Cannabis and the Workplace, Oral Fluid

Question 1

List some causes of impairment.

Answer 1

Legal and illegal substances, alcohol, medical conditions, fatigue, life stresses.

Question 2

List some impacts of impairment.

Answer 2

Inability to concentrate, think clearly and make decisions; dizziness, drowsiness, disorientation and confusion; slowed reaction times and lack of coordination; confrontational and aggressive behaviours, disinterest.

Question 3

What are responsibilities of the worker?

Answer 3

As per policy, declare anything that might impair your ability to do your work safely; work in a safe manner; follow education and training; report concerns to your supervisor.

Question 4

List some signs that someone at work might be impaired.

Answer 4

Personality changes or erratic behaviour; odour of alcohol or drugs on their breath or clothes; glassy or red eyes, unsteady gait, slurring, poor coordination; consistent lateness, absenteeism or reduced productivity or quality of work.

Question 5

What are the laws regarding smoking or vaping cannabis in an enclosed workspace in ON?

Answer 5

ON prohibits smoking or vaping cannabis for recreational or medical purposes in an enclosed workplace.

Question 6

What are the laws regarding edible cannabis in an enclosed workplace in ON?

Answer 6

An employee can consume edibles for medical purposes related to a disability in an enclosed workplace, as long as it does not interfere with workplace health and safety or performing essential job duties.

Question 7

Describe the significance of Aitchison v L & L Painting and Decorating Ltd.

Answer 7

Human Rights Tribunal of ON found that the termination of a painter who smoked cannabis for a medical purpose at work during his breaks was not discriminatory.

Question 8

What three sector regulations in the Occupational Health and Safety Act expressly prohibit impairment or the presence of alcohol or drugs in the workplace?

Answer 8

Regulation 854 (Mines and mining plants), Regulation 855 (Oil and gas – offshore), Regulation 629 (Diving operations).

Question 9

What is the substance use policy of the RCMP?

Answer 9

All employees must be fit for duty when reporting for work, which includes not being impacted by alcohol or drugs.

Question 10

What questions are considered when workplaces are determining if there is a duty to accommodate cannabis use in the workplace?

Answer 10

Is the cannabis use for a medical purpose or because of an addiction, is the cannabis use for a medical purpose smoked or vaped, what is cannabis use causes impairment at work.

Question 11

What are the two main mechanisms for testing workers for cannabis?

Answer 11

Urine and oral.

Question 12

What type of urine testing is used for drug screening?

Answer 12

Point of collection (POC) testing.

Question 13

What are the benefits of POC testing?

Answer 13

A convenient tool with results obtained in a short time period.

Question 14

What type of technology is used for rapid testing?

Answer 14

Immunoassay based technology.

Question 15

What two important things should be considered when using POC testing?

Answer 15

1) A testing procedure designed to reduce issues of sample adulteration and dilution; 2) analytical confirmation of positive screening results.

Question 16

How is the integrity of a sample collected via POC testing ensured?

Answer 16

Use of secure washroom; temperature check of the collected sample; visual inspection for obvious signs of adulteration; use of adulteration strips designed to detect possible tampering.

Question 17

What are the benefits of testing oral fluid over urine?

Answer 17

Quicker and less invasive to collect, meaning the amount of drug measured is a better reflection of cannabis exposure at time of suspected impairment.

Question 18

What advances have led to oral fluid testing gaining acceptance as an alternative biological matrix for detecting drugs in clinical and forensic settings?

Answer 18

Advances in analytical technology and new research.

Question 19

What is oral fluid?

Answer 19

Saliva plus other materials in the oral cavity.

Question 20

From what three glands is oral fluid primarily secreted from?

Answer 20

Parotid, submandibular, sublingual.

Question 21

Describe the composition of oral fluid.

Answer 21

97% water plus electrolytes, immunoglobulins, enzymes and other proteins.

Question 22

Describe the flow rate of oral fluid.

Answer 22

Varies from 0 to several mL per minute.

Question 23

What factors impact oral fluid flow?

Answer 23

Emotional state, hunger.

Question 24

What can cause dry mouth syndrome?

Answer 24

Anxiety of collection procedure, lack of proper hydration.

Question 25

How does THC impact oral fluid?

Answer 25

THC decreases oral fluid and leads to dry mouth.

Question 26

Why does THC cause dry mouth?

Answer 26

Effects is due to stimulation of CB receptors.

Question 27

Describe how THC leads to dry mouth.

Answer 27

Cannabinoid receptors are found on the submandibular glands. THC binds to CB receptors and acts via the parasympathetic nervous system.

Question 28

About how much saliva production are the submandibular glands responsible for?

Answer 28

~70%.

Question 29

In what two ways are cannabinoids believed to block messages from the parasympathetic nervous system?

Answer 29

Binding to receptors in salivary glands and receptors in the brain.

Question 30

Describe THC concentrations in blood and oral fluid.

Answer 30

THC does not distribute well into either and concentrations can thus vary greatly.

Question 31

What factors cause THC blood and oral fluid concentrations to vary?

Answer 31

Dose, route of administration, patterns of use.

Question 32

What happens to the oral mucosa when cannabis is smoked or consumed orally?

Answer 32

Extensively contaminated for a short period of time.

Question 33

Why is oral fluid preferred for THC testing over blood?

Answer 33

Taking blood is an intrusive procedure; requires specialized personnel; poses biohazard issues.

Question 34

Why is oral fluid preferred for THC testing over urine?

Answer 34

Urine samples typically test for the metabolite THC-COOH, making interpretation of such tests difficult; privacy issues for taking the sample; sample adulteration may occur.

Question 35

What three methods can be used for oral fluid collection?

Answer 35

Passive drool, expectoration, oral fluid collection devices.

Question 36

List a benefit and drawback of passive drool collection.

Answer 36

Closest to the concentrations excreted from salivary glands but unpleasant for donors and collectors.

Question 37

What is a benefit of expectoration?

Answer 37

More cost effective than collection devices.

Question 38

List two drawbacks of expectoration.

Answer 38

Expectorated oral fluid is viscous and contains mucus, food particles and other debris; dry mouth after cannabis use may make it difficult to obtain an adequate sample.

Question 39

What is expectoration?

Answer 39

Coughing up and spitting out phlegm or mucus from the respiratory tract.

Question 40

Describe the process of oral fluid collection via collection devices.

Answer 40

Use a pad or sponge to absorb oral fluid and a buffer to stabilize the drug and extract them from the collection pad. Pad filters oral fluid. Buffer reduces viscosity and absorption of lipophilic cannabinoids onto container surfaces.

Question 41

When can an officer demand a driver provide a sample of oral fluid to be tested by the approved drug screening equipment?

Answer 41

Under reasonable suspicion that the driver has a drug in their body.

Question 42

What is considered sufficient evidence for an officer to proceed with their investigation into impaired driving?

Answer 42

Positive test result.

Question 43

What is the Drugs and Driving Committee (DDC)?

Answer 43

A committee within The Canadian Society of Forensic Science.

Question 44

What is the role of the DDC?

Answer 44

To act as an advisory body to the DoJ with respect to issues of drug impaired driving.

Question 45

What professionals comprise the DDC?

Answer 45

Forensic toxicologists and other experts from across Canada.

Question 46

What are the two forms of drug screening equipment approved for use in ON?

Answer 46

1) Drager DrugTest 5000 and a Drager Drug Test 5000 STK-CA when used together and 2) SoToxa, Abbott SoToxa Test Cartridge and Abbott SoToxa Oral Fluid Collection device when used together.

Question 47

What is the oral fluid cut-off for THC?

Answer 47

25 ng/mL.

Question 48

What is the oral fluid cut-off for cocaine?

Answer 48

50 ng/mL.

Question 49

What is the oral fluid cut-off for meth?

Answer 49

50 ng/mL.

Question 50

What are the DDC recommendations designed to do?

Answer 50

Maximize likelihood of an individual testing positive on drug screening equipment also having the drug in their blood at or above any per se limit and to minimize the likelihood of individual testing negative on drug screening equipment but having the drug in their blood at or above any per se limit.

Question 51

True or false: Passive inhalers of cannabis will be confused with actual consumers in an oral screen.

Answer 51

False: the 25 ng/mL cut-off is well above levels observed from passive inhalation.

Question 52

Within how many hours of smoking do smokers generally test negative for THC?

Answer 52

Within 4 hours.

Question 53

Within how many hours of ingestion do oral THC users generally test negative on drug screening equipment?

Answer 53

Within 4 hours.

Question 54

What practical considerations should be made regarding drug screening equipment to be used in Canada?

Answer 54

Electrical requirements, battery, printer; Metric system, language requirements; roadside testing – portability, ruggedness, time to complete; storage and operating temperatures; storage questions (i.e., storage temp).

Question 55

At what minimum ambient temperature range should an oral fluid collection system be capable of being stored at?

Answer 55

5 to 30 deg C.

Question 56

What type of legal challenges have been seen for oral fluid screening?

Answer 56

Some defense lawyers have obtained their own devices and performed testing to refute use for impaired driving; constitutionality cases have also been filed.

Question 57

How to increase confidence in oral fluid screening devices?

Answer 57

Increased education and research.

Question 58

What types of future research should be done on oral fluid drug testing equipment?

Answer 58

Incidence of false positives, use in cold climates, correlation between positive oral fluid results and per se drug levels.