Workplace Cannabis Policies: A Moving Target.

Introduction: This article proposes a workplace cannabis policy paradigm that encompasses rapidly changing laws and regulations, legally defensible drug testing policies, and the needs of particular workplaces. Numerous states have now decriminalized medical or recreational use of cannabis, although U.S. federal law still defines cannabis as a Schedule I substance with no currently accepted medical use and a high potential for abuse. For employers and employees, the confusion generated by this contradiction is exacerbated by the widely varying effects of the available cannabis delivery systems, the primitive and cumbersome drug testing protocols often used in workplace settings, difficulties in measuring cannabis-related workplace impairment, and a rapidly changing cultural ethos regarding cannabis. Although other articles have addressed many of the broad theoretical constructs, there exists little practical guidance on how workplace drug programs should address cannabis use by employees, both on the job and during off-hours. Materials and Methods: Research for this review was performed in the PubMed/National Library of Medicine database. Discussion: Cannabis use is associated with cognitive deficits, motivation problems, and perceptual distortions, so employers have a legitimate interest in preventing on-the-job impairment related to cannabis use. Similarly, employees have a legitimate interest in behaving as they wish outside of the workplace, as long as that behavior does not affect their job performance. Relevant statues and case law on the subject of cannabis in the workplace reflect different legal models across jurisdictions, in addition to legislators and judges' attempts to manage this tension between employer and employees. Conclusion: An effective workplace cannabis policy must fit into a larger workplace drug and alcohol policy. It should be constructed with a collaborative effort of addiction professionals, labor attorneys, and human resource professionals. Only then can the ultimate workplace cannabis policy comply with relevant laws, protect workplace safety and productivity, and support employees while remaining flexible enough to adapt to changes in the legal environment.

Schizophrenic Patients and Cocaine Use: Antecedents to Hospitalization and Course of Treatment.

This study was designed to assess whether cocaine abuse was associated with a different set of antecedents and course for hospitalized schizophrenic patients. Forty-three cocaine-using and 27 non-cocaine-using patients with schizophrenia admitted to a dual diagnosis unit were compared with regard to antecedents to hospitalization such as prior treatment episodes, reliance on drugs for pleasure and tension reduction, and criminal history as well as course of hospital treatment. Cocaine-using patients were more likely to have had a history of prior inpatient drug treatment and to rely on drugs to a greater extent for tension reduction and pleasure. There was a trend for cocaine users to have a history of arrests for violent crimes. Although cocaine-using patients exhibited lower levels of global distress during the first week of hospitalization, they were no different from their counterparts who abused nonpsychostimulant drugs with regard to outcome of hospital treatment. These findings suggest that the lifetime course of illness among schizophrenic patients presenting for hospitalization who abuse cocaine may be characterized by episodes of repeated inpatient drug treatment and impaired impulse control. More rigorous discharge planning and aftercare program monitoring in the community as well as stress management interventions directed to tension reduction are therefore warranted.

Addiction and the Americans with Disabilities Act.

On July 26, 1990, the U.S. Congress enacted the Americans with Disabilities Act (ADA), which was intended as a broad, national, civil rights-oriented mandate "for the elimination of discrimination against individuals with disabilities," both physical and mental. ADA protection is extended, in limited form, to those with addiction disorders. However, many addicted individuals are denied ADA protection because of exclusionary criteria in the ADA itself and because of increasingly restrictive interpretations of the ADA in recent cases. The benefit to the addicted persons, and to the larger society, is lost when unfair discriminatory practices preclude employment of otherwise qualified, though stigmatized, individuals. The ADA currently falls short, in many respects, of preventing such discrimination against those with addictions.

Physical examination of substance abusers.

Preview How can physicians make appropriate treatment decisions in substance abusers who have serious medical illness, especially when patients may not offer the information needed? Drs Westreich and Rosenthal summarize common physical findings that suggest abuse of specific substances. Recognizing these signs allows physicians to reliably diagnose chemical use, leads to improved outcomes, and lends weight to recommendations for substance-abuse therapy.