Why is monitoring important? What role does it play in Employee Wellness? It is estimated that 10 percent of the population have a substance use disorder. In the workplace this can lead to problems with attendance, performance, productivity, morale and safety.

Recovery from substance use disorders is a process and evidence has shown that treatment alone is insufficient for maintaining stable abstinent remission. Evidence has also demonstrated that it is the relapse prevention activities that occur after treatment that are the best predictors and indicators of long term success.

Medical monitoring of employees in early recovery from substance use disorders allows employers to return these employees to work under an evidence based program that has demonstrated the highest rates of successful sustained remission. For the substance dependent employee, participation in a medical monitoring program provides them with the best possible chance for long term recovery. For employers, they are mitigating liability within a safety-sensitive workplace while getting a more productive and healthier employee.

A substance use policy, and the rules inherent in this policy are important for outlining the employer’s expectations for a safe, healthy and productive workplace, as well as a crucial tool for contingency management.

For more information on the rationale, development and implementation of a substance use policy and contingency management protocols please see The Canadian Model version 6, July 2018.

1. Technical Non-Compliance: refers to single incidents of non-critical non-compliance such as:

• Missing a single monitoring session
• Attending less than the requisite number of peer support group meetings
• Not submitting evidence of peer support group meeting attendance

Oversight bodies and employer designates may not take any action with the first report of technical non­compliance. With more than one report, they may choose to interview the participant to reinforce expectations and to ensure the employee remains fit for duty.

2. Moderate Non-Compliance: refers to escalating or patterns of technical non-compliant behaviours or attitudes, which individually may not be of concern, but combined, may suggest a higher risk for relapse. These may include:

• Missing more than a single monitoring session or frequent rescheduling
• Continued attendance of less than required mutual support group meetings
• Continued failure to track and/or report mutual support group attendance

With a Level 2 report, the oversight body or employee designate may choose to interview the participant to reinforce requirements and to ensure the employee is fit for duty. There may be additional consequences at this level.

3. Critical Non-Compliance: refers to critical incidents such as:

• Refusal or Failure to attend for biological testing
• Adulterated biological samples
• A positive biological test
• PharmaNet evidence or disclosed use of unauthorized contraindicated medications
• Disclosure of use or relapse

Critical incidents of non-compliance suggest relapse or unacceptable safety risk, and these are reported immediately. Level 3 reports result in an immediate intervention such as removal of the employee from safety sensitive work or the suspension of benefits, with further possible consequences.

Employees living in the Metro Vancouver area are expected to attend the office for monitoring appointments. Once stable abstinent remission has been achieved and the employee has returned to work, consideration may be given to alternating between in office and telephone appointments. If verified by the employer that there is hardship placed on an employee to attend the office, arrangements may be made for more frequent, or all sessions to occur by telephone.

In many cases, the employer pays for the medical monitoring of their employees. Prior to return to work, an insurer may cover the costs, with the costs then transferring to the union or employer upon return to work. There are also cases where there is a cost share arrangement made between the employer and the employee, and in other cases the employee is solely responsible for the costs of their monitoring. The duration for which each invested party pays may also be proportionate to the term of the RPA. In considering the various options, it is important to be aware that the cost of monitoring should not be a barrier to returning to work.

Medical monitoring is a form of evidence based contingency management and a critical component in the safe return to work of safety-sensitive employees recovering from substance use disorders.

Alliance Medical Monitoring Inc. observes and reports back to the employer designate or oversight authority the employee’s compliance with the terms of their individualized monitoring agreement, known as a Relapse Prevention Agreement. This agreement includes, but is not limited to, randomly generated, unpredictable biological testing, involvement in peer support programs, face-to-face or telephonic sessions with a monitor, review of prescribed and over the counter medications, and participation in recovery-based therapeutic peer support.

Although recommended, an evaluation is not necessary to enroll an individual in monitoring.

Normally, an Independent Medical Evaluation (IME) outlines both treatment recommendations and monitoring requirements and these requirements are incorporated into the terms of the monitoring agreement that your employee will sign. There are circumstances, however, where enrolling a participant into a monitoring program without the completion of an assessment, is required. Alliance can facilitate monitoring based on your particular situation.

If you suspect that any employee is impaired or under the influence at work, you may demand a 'reasonable cause' biological test. Your first step is to talk to the employee and explain your concerns and any observable behaviour(s) that led to the suspicion that they might be under the influence. If your employee is already being monitored, contact the monitoring agency who will arrange for immediate testing. If your employee is not being monitored, you can contact Alliance during office hours and we will arrange for immediate testing of your employee.

Alliance Medical Monitoring Inc. also offers 24/7 post incident and reasonable cause testing programs, as well as pre-employment/pre-access testing. Contact Alliance to find out how these services may be beneficial to your organization.

The Independent Medical Evaluation normally determines the medical monitoring requirements. A testing only program means that the employee is only subject to biological testing, and is not required to participate in any other requirements of a more fulsome Relapse Prevention Agreement. If unsure which program is best for your circumstances, please contact us directly and we would be happy to help.

The terms for return to work are usually referenced in the Independent Medical Evaluation. Some companies also have clauses in their Substance Use Policy regarding the timelines and conditions for return to work. Alliance is not involved in these decisions.

Medical Monitoring of safety sensitive employees who are returning to work after treatment for a substance use disorder addresses employers’ obligation to ensure a safe work environment and does not contravene human rights legislation, occupational health and safety legislation, or privacy legislation.

Alliance Medical Monitoring Inc. is responsible for reporting incidents of non-compliance and is not responsible for determination of the consequence to a participant as a result of a report of non-compliance. It is recommended that clients have a process in place to address such reports. Possible options for intervention by a client may include interviewing the participant for details and to reinforce requirements and expectations, warning of escalated discipline in the event of future reports of non-compliance, removal of the employee from safety sensitive work, suspension of benefits, referral for re-evaluation, or any other measure deemed appropriate by the client.

Randomly generated biological testing dates than cannot be predicted or anticipated are an essential component of medical monitoring, and evidence has shown that this type of testing protocol is not only best practice, but also reduces incidents of relapse. While there may be rare occasions where an employee cannot leave the workplace, if these were to occur more frequently, it would not be possible for Alliance to report with any degree of confidence that your employee is remaining abstinent and they may become ineligible for monitoring. Please discuss any concerns with the monitor directly to determine appropriate alternative arrangements which will retain the integrity of the monitoring program.

Yes, there are occasions where a non-safety sensitive employee will have a recommendation by an Independent Medical Evaluator to have a period of medical monitoring prior to and in the early months of returning to work.

While many of our clients do have an Occupational Health and Wellness Department or a Human Resources Department, we also work directly with unions, company owners or management, oversight authorities, etc., in helping employers to facilitate monitoring within the circumstances of their individual workplace.