Monitoring RPA

• What does RPA stand for?

• RPA is Relapse Prevention Agreement. This is the agreement you signed at enrollment which outlines your customized terms for monitoring.
  
  

• How do I keep this private at work?

• You are under no obligation to disclose your personal health matters to colleagues at work. Normally, there is an employer designate whose responsibility is to oversee employee health concerns in a confidential manner. You are encouraged to discuss confidentiality policies in your workplace with your employer or designate.
  
  

• Monitoring takes too much time away from my family. Between work and monitoring, I have no life.

• It is important for recovery to become integrated into your lifestyle by choosing times and locations for your recovery activities which do not conflict with other important areas of your life. Unfortunately, there will be times where scheduling conflicts may occur, however, overall recovery will ideally become another important aspect of your life, not something viewed as a separate and burdensome obligation.
  
  

• Why do I have to travel so far for a 10 minute appointment?

• Monitoring sessions are scheduled in 30 minute increments and are designed to cover the key aspects of your recovery program. Some individuals use the entire 30 minutes, while others, especially those with longer term abstinence, are able to speak to their recovery program quickly. Once a participant has reached this stage in their recovery, concessions may be made, on a case by case basis, for alternating telephone and in-person sessions. Please speak to your monitor if you feel this is an option you would like to discuss.
  
  ** Note that participants in the first 3 months of monitoring, and who reside locally, are not normally eligible for telephone sessions.
  
  

• My work requirements make monitoring too difficult.

• Monitoring is normally a condition of work and accordingly, your employer may work with you to ensure that you are able to balance your work requirements, with the requirements of your monitoring.
  
  

• Monitoring is not my choice and it is just putting more stress on me.

• Monitoring can feel overwhelming to start and it can take some time to integrate recovery into your lifestyle. It is important to be patient with yourself, utilizing healthy coping skills to find balance while integrating recovery into your lifestyle.
  
  

• What happens to all this when I go back to work?

• Monitoring normally continues for a period of 1 year, and up to 10 years or more, depending on your position and the recommendations. This means that in most circumstances, monitoring will continue once you have returned to work. Your specific terms are written into your RPA. If you have any questions or concerns about the expectations of your monitoring, please speak to your monitor.
  
  

Monitoring Sessions

• What happens if I miss my monitoring session?

• Failure to attend enough monitoring sessions each month will be reflected on the monthly progress report as non-compliance.
  
  If you forget an appointment, and make it up before the end of the 1 week period / 2 week period / month, depending on your session frequency, you will not be non-compliant.
  
  If you fail to attend a scheduled appointment without giving adequate notice (24 hours), you will be charged a $50 missed appointment fee which is payable prior to your next appointment, including if your next appointment is the “make-up” appointment.
  
  

• The monitoring sessions interfere with my work schedule

• Monitoring sessions are a requirement of your RPA as recommended by your Addiction evaluator. The employer, if informed of the necessity for this appointment for medical reasons, will usually accommodate this brief absence. 
  
  Additionally, there are monitors available 5 days per week, from 7:00am until 4:30pm. It is anticipated that this availability will allow participants to schedule appointments in as convenient a manner as possible around work commitments.
  
  

Non-compliance and Reporting

• What kinds of things will make me non-compliant?

• The following is a list of some of the most common examples of reportable non-compliance:
  
  • Failure to attend for testing as required
  • Failure to attend mutual support group meetings / enough meetings
  • Failure to schedule/attend monitoring sessions
  • Non-negative test results
  • Disclosure of use/relapse
  • Failure to attend home group/caduceus group as required
  • Inappropriate behaviours towards any staff of Alliance or the staff at any collection site or laboratory
  • Failure to comply with any of the terms in your RPA resulting from specific recommendations in your evaluation.
  
  

• What happens if I am non-compliant?

• The role of Alliance Medical Monitoring Inc. is to report compliance and non-compliance with the terms of your Relapse Prevention Agreement. If you are non-compliant, this will be reported to your designate. If you are reported non-compliant, your designate will decide what the next steps are to occur.
  
  

• What happens after I am reported non-compliant?

• The role of Alliance Medical Monitoring Inc. is to report compliance and non-compliance with the terms of your Relapse Prevention Agreement. If you are reported non-compliant, your designate will decide what the next steps are to occur.
  
  

• What is in a progress report?

• A monthly progress report outlines compliance or non-compliance with the key terms of the Relapse Prevention Agreement: 
  
  • Testing attendance and results
  • Mutual Support Group attendance / home group / sponsor
  • Monitoring session attendance
  • Disclosure of use/relapse
  
   ** And any other custom terms specific to your RPA based upon the report from your specialist.
  
  

Biological Testing

• How am I notified for testing?

• You will be notified for testing one of two ways:
  
   1. Online notification – participants who have a smart phone and/or regular computer access will be provided a login id and password which they will use daily to log into the Alliance website for determination of testing status. Once you check-in, you will be advised either that you are not required for testing, or that you are required for testing.
  
   2. Call-in notification – All participants are given a Numeric Identity Code. Participants who do not have regular computer access will use the dedicated telephone number which they will call daily for determination of testing status. When you call in, you will be listening for your Numeric Identity Code to be announced. If your Numeric Identity Code is announced, you are required for testing. If your Numeric Identity Code is not announced, you are not required for testing.
  
  

• Do I have to check in everyday?

• Yes, it is your responsibility to check in for your testing status every day, Monday through Sunday, to determine whether or not you are up for testing.
  
  

• What happens if I miss a test?

• Missed tests are typically reported as critically non-compliant unless there is a valid and verifiable explanation for why the test was missed.
  
  

• Work won’t let me leave to test, so I cannot get there before the collection site deadline for testing.

• Monitoring is typically a condition of ongoing employment so normally your employer will take whatever steps are necessary to facilitate you leaving for testing. If you are in a position where leaving can be an issue, please speak to your monitor so that they may speak to your employer in order to determine strategies for facilitating random testing for you.
  
  

• What if I get called for a test while I am at work? I can’t miss work for testing, my job is too important.

• Biological testing is part of the monitoring program which your employer designate is requiring you to participate in. If there is a concern around your attendance for testing, please speak to your monitor who will follow up with your employer.
  
  

• Can there be a false positive result?

• A false-positive test is extremely unlikely due to the confirmation testing done before reporting a non-negative result. As part of the testing process, in the event that a participant returns a non-negative result, our Certified Medical Review Officer will speak to the participant to determine if there is a reasonable explanation for the result.
  
  

• How many tests do I have to provide?

• Test dates are randomly generated and may total in excess of 36 per year as per the recommendations of Addiction Evaluator. This does not necessarily mean 2 or 3 tests each month as you may be tested 1 time one month and 4 times another month, depending on the dates generated by the computer.
  
  

• Can I get more notice for testing?

• The majority of participants are provided same-day notification, with the requirement to attend the lab no later than 1 hour before closing on that day. Notification will be clarified with you as it relates to your specific circumstances during enrollment and at your first monitoring session.
  
  

• Why is missing a test the same as a positive test? I didn’t use. I just forgot to check in/go for my test.

• A missed test is treated the same as a positive test because there is no means for Alliance to determine whether or not you would have returned a negative result had you attended as required. Some participants ask to be tested the next day, however, a negative result the next day is not indicative of a negative result had you tested as originally required. There are many substances which can fall below cut-off levels in one day. This is why it is important to put reminders and safeguards in place to ensure you attend all tests as required.
  
  

Chain of Custody

• What does Chain of Custody mean in biological testing?

• Chain of custody is a legal process for collecting biological samples, whether urine, hair, oral saliva, etc.
  
  

• Why am I subject to chain of custody testing?

• All testing through Alliance Medical Monitoring Inc. is conducted following chain of custody protocols and procedures for your protection, as we want to be certain that when the sample is tested, it is your sample. The first step in this process is that you must show a government issued photo ID, like a driver’s licence, Provincial ID, or a passport, to prove who you are. The chain of custody systems and protocols are also designed to ensure accuracy and reliability of results.
  
  

• What is the difference in a chain of custody urine test, and a urine sample I leave at my doctor’s office?

• The biggest difference is that in a chain of custody urine collection, your urine sample does not leave your sight until the sample has been poured off into 2 separate containers, those containers have been sealed with tape that you initial, the 2 sealed containers are then placed in a bag with a copy of a form that has been filled out and signed by you, and then that bag is sealed. Only after the bag is sealed and you have been provided a copy of the form, can you leave the collection site. The only person who can break the seals is the laboratory technician who will be testing your sample.
  
  

• What will I have to do when I am tested?

• • You will be asked to present Government issued photo ID, such as a driver’s license, a passport or Provincial ID.
  
  • You will be asked to leave coats, bags, briefcases, etc. outside the collection area, and will be asked to empty the contents of your pockets and remove hats.
  
  • The collection of the specimen will NOT be observed, unless you have otherwise been advised that the collection will be witnessed.
  
  • You will be asked to wash your hands before collecting the specimen.
  
  • You will be asked to provide a minimum of 45 mls of urine. If your specimen is less than 45 mls, you will be asked to wait, drink some fluids and submit another specimen. You may NOT leave the collection site until an adequate specimen has been provided. Please note that if you leave, it will be reported to Alliance and a report of non- compliance will be issued.
  
  • When you give your specimen to the lab assistant, they will note and record the temperature of the collected specimen on the form. The lab assistant will seal your specimen(s) with a security seal and you will initial it. You will also fill out the portion of the form certifying that the specimen is your freshly voided urine. By signing this form you are also certifying that the Chain of Custody Protocol has been followed.
  
  • As part of the protocol, your specimen is not to leave your sight until all the paperwork has been completed, the specimen has been sealed and packaged ready for shipping.
  
  • Please note that in the case of a dual collection, you will be asked to repeat this procedure for the second collection, not less than 40 minutes after the first collection. You will be provided water to drink while you are waiting.
  
  • Patience with the process is appreciated. The systems and protocols are designed to ensure accuracy and reliability of results.
  
  

• Why is my urine sample poured off into 2 separate containers?

• In the event of a positive test result for contraindicated drugs, and where you deny any use of substances that would have resulted in this positive test, you will be interviewed by our Medical Review Officer. As part of that interview, the Medical Review Officer may ask you if you want to have the second sample tested by another laboratory. Please be advised that in the event you decide to have the second sample tested, the cost for re-testing will be at your own expense.
  
  In the case of a positive test for alcohol, the second sample will not be re-tested, as the metabolite for alcohol degrades over time and re-testing is not considered reliable.
  
  

MRO

• What does MRO stand for?

• MRO stand for Medical Review Officer, who is a licensed physician with special training and who is certified to review laboratory drug testing results. In the case of a positive laboratory test result, the MRO must determine whether this indicates the use of contraindicated substances, or whether there may be a legitimate medical explanation for the positive test result. In the event of a positive test result, you may be interviewed by the MRO.
  
  

Soberlink

• What is Soberlink?

• Soberlink is a handheld breathalyser device.
  
  

• How does Soberlink work?

• Soberlink collects a breath sample to measure Breath Alcohol Concentration (BAC), while simultaneously taking a photo of you to confirm your identity. Soberlink then wirelessly transmits the test results to the secure Sober Sky portal, where instant alerts notify Alliance if scheduled tests are missed or if there are positive results.
  
  

• What if I go camping or on a hike where there is no wireless or cellular coverage?

• Soberlink has the ability to store up to 100 breath tests, which will upload as soon as you reach a cellular or wireless zone.
  
  

• Will Soberlink work if I travel?

• Soberlink will work as long as there is cellular or wireless connection where you travel. Alliance participants have travelled with their Soberlink devices across Canada, the US and in international areas like Mexico and Europe.
  
  

Vacations / Excused Absences

• Why do I have to fill out an Away Notification form every time I go somewhere?

• The Away Notification form is designed to protect you, the participant, in the event that you are unavailable for monitoring due to vacations or absences. By completing this document, and creating a plan for monitoring while you are away, you are protecting yourself from non-compliance which may result from being unavailable for monitoring or testing without consent.
  
  

• What if I have a pre-booked 6 week vacation?

• In the event of pre-booked vacations upon your enrollment, an Away Notification form will be generated and a monitoring plan will be created for you while you are away. It is likely, due to the length of the absence, that you will be required to be re-evaluated for fitness to return to work upon your return.
  
  

Mutual Support Group Meetings

• What is a mutual support group?

• Mutual support groups are meant to provide emotional support, advice, encouragement and accountability to people who are motivated to recover from a disorder, in this case a substance use disorder. An appropriate mutual support group meeting is a group of individuals, whose sole purpose is to remain abstinent.
  
  

• Why do I have to attend AA / NA? You are forcing religion on me.

• Although spiritual, the Higher Power referenced in 12 step programs may represent any helpful source of support outside of yourself. There are secular alternatives to 12 Step Meetings, such as Smart Recovery, Refuge Recovery, Buddhist Recovery, Sober Agnostics, or LifeRing. The mutual support group you choose must, however, have as its identified purpose, abstinence based recovery from a substance use disorder.
  
  

• What happens if I don’t attend enough meetings each week?

• If you do not attend enough meetings each week, this will be reported on your monthly progress report.