegal) it is not just a moral question. Thank goodness not all decisions are made on the back of social opinion which is often ill-informed and uneducated. I would also recommend caution and consider the impairment risk.

Matthew Bennett

Hi

↪Andy Huntley

. Like you I have also been involved in the devastating impact drugs and alcohol have and are having on society. My reference to 'aspire to' relates to a system that is lean on documents, rather one that targets the real matter at hand; one that is able to act quickly and effectively, without getting bogged down in bureaucracy. Pragmatism over Dogmatism. In a matter as complex as this it needs to be research based.

I'm not entirely certain I know what you are saying in you closing sentence. I will acknowledge that there are considerable challenges is assessing cognitive capacity and establishing impairment. I standby saying that doing so is significant to the protection of workers, and just because its hard should never stop us from aspiring to the challenge. Also complex and needs to be research based.

Wayne Nicholl

↪Leanne Summers

Thanks for starting this chat. A really important point that will affect more and more businesses in due time. Loving the dialogue. For me it goes back to the basics - what is the risk? And what do we need to do to mitigate the risk? This won't be a 'one glove fits all' but not one that can be swept under the mat either. Look forward to following this one - thanks again

Jon Harper-Slade

There are other methods to test for impairment that don’t involve testing for the presence of substances. Psychomotor Vigilance Testing appears to have a solid evidence base and I know there is at least one provider in NZ offering that service currently (see AlertMeter®️from Fatigue Risk Management solutions). This is probably most useful for those that operate plant, machinery, vehicles, etc.

This is not a new issue; people are prescribed controlled drugs (that carry a risk of impaired performance) as a matter of routine, for disorders including sleep, anxiety, pain, and depression (which coincidentally are the things people are prescribed CBD/THC medications for). Existing policies should already allow for this.

Much of this (in my opinion) is driven by stigma, prejudice, and old fashioned views associated with certain substances and really shows the limitations of some current approaches to substance testing.

Probably worth mentioning that discrimination becomes an issue if policies are not properly thought through and if decisions are not appropriately justified or consulted on (including speaking to workers who may be impacted).

Finally screening for and preventing impairment tackles the safety risk management element; reasons why people might be impaired are the health element that drug testing and compliance approaches won’t really help with.

Prescription medicinal cannabis

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