September 14, 2017
[AYR, ON] – Cannabis (marijuana) use, that has been authorized for medical purposes has soared in Canada over the last number of years. Recently, we have seen a large spike in authorizations, which is likely due to the pending legalization of cannabis and society’s general acceptance of cannabis use as a “cure-all” for a variety of medical conditions. It may seem to employers that ‘everyone’ is now using cannabis and claiming it is for medical purposes.
Although authorized by a physician, cannabis, namely THC, remains a psychoactive substance that has the potential for safety concerns at work, especially with employees working in safety sensitive or safety critical jobs.
As more research studies are conducted that outline the impact of cannabis on operating a motor vehicle, decision making skills and reflexes, it is apparent that if a worker has an authorization for Cannabis for Medical Purposes, they would require an evaluation to determine whether or not they are fit for duty in a safety sensitive occupation.
Employers should be advised that the comments in this article relate to the non-DOT review of marijuana laboratory confirmed positive tests and are not applicable to programs subject to U.S. DOT Regulations. Any worker subject to DOT Regulations who tests positive for THC or THC metabolite, regardless of whether it’s medical or not, will have their drug result reported to the company as positive and is still medically disqualified from performing safety sensitive duties defined and governed by U.S. DOT until he/she stops using cannabis, has an evaluation by a Substance Abuse Professional and complies with and completes the Substance Abuse Professional’s requirements, and then tests negative on all required DOT tests.
The MROs at DriverCheck Inc. have experienced first-hand the increase in authorizations for cannabis for medical purposes, and subsequently, an increase of laboratory confirmed positive drug tests for cannabis. It is the responsibility of the MRO to determine whether the positive drug test for cannabis (THC or THC metabolite) is due to a medical authorization for cannabis for medical purposes or illicit use. There are many dispensaries where physicians can write a letter or referral to authorize their patient to purchase “medical cannabis”. These dispensaries, however, are not legal sources in Canada and products purchased from such dispensaries are NOT considered to be a legitimate medical explanation, despite the fact that physicians are recommending or signing referrals for patients to attend.
The ONLY source of legal cannabis, at the moment, is that which is purchased from a Health Canada Authorized Licensed Producer (LP) or for some patients, grown legally with Health Canada authorization. Physicians must complete a form to authorize their patient to register with and purchase cannabis from an LP. As MROs, we verify that there is an authorization from a physician, that the worker is registered with an LP and that they are actually purchasing the cannabis from said LP. Only once we can verify all of this information are we satisfied that the cannabis was procured legitimately.
Though the worker may have a legitimate medical explanation, it does not alleviate the safety concerns in the workplace, nor does it mean they are fit for safety sensitive duties.
It is important to remember that the role of the MRO is to determine if there is a legitimate medical explanation for the positive test and to alert the employer of potential safety risks. During the MRO review, an imminent safety risk may be found to which the MRO will ensure that the employer is aware. However, to determine fitness for duty, an additional hands-on assessment is required.
With respect to Cannabis for Medical Purposes – we wholeheartedly agree that there are numerous concerns with workplace safety, despite a legitimate medical explanation. We make recommendations that the authorizing physician be contacted to make a determination as to whether the employee can safely perform their duties at work. It may then be necessary for the individual to undergo a Fitness for Duty evaluation by a qualified medical practitioner with corresponding expertise to determine if the donor is medically qualified to perform their duties. DriverCheck is now able to work with your company to help facilitate this process.
At DriverCheck, our result letter sent to the employer will ALWAYS include a notation to alert you that there is an employee with authorization to use Cannabis for Medical Purposes and that we have verified this. It will also include a recommendation for an assessment, as previously outlined above, due to the known impact of cannabis on work performance and safety.
In summary DriverCheck’s MRO review process is:
Tests with a laboratory confirmed positive result for THC or THC metabolite for which a valid authorization exists will:
Be reported as a verified negative once the following is confirmed:
A valid authorization for cannabis for medical purposes;
Proof of registration with a Licensed Producer;
A valid receipt for their purchase from a Licensed Producer covering the timeframe of the test;
The above information corresponds with the results.
However, with verified negative cannabis tests, you will be alerted to authorized cannabis for medical reasons with a safety warning that is specific to these types of results.
As Canada’s fitness for duty experts, our top priority is the safety of your staff and workplace.
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About Dr. Melissa Snider-Adler, M.D., C.C.F.P., M.R.O. (AAMRO), D,A.B.A.M.:
Chief Medical Review Officer, DriverCheck Inc.
Dr. Snider-Adler is the Chief Medical Review Officer for DriverCheck. Her background is in Family Medicine, but now works primarily in the field of Addiction Medicine. She has been providing Opioid Agonist Therapy in multiple practice settings throughout Ontario for the last sixteen years. Dr. Snider-Adler is certified as a Medical Review Officer by the American Association of Medical Review Officers. She is also certified as a Physician practicing Addiction Medicine by the American Board of Addiction Medicine. Dr. Snider-Adler is an Assistant Professor at Queen’s University Department of Family Medicine. She was one of the authors of the 2011 Methadone Maintenance Treatment Program Standards and Clinical Guidelines and continues to work as a Peer Assessor for the College of Physicians and Surgeons of Ontario where she also sits on the Methadone Assessors Committee. Dr. Snider-Adler gives talks across Canada to companies, physicians and the community about workplace substance abuse and addiction prevention and treatment.