Heroin’s Explosive Growth

The DEA just recently released new statistics on Heroin use in the U.S. and, you guessed it…death rates more than tripled between 2010 and 2014. Assuming the trend continues, there will be approximately 14500 deaths in 2016, up from about 3000 in 2010. The primary cause is related to an increase in the number of users (now about 435,000); however many of these are also “new” users with access to high-purity, low cost Heroin. Not a good combo.

With the rise in use, it may be a good time for safety managers and supervisors to brush up on identifying the signs and symptoms of use in the workplace. Since Heroin is one of the substances tested in the “5-panel” DOT drug test, it is also universally tested for in drug-free workplace programs as well.

Signs and Symptoms of Heroin use

How it’s taken:

Inhaled: A common method of smoking heroin is to use a sheet of aluminum foil and a straw. The user holds the straw in his mouth and ignites a lighter underneath the foil. As the heroin melts, it produces a white smoke and runs down the sheet of foil. The user inhales the smoke through the straw, “chasing” the heroin with the lighter as it liquefies and runs down the foil. Sheets of foil with burn marks on the bottom and black lines on the top are giveaways that a person is smoking heroin. Sometimes, the stem of a ball-point pen is used instead of a straw. Finding disassembled pens among the person’s belongings may also be a sign that he is smoking heroin.

Snorted: Snorting involves either inhaling powdered heroin or heroin dissolved in small amounts of liquid through the nose. The drug then enters the bloodstream through the nasal tissues. It’s usually snorted by using a straw or rolled up paper.

Intravenous: Shooting up heroin involves injecting the drug into a vein, though some people switch to injecting into a muscle once an overused vein collapses. The paraphernalia used to inject heroin include:

• A hypodermic needle
• Cotton balls for straining the liquid
• A spoon for “cooking” or liquefying the drug
• A tie-wrap for wrapping around the arm so the vein protrudes

Physical Effects:

• Suppressed breathing
• Dry mouth
• Warm flushing of the skin
• Itchiness
• Nausea
• Dilated pupils
• Constipation

Mental Effects:

• Short term euphoria
• Clouded mental functioning
• Alternating wakeful and drowsy states
• Deteriorated decision making and self-control

Addiction/Withdrawal Effects:

Some of the symptoms experienced may include:

• Drug cravings
• Restlessness
• Nausea
• Vomiting
• Muscle pain
• Muscle weakness
• Bone pain
• Mental and physical fatigue

How to handle someone who is exhibiting signs and symptoms of Heroin use in the workplace:

Nearly all drug free workplace and ALL DOT drug testing policies allow for “Reasonable Suspicion” testing. A reasonable approach for most workplaces would be to follow the steps below. If your safety manager or supervisory staff has not been formally trained on spotting the signs and symptoms of substance abuse you can do so at athandtraining.com.

(Note: The process below may not reflect your specific drug testing workplace policy or company process and is presented here as an example of standard best practices only). 

Step 1. If the employee is performing a safety sensitive duty where they may cause harm to themselves or others the employee should be immediately removed from duty.

Step 2. If the signs and symptoms were reported by other employees take a minute to interview them. Is this a one-off observation…or an ongoing pattern they are just now reporting? When and where did they make the observation? Other witnesses?

Step 3. (Optional) Involve a second supervisor to confirm your observations when possible. 

Step 4. Make the observations personally. Direct and close personal communication should be attempted. Look to confirm observations of for additional signs or symptoms. Ask open ended questions that require more detailed or thoughtful responses.

Step 5. Interview the employee in a private area – preferably with another supervisor. Simply state your observations and ask for an explanation.

Step 6. Document their answers. Use this form if you do not have one. Have a second supervisor sign off. Be VERY specific in detail. For example, do not document that you thought the employee “Seemed aloof”, rather document that the fact that you had to repeat simple questions more than once and received a delayed response. The DOT states your observations should be “Specific, Articulable and Contemporaneous.”

“Specific” example: “Tom had abnormally pinpoint pupils”.

“Articulable” example: “Tom lost his balance twice while I interviewed him” as opposed to “I had a feeling Tom wasn’t ‘all there.'”

“Contemporaneous” example: Meaning the observations were made just before, during or after performing their job duty.

Step 7. Initiate a reasonable suspicion test. If you and/or both supervisors are “reasonably suspicious” that the employee is under the influence, then it’s time to initiate a drug and/or alcohol test. You DO NOT NEED to have proof or self-admission in advance of initiating a test! You should clearly explain what has been observed or documented by management. Then management or HR should explain that to rule out the possibility that the employee is in violation of the company’s drug and alcohol policy, the employee will be sent for a drug or alcohol test.

Step 8. Transportation. If the testing facility is not located on premises, the supervisor should arrange transportation to the collection facility. The employee should not be allowed to drive their self.

Step 9. Contact the collection facility to schedule collection.

Step 10. The employee should be removed from performing safety sensitive duties until the results of the drug test come back from the laboratory or medical review officer. With DOT or federally regulated testing all test results would be reported by a medical review officer.