Occupational health concerns of cannabis use

Last updated

Occupational health concerns over the use of cannabis among workers are becoming increasingly important as cannabis becomes legal in more areas of the US. [1] [2] Of note, employers have concerns of workers either coming to work acutely impaired or recent use of cannabis still being detected in the body. Employment issues such as ADA law as it relates to accommodations for cannabis, paying unemployment benefits or paying out workers compensation benefits and disability claims are all important issues. While federal law still prohibits use, employers in different states have taken different stances based on whether they are federal contractors, perform safety sensitive work or whether the cannabis use is acutely impairing the employee.

Contents

Cannabis is currently the most commonly used illicit drug in the world and one of the earliest plants cultivated by humans. Early evidence of cannabis use in medicine has been found in China and India for religious and medicinal uses. Archaeological research shows early civilization cultivation of hemp in India to create a variety of products from ropes, textiles and paper. In countries, such as Nepal and China, cannabis seeds are still used today both as a pharmaceutical as well as a food enhancer. [3] Lack of concentration, impaired learning and memory, alterations in thought formation, expression and sedation have been associated with cannabis use. Physiological signs include tachycardia, dilated pupils with injected conjunctiva, dry mouth and increased appetite Studies have also confirmed that impairment is related on a dose response relationship.

As cannabis use increases and more states legalize use in the US, there are concerns surrounding the use of cannabis and its effects on job performance and safety. There are also concerns that the concentration of THC have increased over the past 50 years, thereby increasing the effects of the drug. [4] The Controlled Substances Act of 1970 currently lists cannabis as a Schedule 1 drug, deeming it to be a substance with high risk of dependence, abuse and no (supervised) medical uses. The CATO institute estimates that legalizing drugs would save $41 billion per year along with $46.7 billion in revenue, if taxed at the same rates as alcohol and tobacco. [5]

Employers and employees have faced new challenges in the workplace with the increasing legislation of cannabis. State law can have provisions, for an employer to refuse to hire based on marijuana use, under the concern of safety, productivity and company reputation. Companies that have “safety sensitive work” or include operating machinery or large vehicles are also free to institute a zero-tolerance policy for its employees. For the approximate 10 million CDL (Commercial Drivers Licenses) drivers in the USA, federal law requires they pass employer drug tests under the Omnibus Transportation Employee Safety Act of 1991.

Individual states in response to the federal government differed in how they dealt with cannabis. California was the first state to pass medical marijuana in 1996, followed by 23 other states currently permitting the use of medical marijuana.

In the case of U.S. v. Stacey among several others, the legality of cannabis use has been contested since citizens who argue for protection under state law, are always subject to federal charges [6] While there has been some guidance from the Department of Justice to the DEA to reassess its priorities in the drug war and to target larger threats and substances, the interpretation is still subjective and has not prevented large scale raids on medical marijuana facilities across the country. [4]

State response to cannabis

California was the first state to pass medical marijuana in 1996, followed by 23 other states currently permitting the use of medical marijuana [7] For the states that have legalized medical marijuana, employees and employers have had to face new challenges in the workplace. State law can have provisions, for an employer to refuse to hire based on marijuana use, under the concern of safety, productivity and company reputation. Companies that have a lot of “safety sensitive work” or include operating machinery or large vehicles are also free to institute a zero-tolerance policy for its employees. For the approximate 10 million CDL (Commercial Drivers Licenses) drivers in the USA, federal law requires they pass employer drug tests under the Omnibus Transportation Employee Safety Act of 1991.

Drivers that use cannabis show impairment both in simulator and on the road tests, mainly on the abilities to “..concentrate and maintain attention, estimate time and distance, and demonstrate coordination on divided attention tasks—all important requirements for operating a motor vehicle” [4]

The Department of Transportation (DOT) has also stated in its Drug and Alcohol Testing Regulations that cannabis is not acceptable for any employee engaged in safety sensitive work. Currently, there are federal laws that give employers guidance and protection on how to ensure a drug free workplace despite the increase in cannabis use. According to the National Association of Attorneys General (NAAG), in Colorado the number of positive drug tests for marijuana went up by 20% between 2012-2013, compared to the national average increase of 5% [8]

For those companies that have received federal grants and have federal contracts over $100,000, they follow The Drug Free Workplace Act of 1988, a comprehensive policy, which includes drug prevention methods, information about employee assistance programs and disciplinary consequences of drug use in the workplace [9] Federal agencies are required to use the Substance Abuse and Mental health Services Administration (SAMHSA) procedures for testing and recommend private employers use the same criteria for consistency. [10] The policy requires employees to report any criminal drug violations in the workplace to the employer within 5 calendar days which may subsequently result in discipline including termination, regardless of state law. [11]

The Occupational and Safety Act of 1970 includes a general duty clause for employers to protect employees from exposure for those compounds with no regulated standards of safe exposure. It has been defined broadly as to “maintain conditions or adopt practices reasonably necessary and appropriate to protect workers on the job. [12] The ADA prohibits employers from discriminating against disabled individuals, which is defined as “a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.”

Employers under this law have an obligation to provide “reasonable accommodations” to the disabled employee, so they may perform the essential duties of the job, as long as those accommodations don’t pose an undue hardship on the employer". [13] The ADA section 12114(a) however states that these rights are not granted to employee or applicant who is currently engaging in the illegal use of drugs [13] The ADA does not require employer coverage when the employee is engaging in the “illegal use of drugs”, including marijuana which is still illegal under the Controlled Substance Act.

Wrongful termination for cannabis

Coats v. Dish Network LLC, held that a “state’s lawful activities statute does not protect a worker’s off-duty use of medical marijuana because this activity is not lawful under federal law” under the ordinary meaning of “permitted by law” [14]

Workers compensation benefits

The Federal Employees Compensation Act (FECA) provides for the payment of workers’ compensation benefits, including wages and medical benefits, to civilian officers and employees of all branches of the federal government, whereas state law has oversight over its own workers’ compensation program

FECA prohibits employees from receiving compensation when the injury “was proximately… caused by the intoxication by… illegal drugs.” [15] [16]

Unemployment benefits

Colorado Court of Appeals in Beinor v Industrial Claim Appeals [17] agreed with the employer and held that unemployment insurance benefits could be withheld due to the violation of the employer’s zero tolerance drug policy. Worker was a sweeper using cannabis legally outside of working hours. Colorado State statue “disqualifies an individual from receiving unemployment benefits after the presence of a controlled substance was not medically prescribed was found in the worker’s system during worker hours.”

Drug testing in the workplace

Cannabis has unique pharmacokinetics and metabolism which makes it a challenge to drug test for acute impairment vs recent use. THC is deposited in fat and can be detectable in urine for up to a month or more. However, it is not always an indicator of acute impairment. Further there are privacy concerns, from invasive blood testing for compounds, under the 4th Amendment of the US constitution. Variability in study designs, ethical dilemma of safety and productivity, work type and drug metabolism in users. When smoked, blood levels of THC immediately rise and are distributed primarily in the lungs and brain. THC is metabolized to the transient psychoactive substance THC-OH, which is finally converted to THC-COOH, the physiologically inactive metabolite. The immediate euphoria and subsequent impairment from THC-OH, as suggested by older studies may last about 6 hours, with some limited studies showing impairment lasting as long as 24 to 48 hours [18] Specific studies that assess driving and impairment show a return to "...nonimpaired state within 3-6 hours.“ [4]

The method of testing cannabis in urine can be misleading, due to the potential for interpreting a positive result for THC-COOH, as an indicator of acute impairment.[ citation needed ]

Challenges for healthcare providers

FSMB (Federal State Medical Boards) after reviewing over 50 major studies in the field, have offered these 10 recommendations: [19]

1)Thoroughly document patient’s visit prior to considering cannabis use for those with good compliance. Information on the inadequacy of response to other treatment, comprehensive history and physical condition should be included.

2) Don’t treat close friends or family.

3) Inform risks and benefits.

4) Compliance Contract, concerns of diversion.

5) Regular Visits are recommended.

6) No relationships with dispensaries or cannabis companies.

Measuring impairment for workers

A large study in France of over 10,000 crashes, concluded an odds ratio of 2.18 for THC level less than 1 ng/ml up to 4.72 for THC 5 ng/ml for being involved in a crash. [20] Some researchers such as Donzé N, Ménétrey have considered categorizing impairment as the sum of THC, THC-OH and THC-COOH, which would be more accurate for assessing impairment since it would include the active metabolite; however, more research is needed along with better point of care detection. Some Norwegian studies have suggested that individuals with levels of 2-5 ng/mL experienced “moderate established impairment” and levels of THC above 5 -10 ng/ml was likely to be severe impairment. [20]

The consensus from a meta-analysis study shows that serum levels of an average of 3.8 (ranging from 3.1 to 4.5) for oral cannabis and an average of 3.8 (ranging from 3.3 to 4.5) for smoker cannabis cause a similar impairment to a BAC of around 0.05g/dL, i.e. a 5 ng/mL cutoff would resemble the level of impairment allowed for alcohol under federal testing laws. [21] However, since the presence of metabolites does not automatically indicate impairment, an immediate physical exam by a physician is advised to correlate findings clinically to diagnose impairment. [21]

Related Research Articles

Cannabis edible Food product containing cannabis extract

A cannabis edible, also known as a cannabis-infused food or simply an edible, is a food product that contain decarboxylated cannabinoids from cannabis extract as an active ingredient. Although edible may refer to either a food or a drink, a cannabis-infused drink may be referred to more specifically as a liquid edible or drinkable. Edibles are a way to consume cannabis. Cannabis edibles may affect people for a longer period of time than smoked cannabis.

Medical cannabis Marijuana used medicinally

Medical cannabis, or medical marijuana (MMJ), is cannabis and cannabinoids that are prescribed by physicians for their patients. The use of cannabis as medicine has not been rigorously tested due to production and governmental restrictions, resulting in limited clinical research to define the safety and efficacy of using cannabis to treat diseases.

The Occupational Safety and Health Administration is a large regulatory agency of the United States Department of Labor that originally had federal visitorial powers to inspect and examine workplaces. Congress established the agency under the Occupational Safety and Health Act, which President Richard M. Nixon signed into law on December 29, 1970. OSHA's mission is to "assure safe and healthy working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance". The agency is also charged with enforcing a variety of whistleblower statutes and regulations. OSHA's workplace safety inspections have been shown to reduce injury rates and injury costs without adverse effects to employment, sales, credit ratings, or firm survival.

Occupational Safety and Health Act (United States)

The Occupational Safety and Health Act of 1970 is a US labor law governing the federal law of occupational health and safety in the private sector and federal government in the United States. It was enacted by Congress in 1970 and was signed by President Richard Nixon on December 29, 1970. Its main goal is to ensure that employers provide employees with an environment free from recognized hazards, such as exposure to toxic chemicals, excessive noise levels, mechanical dangers, heat or cold stress, or unsanitary conditions. The Act created the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH).

Driving under the influence Driving a motor vehicle while under the influence of an impairing substance

Driving under the influence (DUI) is the offense of driving, operating, or being in control of a vehicle while impaired by alcohol or drugs, to a level that renders the driver incapable of operating a motor vehicle safely.

A drug test is a technical analysis of a biological specimen, for example urine, hair, blood, breath, sweat, and/or oral fluid/saliva—to determine the presence or absence of specified parent drugs or their metabolites. Major applications of drug testing include detection of the presence of performance enhancing steroids in sport, employers and parole/probation officers screening for drugs prohibited by law and police officers testing for the presence and concentration of alcohol (ethanol) in the blood commonly referred to as BAC. BAC tests are typically administered via a breathalyzer while urinalysis is used for the vast majority of drug testing in sports and the workplace. Numerous other methods with varying degrees of accuracy, sensitivity, and detection periods exist.

Cannabidiol Phytocannabinoid discovered in 1940

Cannabidiol (CBD) is a phytocannabinoid discovered in 1940. It is one of 113 identified cannabinoids in cannabis plants, along with tetrahydrocannabinol (THC), and accounts for up to 40% of the plant's extract. As of 2019, clinical research on CBD included studies related to anxiety, cognition, movement disorders, and pain, but there is insufficient high-quality evidence that cannabidiol is effective for these conditions.

Removal of cannabis from Schedule I of the Controlled Substances Act Proposed change to the Controlled Substances Act in the United States

In the United States, the removal of cannabis from Schedule I of the Controlled Substances Act, the most tightly restricted category reserved for drugs that have "no currently accepted medical use,” has been proposed repeatedly since 1972.

Legalization of non-medical cannabis in the United States Legalization of marijuana in the United States

In the United States, the non-medical use of cannabis is legalized in 18 states and decriminalized in 13 states as of June 2021. Decriminalization refers to a policy of reduced penalties for cannabis offenses, typically involving a civil penalty for possessing small amounts, instead of criminal prosecution or the threat of arrest. In jurisdictions without penalty the policy is referred to as legalization, although the term decriminalization is sometimes used for this purpose as well.

"Right to know" empowers "people by allowing them to participate in an informed way in decisions that affect them, while also holding governments and others accountable". It pursues universal access to information as essential foundations of inclusive knowledge societies.

Drug policy of California Overview of the drug policy of the U.S. state of California

Drug policy of California refers to the policy on various classes and kinds of drugs in the U.S. state of California. Cannabis possession has been legalized with the Adult Use of Marijuana Act, passed in November 2016, with recreational sales starting January of the next year. With respect to many controlled substances, terms such as illegal and prohibited do not include their authorized possession or sale as laid out by applicable laws.

Cannabis in the United States Overview of the use and culture of cannabis in the United States

The use, sale, and possession of cannabis over 0.3% THC in the United States, despite laws in many states permitting it under various circumstances, is illegal under federal law. As a Schedule I drug under the federal Controlled Substances Act of 1970, cannabis over 0.3% THC is considered to have "no accepted medical use" and have a high potential for abuse and physical or psychological dependence. Cannabis use is illegal for any reason, with the exception of FDA-approved research programs. However, individual states have enacted legislation permitting exemptions for various uses, including medical, industrial, and recreational use.

Cannabis in Colorado Overview of the use and culture of cannabis in Colorado, U.S.

Cannabis in Colorado has been legal for medical use since 2000 and for recreational use since late 2012. On November 7, 2000, 54% of Colorado voters approved Amendment 20, which amended the State Constitution to allow the use of marijuana in the state for approved patients with written medical consent. Under this law, patients may possess up to 2 ounces (57 g) of medical marijuana and may cultivate no more than six marijuana plants. Patients who are caught with more than this in their possession may argue "affirmative defense of medical necessity" but are not protected under state law with the rights of those who stay within the guidelines set forth by the state. The Colorado Amendment 64, which was passed by voters on November 6, 2012, led to recreational legalization in December 2012 and state-licensed retail sales in January 2014. The policy has led to cannabis tourism. There are two sets of policies in Colorado relating to cannabis use: those for medicinal cannabis and for recreational drug use along with a third set of rules governing hemp.

Cannabis drug testing Drug test methodologies for the use of cannabis in medicine, sport, and law

Cannabis drug testing describes various drug test methodologies for the use of cannabis in medicine, sport, and law. Cannabis use is highly detectable and can be detected by urinalysis, hair analysis, as well as saliva tests for days or weeks.

Work-related road safety in the United States

People who are driving as part of their work duties are an important road user category. First, workers themselves are at risk of road traffic injury. Contributing factors include fatigue and long work hours, delivery pressures, distractions from mobile phones and other devices, lack of training to operate the assigned vehicle, vehicle defects, use of prescription and non-prescription medications, medical conditions, and poor journey planning. Death, disability, or injury of a family wage earner due to road traffic injury, in addition to causing emotional pain and suffering, creates economic hardship for the injured worker and family members that may persist well beyond the event itself.

Drug policy of Michigan Overview of the drug policy of the U.S. state of Michigan

The U.S. state of Michigan has various policies restricting the production, sale, and use of different controlled substances. Some of the policies are unique to the state while others are similar to federal law. Laws pertaining to controlled substances can be found almost exclusively in various sections of public health code, specifically Act 368 of 1978.

Cannabis in New York Use of cannabis in New York State

Cannabis in New York is legal for recreational and medical use. Adults aged 21+ are allowed to possess up to 3 ounces (85 g) of cannabis or 0.85 ounces (24 g) of concentrated cannabis. Adults 21 and older are allowed to possess up to 5 lbs individually in their own homes. In addition, home cultivation of up to three mature and three immature cannabis plants per individual will be permitted, with a maximum of twelve plants per household, once regulations for home grow are in place. Previously, the possession of small amounts of cannabis had been decriminalized and was treated as a violation. The medical use of cannabis is permitted in certain circumstances. On March 30, 2021, both houses of the New York State Legislature approved legislation to legalize marijuana. The bill was signed into law by former New York Governor Andrew Cuomo on March 31, 2021. The law also resulted in previous marijuana-related criminal records in the state of New York being expunged. As of October 2021 New York State prohibited employers from testing both prospective and current employees for cannabis use or otherwise discriminating against employees who use cannabis outside of work hours.

Two main questions arise in the law surrounding driving after having ingested cannabis: (1) whether cannabis actually impairs driving ability, and (2) whether the common practice of testing for THC is a reliable means to measure impairment. On the first question, studies are mixed. Several recent, extensive studies–including one conducted by the National Highway Traffic Safety Administration and one conducted by the American Automobile Association (AAA)–show that drivers with detectable THC in their blood are no more likely to cause car crashes than drivers with no amount of THC in their blood. Others show that cannabis can impair certain abilities important to safe driving –but no studies have been able to show that this increases the actual risk of crashing, or that drivers with THC in their blood cause a disproportionate number of crashes. On the second question, the studies that have been conducted so far have consistently found that THC blood levels and degree of impairment are not closely related. No known relationship between blood levels of THC and increased relative crash risk, or THC blood levels and level of driving impairment, has been shown by single-crash or classic-control studies. Thus, even though it is possible that cannabis impairs driving ability to some extent, there are currently no reliable means to test or measure whether a driver was actually impaired.

Outline of cannabis Overview of and topical guide to cannabis

The following outline is provided as an overview of and topical guide to the plant Cannabis sativa and its relatives Cannabis indica and Cannabis ruderalis, the drug cannabis (drug) and the industrial product hemp.

Workplace hazard controls for COVID-19 Prevention measures for COVID-19

Hazard controls for COVID-19 in workplaces are the application of occupational safety and health methodologies for hazard controls to the prevention of coronavirus disease 2019 (COVID-19). Vaccination is the most effective way to protect against severe illness or death from COVID-19. Multiple layers of controls are recommended, including measures such as telework and flexible schedules, increased ventilation, personal protective equipment (PPE) and face coverings, physical distancing, and enhanced cleaning programs.

References

  1. ↑ Biasutti, Wade R.; Leffers, Kurt S. H.; Callaghan, Russell C. (2020-08-03). "Systematic Review of Cannabis Use and Risk of Occupational Injury". Substance Use & Misuse. 55 (11): 1733–1745. doi:10.1080/10826084.2020.1759643. ISSN   1082-6084. PMID   32441179. S2CID   218834536.
  2. ↑ Phillips, Jennan A.; Holland, Michael G.; Baldwin, Debra D.; Gifford-Meuleveld, Linda; Mueller, Kathryn L.; Perkison, Brett; Upfal, Mark; Dreger, Marianne (2015-04-10). "Marijuana in the Workplace: Guidance for Occupational Health Professionals and Employers: Joint Guidance Statement of the American Association of Occupational Health Nurses and the American College of Occupational and Environmental Medicine". Workplace Health & Safety. 63 (4): 139–164. doi:10.1177/2165079915581983. PMID   25862727. S2CID   43657638.
  3. ↑ Zuardi, Antonio Waldo (2006). History of cannabis as a medicine: A review. pp. 153–7.
  4. 1 2 3 4 Phillips, Jennan (2015). "Marijuana in the workplace: Guidance for occupational health professionals and employers: Joint guidance statement of the american association of occupational health nurses and the american college of occupational and environmental medicine". Workplace Health and Safety. 63 (4): 139–64. doi:10.1177/2165079915581983. PMID   25862727. S2CID   43657638.
  5. ↑ "The budgetary impact of ending drug prohibition" (PDF).
  6. ↑ Houser, Kimberly A.; Rosacker, Robert E. "High times: A history of marijuana laws in the united states". International Journal of Business and Public Administration.
  7. ↑ "Introduction - NORML. Marijuana Law Reform - NORML. N.p., n.d. Web".
  8. ↑ Liquori, Francesca (February 2016). "The Effects of Marijuana Legalization on Employment Law". National Attorneys General Training and Research Institute Journal. 1 (2).
  9. ↑ "US Department of Labor, Office of the Assistant Secretary for Policy. Drug-Free Workplace Policy Builder Section 7: Drug Testing. DOL elaws—Drug-Free Workplace Advisor".
  10. ↑ Houser, High times: A history of marijuana laws in the united states.
  11. ↑ Costello, Bob. "Truck Driver Shortage Analysis.".
  12. ↑ "US Department of Labor. Occupational Health and Safety Administration. OSH Act of 1970. Sec. 5. Duties". osha.gov. table OSHACT.
  13. 1 2 "What Is the Americans with Disabilities Act (ADA)?" ADA National Network. Accessed November 2016". adata.org.
  14. ↑ "Coats v. Dish Network, Llc., 13 SC 394 No. (Colo. Jun 15, 2015)".
  15. ↑ "Moore v. Sullbark Builders Moore v. Sullbark Builders, Inc., 680 S.E.2d 732 (N.C. Ct. App. 2009".
  16. ↑ "Noll vs. LePage Bakeries Noll v. Lepage Bakeries, Inc., Me. W.C.B. No. 16-25, (App. Div. 2016)".
  17. ↑ "Beinor v. Indus. Claim Appeals Office, 262 P.3d 970 (Colo. App. 2011)".
  18. ↑ "J. A. Phillips et al., "Marijuana in the Workplace" 461".
  19. ↑ "Chaudhry HJ, Hengerer AS, Snyder GB. Medical Board Expectations for Physicians Recommending Marijuana. JAMA. 2016;316(6):577-578. doi:10.1001/jama.2016.7741".
  20. 1 2 Ménétrey, Annick; Augsburger, Marc; Favrat, Bernard; Pin, Marie A.; Rothuizen, Laura E.; Appenzeller, Monique; Buclin, Thierry; Mangin, Patrice; Giroud, Christian (2005-07-01). "Assessment of Driving Capability Through the Use of Clinical and Psychomotor Tests in Relation to Blood Cannabinoids Levels Following Oral Administration of 20 mg Dronabinol or of a Cannabis Decoction Made with 20 or 60 mg Δ9-THC*". Journal of Analytical Toxicology. 29 (5): 327–338. doi: 10.1093/jat/29.5.327 . ISSN   0146-4760. PMID   16105257.
  21. 1 2 Khiabani, H. Z.; Bramness, J. G.; Bjørneboe, A.; Mørland, J. (2006). "Relationship between THC concentration in blood and impairment in apprehended drivers". Traffic Injury Prevention. 7 (2): 111–6. doi:10.1080/15389580600550172. PMID   16854704. S2CID   23286310.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.