ADHD affects around one in twenty New Zealanders and the number of people diagnosed with the disorder is on the rise. In recent years in particular, there has been a steep increase in the number of adults diagnosed with ADHD. But what’s this got to do with workplace drug testing?

Brief information on ADHD

ADHD, or Attention Hyperactivity Disorder, is a complex neuro-developmental disorder characterised by patterns of inattentive, impulsive and sometimes hyperactive behaviour. Often, people with ADHD also face emotional regulation challenges.

These behaviours stem from underlying neurological differences. Without intervention, ADHD can lead to significant functional disability across all areas of life. However, with evidence-based treatment and support, individuals with ADHD can learn to manage challenges, embrace strengths and lead fulfilling lives.

This support can include medication. There has been a lot of media attention in recent years on the significant rise in ADHD sufferers being prescribed medication. In a recent news article published a few months ago, it was claimed that the number of Australians being prescribed ADHD medication has doubled in five years.

What’s the link between ADHD and workplace drug testing?

While there are many medicines and combinations of medicines that can be prescribed for ADHD, often a stimulant medicine is part of the mix. Stimulants used in treatment of ADHD help improve behaviour, attention and memory in ADHD by adjusting chemical messengers in the brain.

While there are different stimulants that can be prescribed for ADHD, some are what can be described in layman terms as amphetamine-like. The most common ADHD medications are Dex Amphetamine, Adderall, Concerta and Ritalin. The latter is the most common ADHD medicine prescribed.

The fact that these medications are essentially amphetamines (low dose)is a critical aspect. It’s why some people on ADHD medication may provide a not-negative test during workplace drug testing. A not-negative is more likely if the dose was very recent or is a medium to high dose

While the drugs that can be detected by testing can vary, depending on the workplace drug testing provider and the Workplace, those testing to AS/NZS Standards routinely check for amphetamines. That’s because, while amphetamines can be prescribed for various medical conditions, including ADHD, it can also be an abused drug taken illegally in higher quantities for recreational purposes.

An example is an illicit amphetamine is one commonly called speed. Speed and other amphetamine type substances are generally considered as a psychoactive substance that gives user feelings of happiness, confidence and energy. It can also lead to an increase in heartbeat and breathing, fits, passing out, paranoia, mood swings, hallucinations, confusion and more, which is why it has no place in a workplace where safety is important.

It should be highlighted that when taken as prescribed, amphetamine-like medication is largely safe and medically indicated. While side effects can occur, for most people on long-term prescribed use, the medication has proven to be safe and effective and if it is taken according to the prescriptions, are safe to work and drive a vehicle.

Medications with risk and side effects are not just for those treated for ADHD

While ADHD medication is increasingly being prescribed, it is one only of the prescribed medications that can lead to not-negative workplace drug testing results. It is not the only legally prescribed medication that triggers a not-negative result and needs sensitive, safety-focused responses in the workplace. It’s important to understand that prescribed drugs can lead to being unsafe at work and have functions similar to many illegal drugs. Workplace drug testing is not designed only to detect illicit drugs but to detect substances with the potential to be a safety issue. Taking a medication prescribed for another is illegal.

So, what drugs that are medications can lead to the person taking the medication being unsafe to drive or work in safety-focused roles, even when the drug is taken as directed? Examples can include codeine, morphine and fentanyl, all opioids, which belong to the same drug family as heroin. Opiates are widely prescribed and used and present considerable risks such as tolerance, dependence, addiction, low oxygen levels due to suppressed breathing response, fainting, dizziness, sedation and more. Another example that is very topical of late is medicinal cannabis.

While most doctors should and do discuss side effects with their patients, you must remind workers that there is a responsibility on them to explore the potential side effects when taking prescribed medication, particularly if they work in a job where workplace drug testing is carried out and if they plan to operate a vehicle privately or for work. Questioning a doctor about side effects, telling the doctor about what your work hazards and whether a drug could affect their ability to drive or work should always be part of the conversation.

Could someone face consequences for failing workplace drug testing while on medication?

What happens when someone’s ADHD or other medication is detected in workplace drug testing? Could someone – perhaps wrongly – lose their job or face significant consequences?

In general the answer is no.

Initial testing (an onsite drug screen), which may produce a not-negative test for amphetamines, should always be followed by confirmation testing, using a method that identifies the exact substance o drug compound and not just the family or class of substances. This confirmed laboratory test is a more accurate and definitive, independent laboratory analysis. This testing will be able to distinguish between the different forms of amphetamines taken and is the only test result on which a workplace should exercise any employment consequences.

An initial not-negative result does not mean that illicit substances, medication or sometimes even a substance that is a safety risk is the reason for that result. Prescription medications can trigger a not-negative result as we have highlighted earlier and the laboratory report is essential however it can only tell you if the medication is consistent with the substance declared or if it was taken or declared to mask the use of an illicit drug.

The confirmed Lab result will tell you whether the medication declared has caused the result, but not that it is legally prescribed for and to the worker and is being used as directed.

What is needed next if a prescribed medication detected in a routine drug test has been confirmed? Even if the medication is identified and proven to be prescribed to that person, especially in the case of a worker claiming prescribed Cannabis(THC), how do you know if you should be concerned about the potential for it to affect workplace safety or what other actions for Health and safety you may need to take?

The workplace can request proof of a legal prescription and legally dispensed medication (the packet or bottle of medication) to the worker, but an MRO is able to work better within the medical privacy boundary to provide the workplace with support to better understand workplace risk and, in most cases, can report on fitness to work specific to the worker, medication, and workplace risk.

A Medical Review Officer (MRO) can provide advice on whether the medication is considered safe to take for the worker, taking into account the job role, and the medical condition the medication is treating. Furthermore, the MRO can also verify a legitimate test process and positive result relevant to safety, determine if the drug test is consistent with the declared medication dose and give you the support to apply the tools you have to manage the individual via your company’s drug and alcohol policy.

If you are a worker who is on ADHD medication that is amphetamine-like, or in fact, any of the medications that may cause safety concerns, i.e. Opiates for pain or antianxiety meds with the potential to affect your performance and your workplace carries out drug testing, it’s a good idea to explore this with your doctor and let your employer know immediately. It is the smart and responsible thing to do to be proactive rather than having to explain a not-negative result after the fact or, more importantly, to place yourself and others at unnecessary risk.

For workplaces, there are also some key messages:

• Firstly, it’s important to include detailed information and advice about prescribed medication, including ADHD medication, in your workplace drug and alcohol management policy and the responsibility to report it.
• Educate your workforce on the risks of coming to work after taking certain types of prescription drugs. Some medications may only present risk in the first week of use or for increased dosage.
• Reiterate to your workforce that the aim of managing certain prescription drugs properly is to ensure workplace safety.
• Encourage your workforce to report to their manager or supervisor immediately if they have been prescribed medication that could make them unsafe to work or could potentially lead to a not-negative drug test.
• Implement random workplace drug testing to raise awareness of the policy and improve early identification and workplace safety. Drug and alcohol testing is the only sure way to know if someone may be under the influence of a drug or alcohol and is unsafe to be in the workplace.

By Ann-louise Anderson, Inscience Limited