AS/NZS 4308:2023 sets the benchmark for procedures concerning urine specimen collection, storage, handling, onsite drug screening tests, and dispatch to a laboratory. It’s a vital resource for maintaining best practices in drug testing.

1. The first key change is a DECREASE in the screening cut-off for cocaine metabolites, from 300 ug/L down to 150 ug/L, and a corresponding drop in the confirmatory cut-off from 150 ug/L down to 100 ug/L. This should result in more detections on-site, along with confirmatory testing being more likely to match the initial screening result.
2. The second key change is a DECREASE in the confirmatory cut-off levels for Benzodiazepine metabolites, from 200 ug/L down to 100 ug/L. This will reduce the likelihood of a non-negative on-site screen returning a confirmed negative confirmation due to a mixture of metabolites being present in the urine with no individual component over 200 ug/L. Screening cut-offs for Benzodiazepines remain at 200 ug/L.
3. The third key change is allowing laboratories to report parent/metabolite drug(s) that are detected below the cut-off, but between the laboratories limits of quantitation (LOQ) and the cut-off, where another drug/metabolite has been detected above the cut-off. For example, when amphetamine is detected in a sample and a low level of Methamphetamine is present, that Methamphetamine result will additionally be reported to aid in the interpretation of results.

Other minor changes/additions include:

• Expanded reference to Informed Consent in relation to scope of testing.
• Centralised QC testing of devices at the main storage site, as opposed to on -site prior to testing.
• Allowances for Liquid Chromatography Mass Spectrometry (LCMS) based screening of drugs, with cut-offs as per confirmatory methods.
• Oxycodone has specified cutoffs for screening and confirmation, but is not included in the main testing panel.

There are no changes to the testing process for THC in the urine standard. All cut-offs remain the same.

AS/NZS 4308:2023 also introduces a crossover period for 3 years where both standards are in effect, allowing manufacturers, laboratories, and collection agencies to implement changes when devices, laboratory procedures and processes have been updated to meet the new requirements.

A Safework Health representative is available to discuss the upcoming changes and the proposed timeline for implementation. Contact our team today!

We are pleased to announce Pathology Asia’s inclusion as a member of the Global Diagnostics Network (GDN), a strategic working group of diagnostic laboratories from around the world. Pathology Asia was introduced to this globe-spanning community in July 2023.

Pathology Asia’s membership in the GDN reinforces its commitment to ensuring that healthcare professionals are well-informed when making choices that will shape medical decisions and health diagnoses. It also furthers their goal to become a fully integrated digital healthcare organisation.

The GDN was conceptualised by US-based Quest Diagnostics as a worldwide community of leading healthcare companies.  This worldwide network was designed to develop collaborations among the world’s leading healthcare companies to address the growing need for advanced diagnostic testing and high-quality healthcare services.

Presently, the Network has a presence in countries with two-thirds of the world’s population and over 90% of the global pharmaceutical market.  Its members include Quest Diagnostics, Al Borg Medical Laboratories, Apollo Health & Lifestyle, Dasa, GC Labs, Healius, Lifelabs, LSI Medience , KingMed Diagnostics, Pathology Asia, Strand Life Sciences, and SYNLAB.

Safework Health has been a member of the Pathology Asia group since 2019. The Group is one of the largest and fastest-growing diagnostics groups in the region and comprises leading diagnostic laboratories across Southeast Asia and Australia.

Performing the testing of wastewater, is that something you can carry out on all sites? Is it an easy test to complete?

Wastewater testing can be performed effectively at any site. All that is required is to get access to the effluent outflow or the wastewater holding tanks for sampling. If required, Safework Health can send our staff to your sites and assess what needs to be done for testing and advise on the optimum testing regime tailored to your needs. Wastewater testing requires as a minimum that the number of staff at the site at the time of testing be made available. The effluent flow rate would be helpful but is not critical, as it can be approximated from the staff numbers assuming the average number of toilet visits and the average Australian toilet flush volume. Each sampling episode is easily done by taking ~300mL of wastewater from the effluent stream. Reports will be available within 7 working days of receipt of the sample.

Do we need to notify the employees that we are going to conduct wastewater testing?

There is no requirement – either legally or by custom, in Australia or internationally – to inform a site that wastewater testing is being or is planned to be performed. Wastewater testing is a whole-site testing procedure and does not impact the individual workers. Results reveal the magnitude of drug use at a site collectively and cannot identify the individual workers involved, so no case can be made for generally informing a site that testing will take place.

Do you see a time when we will have standards for hair testing?

It is generally believed the European SoHT (Society of Hair Testing) recommendations will be adopted as the international standard for hair testing by the EU over the next 2 to 3 years – specifically the 2022 Consensus on Hair Testing. The current delay is due to problems reconciling French guidelines with German practice. Once the EU has given its imprimatur, the US and Australia will follow suit to comply with international best practice guidelines.

Can you share that evidence base for >1 per year drug and alcohol testing programs reducing accidents by X%?

In progress. The review of the literature will be made available on 12 December 2023.

Do the laboratory test results reflect how long ago the worker is likely to have taken THC? Namely, can the result be converted into a rough timeline of when the THC was used?

No exact figure can be given. Urinary THC (provided the donor’s physiological details are supplied) may potentially supply the most accurate (albeit rough) estimate.

The oral fluid detection window for THC is roughly 8-12 hrs for standard doses of medicinal cannabis, ~ 12-18 hours for a NIDA-standard low dose 5mg THC cigarette, 18-24+hrs for a NIDA moderate dose 10mg THC cigarette. By use of the detection window a crude estimate of the maximum time since use can be made.

Urine detection windows are more complex. THC is a lipid-soluble molecule which partitions into the body fat. The more frequent the use of cannabis, and/or the more adipose tissue a donor has, the longer the detection window for THC – ranging from 3 to 5 days for a standard NIDA cigarette in a donor with normal BMI to 7 days for an obese donor with a BMI > 28.

By factoring in the height/weight and age of the donor and the stated frequency of use, a rough estimate of the time since use (i.e., more than ‘x’ hours but less than ‘y’ hours before collection) can be made for a range of THC doses, as well as determining whether a particular urinary THC level is consistent with the donor’s stated dosage and declared time since use. It should be noted these estimates are rough and not exact and that, while oral fluid THC correlates well with THC-associated impairment (if it’s not detected, the donor’s not affected), urinary THC levels do not correlate with impairment.

Find out more about Safework Health’s national occupational health team.

In this webinar, we will explore:

• Legislative Requirements and Fiduciary Duty-of-Care: We’ll dive into the legal obligations and fiduciary responsibilities related to workplace drug testing.
• Assessing Your Workplace Needs: Learn how to assess your workplace to determine the extent of substance abuse issues and identify specific needs.
• Developing a Written Policy: We’ll provide guidelines and a template to help you create a robust and effective drug-free workplace policy.
• Implementing Drug Testing: Discover how to choose the right test mix and testing strategy to suit your business’s requirements, including considerations for frequency and types of testing.
• Education & Training: Explore the importance of providing education and training for employees and additional training for supervisors and other relevant staff.
• Employee Assistance Program (EAP): Gain insights into setting up and assessing your EAP to support employees dealing with substance abuse issues.

REGISTER NOW

Fentanyl and oxycodone are powerful and highly addictive opioids commonly used for pain management.

What is Fentanyl?

Fentanyl is a synthetic opiate drug that is 80 to 100 times more powerful than morphine.

It is used medically as an intravenous anaesthetic and analgesic. However, it is most often encountered as a transdermal (skin) patch to relieve long-term pain, or to supply relief to cancer patients and the elderly. The drug is often misleadingly marketed as ‘safe’.

These patches are frequently discarded when they are around two-thirds used as the quality of pain relief tends to drop over time. Unfortunately, these ‘used’ patches can be reused by addicts when they extract the fentanyl gel. This practice is called ‘dumpster diving’ because they often search for old patches in the garbage. They then distil the pure drug from the patches and often recrystallise the drug to form “Rock.” Fentanyl distillates can be smoked, or the patches can be used directly – either being pasted on the body or chewed.

Traditionally fentanyl powder is often mixed with low-quality heroin. Heroin supplies from Central Asia are drying up. This is pushing users to experiment with fentanyl.

Additionally, increasing amounts of fentanyl are being imported into Australia. Just last year, the Federal Police in Melbourne seized a shipment of fentanyl equivalent to 5 million individual doses.

What is Oxycodone?

Like fentanyl, oxycodone is a synthetic opiate often sold as Oxycontin or Endone which, when taken by mouth, is one-and-a-half times more potent than morphine.

Medically, it is used for managing moderate-to-severe acute or chronic pain and is normally sold as a controlled-release tablet to be taken every 12 hours. As with all opioids, oxycodone induces euphoria and is addictive.

Oxycodone is one of the most abused pharmaceutical drugs in the US and is significantly abused in Australia, although not (as yet!) at levels approaching those in the US.

Once a person becomes physically dependent on oxycodone, they experience strong cravings for the drug, leading to continued use despite the ongoing physical harm. They are also at risk of suffering severe withdrawal symptoms, which can include panic attacks, nausea, muscle pain, insomnia, and flu-like symptoms.

Overdoses can easily be fatal. When not fatal, they can cause spinal cord infarction and ischaemic brain damage that resembles a bad stroke. Oxycodone also interacts badly with many other prescribed drugs – especially some anti-HIV medications – which can substantially slow the rate of clearance of the drug from the body.

Oxycodone and fentanyl are now being increasingly used in combination with stimulants – especially of the amphetamine class (which includes Meth).

There is a long history of people combining opioids with stimulants, such as ‘goofballs’ combining methamphetamine with heroin and ‘speedballs’ which are a heroin plus cocaine mixture. Australia already has a widespread Meth problem, and the number of cases where opioids were combined with Meth is rising.

There is a growing opioid abuse culture in Australia.

Even in 2008, the National Drug & Alcohol Research Centre reported that 91% of injecting drug users in Australia report having used Oxycodone. 23% admitted to using it in the last 6 months.

Fentanyl use has been rising in Australia, especially over the last 4 years – most notably on the Sunshine Coast in Queensland. Programs to stop fentanyl use have been only partly successful as addicts often switch over to oxycodone.

Oxycodone and fentanyl use in Australia is substantially higher in regional areas than in urban and capital areas, but the overall use rate is significant in both areas.

Worksite drug testing has shown that the use of these drugs varies substantially over the week. In remote sites, importation may occur only on specific days – which is then reflected in higher capture rates over the next 24-48 hours.

Cracking down on one opioid – such as oxycodone – only appears to encourage users to switch to another opioid: specifically, fentanyl. This was seen in the closing years of the last decade in Queensland where a crackdown on oxycodone led to a rise in fentanyl abuse.

What is the danger if oxycodone and fentanyl use are on the rise?

Both fentanyl and oxycodone carry a high risk of making users dependent on the drugs, and both have what is called a narrow therapeutic window: a dose sufficient to bring on a high is not much less than the dose required to give a potentially lethal overdose.

The appeal of fentanyl and oxycodone is that the drugs are pharmaceutical – so they have a high purity, and users are less worried about contamination. The drugs are highly potent – ‘more bangs for the buck’ – and because of their rapid uptake cause a ‘quick high’ (especially fentanyl).

The advantage from a medical perspective is that fentanyl can be taken when a patient has an impaired liver, to treat neuropathic pain, and the patches can be used when a patient is nauseous, vomiting or has difficulty swallowing. For the user, the big attraction is that fentanyl is the fastest-acting opioid available.

Fentanyl is cheap – so it is a popular opioid for abuse. Unfortunately, it also has the most prolonged respiratory depression (suppression of the breathing reflex) of any opioid – which arguably makes it the most lethal.

Common workplace drug testing methods include:

• Urine Drug Testing – Oxycodone and fentanyl can be detected in a specifically requested assay in urine. Urine is the superior sample for both drugs, as the detection window is much greater than oral fluid – up to 4 days.
• Oral Fluid Drug Testing – Oxycodone is included in routine oral fluid screening tests, unlike fentanyl which is not included in these tests. The detection window for oral fluid is 36 hours.
• Wastewater Drug Testing – Wastewater drug testing is the best way to get a snapshot of the extent of actual opioid use at a workplace but should include weekend coverage as use varies greatly day-to-day.

Safework Health stands out as one of the select few laboratories in Australia capable of conducting urine testing specifically for oxycodone and fentanyl.

Plus, we offer a verified onsite urine drug screening device that can detect Fentanyl, Oxycodone and Ketamine.

Feel free to reach out to us today for a discreet and confidential consultation.

Isocyanates are a group of highly reactive organic compounds used in the manufacture of:

• adhesives and glues
• coatings lacquers and varnishes
• spray paints
• elastomers and foams
• floor / roof screeding
• hardwearing plastics
• medical dressings

Isocyanates are toxic until they react with other chemicals to form the hardened or ‘cured ‘polyurethane product. Fully-cured polyurethanes are non-toxic, unless they are heated or abraded, which makes them give off isocyanates and other toxic substances.

Isocyanate exposure is associated with numerous health problems. Exposure can cause asthma, skin sensitisation, skin or mucous membrane irritation, and, rarely, a lung reaction called hypersensitivity pneumonitis.

Occupational Asthma

They are one of the leading causes of occupational asthma in Australia. The condition commonly presents as:

• wheezing
• chest tightness and shortness of breath
• cough

The symptoms can occur at work, or much later after work, and the asthma can be made much worse by repeated exposure.

Once a worker has been sensitised, even very low-level exposures might produce a potentially life-threatening asthma attack, which may end their career. Exposure to isocyanate aerosols can lead to hypersensitisation which can give rise to ‘bagpipe lung’ (also known as extrinsic allergic alveolitis or hypersensitivity pneumonitis).

Skin Sensitisation

Sensitisation by skin contact can cause allergies that can affect both the skin and/or the lungs. Acute exposure to these chemicals can cause irritation to the eyes, skin, and mucous membranes of the nose and the throat, occasionally accompanied by headaches and itching. Sensitisation can occur at isocyanate concentrations lower than those that may give rise to irritation.

Potentially Cancer-Causing

Most isocyanates are not carcinogens – the exception is TDI (toluene diisocyanate) which has been found to cause cancer in some laboratory animals (although it has never actually been demonstrated in humans). Isocyanates are not associated with human fertility or pregnancy problems nor with abnormalities of foetal development.

To safeguard workers’ health and minimise the risks associated with exposure, control measures and biological monitoring programs are essential.

Control Measures

Since isocyanates can act as skin and respiratory sensitisers, and to control the risk of future health issues in the workplace, exposure to isocyanates should be kept as low as reasonably practicable.

If adequate control measures are in place – such as closed ventilation systems (spray booths, enclosed moulding machines), air-fed respiratory protection and personal protective clothing/gloves – these conditions, and episodes of isocyanate exposure, are easily preventable.

Biological Monitoring Program

Isocyanate Biological Monitoring (BM) is especially necessary for workers involved with:

• motor vehicle repair paint use
• foam blowing
• hard polyurethane manufacture
• glues and adhesives
• floor screeding
• underground mining.

BM is a simple and cost-effective way to check that workplace control measures are sufficient, being effectively applied and exposure is being adequately controlled.

BM assesses worker exposure to isocyanates, confirms control measures, and prevents health risks. While not a diagnostic tool for isocyanate-related conditions, it helps identify occupational exposure when symptoms arise. BM also gauges skin absorption, especially with glove use. It’s user-friendly, providing personalised results to promote better work habits.

BM aggregates all routes of exposure, inhalation, skin absorption and ingestion, so a result cannot identify the actual source/route of exposure. It will, however, show the need for corrective action to be taken.

Safe Work Australia’s Guidelines for Isocyanate Exposure Monitoring

Safe Work Australia recommends that Biological Monitoring programs for workers using or exposed to isocyanates should include:

• Initial baseline BM upon the commencing employment
• Periodic BM review, generally performed after 6 weeks of commencement (of isocyanate exposure)
• Regular 6-monthly BM every six months. If after 12 months, no adverse health issues are reported this should then switch to annual testing
• Terminal BM performed at the end/termination of the period of isocyanate exposure.

How Is Isocyanate Exposure Testing Performed?

A post-exposure urine sample should be taken, ideally within an hour of the end of exposure, especially for those tasks involving:

i) heating of polyurethane

ii) use of:

• HDI (hexamethylene diisocyanate, used in two-pack spray paints)
• TDI (toluene diisocyanate, used in adhesives and foam blowing)

This is recommended as the above-mentioned isocyanates are all rapidly excreted.

End-of-shift testing should be performed with:

i) Encountering abrasion of polyurethane

ii) Exposure to MDI (methyl phenylene diisocyanate)

If significant skin exposure is a possibility, pre-shift next-day samples should also be considered (due to the delayed absorption through the skin).

BM samples mostly reflect that day’s exposure (reflecting the short half-life of excretion), and generally do not illuminate long-term exposure. For this reason, it is recommended that several samples are taken initially to ensure that ‘normal practice’ is captured.

The urine samples should be sent ideally the same day or the next day to Safework Health for analysis. If shipping is delayed, samples should be stored frozen, if possible, prior to despatch.

How do you interpret results?

Interpretation of results requires an appreciation of the work practices, tasks and controls used by an individual worker on the day of sampling.

Results will fit one of three broad categories:

1. No detection — with no evidence of exposure to the requested isocyanates (no further action required and repeat testing in 1 year)
2. Low-level exposure — meaning that exposure was detected but the levels were within the BMGV (control measures and their use should be checked but repeat testing is not required immediately; the result may be due to intermittent behaviours, such a visor-flipping, if the investigation shows no systematic concerns); and
3. Exposure exceeds the BMGV — this requires action be taken to check the control measures and their use and to resample workers once any issues have been resolved (if results remain elevated, further investigation is required but workers do not need to be removed from tasks). Where work practices or exposure controls are significantly altered then retesting should be considered to ensure that exposure levels have not increased as a result.

Safework Health’s NATA accredited isocyanate urine testing service can detect your workers’ exposure to this harmful chemical. We offer a rapid 5-day turnaround for results, an accurate and cost-effective testing method, and national coverage.

Contact our friendly team today to find out how we can keep your workers safe and healthy.