Time for Unions to Modernize Workplace Drug Use Policies (by Byron Wood).

People use psychoactive drugs for a variety of reasons- to treat medical conditions, to stay alert, relax, socialize, to cope with pain, stress or other problems and for personal enjoyment. The most commonly used psychoactive substances are prescription medications, caffeine, alcohol, tobacco, and cannabis.¹ One in five Canadians experience a Substance Use Disorder at some point in their lifetime.¹ Most people don’t need treatment to overcome their substance use problems, but if they do, they achieve better outcomes if they are provided with individualized treatment options tailored to their unique needs and preferences.² If a person’s substance use problem impacts the workplace, some employers and unions have programs in place that are intended to support the worker as well as to ensure a safe workplace. However, these workplace programs in BC are deeply flawed.³ In 2018 the Hospital Employees Union, which represents 46,000 hospital workers and health care specialists in BC, filed a grievance against the Interior Health Authority (IHA), alleging that their substance use policy discriminates against union members under the Collective Agreement and under the BC Human Rights Code. As a result an Arbitrator ordered IHA to suspend their drug policy and completely overhaul it.⁴ In 2019 the BC Nurses Union co-authored a report calling for an overhaul of the substance use policies for nurses. They found that there was a serious disparity between what is considered best practice in the clinical management of substance use disorders and the treatment and care pathways that nurses are allowed to access. They found that nurses are prohibited from using evidence-based addiction treatments, and forced into care pathways that are potentially harmful.⁵ There have also been a number of individual human rights complaints filed in BC alleging that workplace substance use policies violate the BC Human Rights Code. In particular, a unionized pharmacist, filed a complaint with the BC Human Rights Tribunal after he was forced to stop using the medication Suboxone, the most effective treatment for people with Opioid Use Disorder⁶, and was instead required to participate in a religious treatment program despite being an Atheist.⁷ Society’s understanding of addiction has come a long way over the past few years. It is now taken for granted in most circles that substance use disorder is a health condition not a moral defect. We expect people with substance use problems to be treated humanely and to be offered evidence-based solutions. However, the way substance use problems are addressed in the workplace is lagging behind.³ Changes are needed. Below are some of the recommendations that have come out of the recent reports and rulings. Unions should be fighting to have these recommendations implemented: · Workplace substance use policies should be updated to reflect and promote current evidence-based approaches of addressing substance use. · Employees with substance use disorders should not be singled out and treated differently than employees with other chronic health conditions that have the potential to impact job performance or work safety · Employees should have the freedom and autonomy to use any psychoactive substance they choose when off work · Employees should not be removed from the workplace merely on the suspicion of a substance use problem. · Employees should not be subjected to Last Chance Agreements in which they automatically lose their job if they experience a relapse of their substance use problems. · Employees should be provided with union and legal representation if they are subjected to a workplace drug policy. · If required to see a health care provider for an addiction assessment, an employee should be allowed to choose who they see. Second opinions should be allowed. · Mandatory drug testing should only be considered if an employee has been impaired in the workplace, and an individualized risk assessment has been done. Drug testing should only occur during the employee’s work hours and employees should not have to pay for it. · Employees should be offered a full menu of optional addiction treatments and supports that meet their unique needs and preferences. Coercion should not be used. Culturally appropriate care should be available. · Employees should have the option of using pharmacological treatments such as Suboxone, Methadone and Naltrexone. · Employees should be allowed to access treatment and drug testing through the public health care system. · Employees should not be forced to attend peer support groups or be tracked by medical monitoring companies. · Employers should not have access to an employee’s medical information and should not be permitted to search an employee’s body or personal belongings. Substance use disorder is a health condition not a moral defect and it’s long past time for that to be reflected in workplace substance use policy. Unions have an obligation to take up this fight. 1. “Strengthening Canada’s Approach to Substance Use Issues”, Government of Canada (retrieved Dec. 16, 2020): https://tinyurl.com/ybeoo3tf 2. Rush, B. & Urbanoski, K. (2019). Seven Core Principles of Substance Use Treatment System Design to Aid in Identifying Strengths, Gaps, and Required Enhancements. Journal of Studies on Alcohol and Drugs, 18, 9-21. 3. Chapnick, Jonathan. “Beyond the Label, Rethinking Workplace Substance Use Policies” (2014): https://tinyurl.com/y8qgouyo 4. Interior Health Authority v. Hospital Employees Union. (Labour Relations Code). Awarded Nov. 13, 2018: https://tinyurl.com/ycb58vuw Summary: https://tinyurl.com/yb33g44o 5. “Promoting Evidence Based Treatment Approaches for Nurses with Substance Use Disorders, Report and Recommendations”. BC Nurses Union et al. (2019): https://tinyurl.com/ybbmrq3k 6. “A Guideline for the Clinical Management of Opioid Use Disorder.” BC Centre on Substance Use & BC Ministry of Health (2017): https://tinyurl.com/urnlgje 7. The Pharmacist v. The Doctor and another. (BC Human Rights Tribunal). Decision: Aug. 22, 2019: https://tinyurl.com/y4ejarxr CBC article: https://tinyurl.com/y26c8yxo Further reading: Ross, Dr. Charlotte. “The Business of Managing Nurses Substance Use Problems” (2019): https://tinyurl.com/yb5h5ppw “Position Statement: Supporting Nurses Who Use Substances.” Harm Reduction Nurses Association (2020): https://tinyurl.com/y87a27ak “Atheist nurse wins fight to end mandatory 12-step addiction treatment for health staff in Vancouver”, CBC News, Dec. 11, 2019: https://tinyurl.com/ve4hmhd