title: [Workers with alcohol and drug addiction problems. Consensus Document of the Study Group on Hazardous Workers].
abstract: BACKGROUND
  Italian Law 81/08 (so-called "Unified Text of Laws on Health and Safety at Work"), came into force on 15 May 2008 and incorporates provisions related to medical surveillance of drug and alcohol dependency at the workplace.
  
  
  OBJECTIVE
  Occupational health traditionally addresses the issue of protection of worker from occupational hazards. The issue of protection of third parties from behaviour of workers resulting from drug and alcohol dependency implies an original methodological approach, involving full cooperation of employer, employees, and health and safety consultants.
  
  
  METHODS
  A consensus development meeting was organized under the leadership of the Italian Study Group on Hazardous Workers (La.R.A. group). The meeting brought together physicians of different specialties, legal experts and bioethicists, labour and management policy-makers, to discuss the issue and define the research data available, the standards that were appropriate, and which policies were fair.
  
  
  RESULTS
  The efficacy of medical surveillance, including workplace drug-testing, relies on a comprehensive policy, including written and verbal information on the use of alcohol and drugs on the job, training for supervisors and management, employee education, and employee assistance structures. Sample collection and testing should be carried out in accordance with standardized and tested procedures. Small businesses will need assistance, including development of model policies, setting up consortia for testing services and if necessary request for National Insurance benefits to reduce costs.
  
  
  CONCLUSIONS
  The recently introduced Italian legislation on occupational safety and health closely resembles Finnish law since it consists of a "double channel" for workplace drug testing. At recruitment, the employer is entitled to ask a job applicant for a certificate of "Job fitness", including drug tests, that can be issued only by a public health institution, where the job applicant works on a well-defined set of tasks which require accuracy, trustworthiness, independent judgement or a very good reaction capacity. The employer may also refer the employee to the public health institution to obtain a certificate in the course of an employment contract when there is a legitimate suspicion that the employee is working while under the effects of drugs or alcohol or that the employee is a drug addict. After recruitment, the physician responsible for medical surveillance of workers (the so-called "Competent Physician") is entitled to perform drug tests on employees. The need for a test is decided by the health care professional, not by the employer, and only a general report on the health of the employee ("fit", fit with restrictions" or "unfit") may be given to the employer. Workers positive for drug tests will be referred to a public health institution for re-testing and treatment.
authors.affiliation: Istituto di Medicina del Lavoro, Università Cattolica del Sacro Cuore, Roma. nmagnavita@rm.unicatt.it
authors.forename: N
authors.initials: N
authors.lastname: Magnavita
authors.forename: A
authors.initials: A
authors.lastname: Bergamaschi
authors.forename: M
authors.initials: M
authors.lastname: Chiarotti
authors.forename: A
authors.initials: A
authors.lastname: Colombi
authors.forename: B
authors.initials: B
authors.lastname: Deidda
authors.forename: G
authors.initials: G
authors.lastname: De Lorenzo
authors.forename: Angela
authors.initials: A
authors.lastname: Goggiamani
authors.forename: Giulia
authors.initials: G
authors.lastname: Magnavita
authors.forename: W
authors.initials: W
authors.lastname: Ricciardi
authors.forename: A
authors.initials: A
authors.lastname: Sacco
authors.forename: A G
authors.initials: AG
authors.lastname: Spagnolo
authors.forename: Liliana
authors.initials: L
authors.lastname: Bevilacqua
authors.forename: Manuela Maria
authors.initials: MM
authors.lastname: Brunati
authors.forename: T
authors.initials: T
authors.lastname: Campanile
authors.forename: M
authors.initials: M
authors.lastname: Cappai
authors.forename: Marina
authors.initials: M
authors.lastname: Cicerone
authors.forename: F
authors.initials: F
authors.lastname: Ciprani
authors.forename: M
authors.initials: M
authors.lastname: Di Giannantonio
authors.forename: G
authors.initials: G
authors.lastname: Di Martino
authors.forename: Laura
authors.initials: L
authors.lastname: Fenudi
authors.forename: S
authors.initials: S
authors.lastname: Garbarino
authors.forename: Annunziata
authors.initials: A
authors.lastname: Lopez
authors.forename: Francesca
authors.initials: F
authors.lastname: Mammi
authors.forename: D
authors.initials: D
authors.lastname: Orsini
authors.forename: Dalila
authors.initials: D
authors.lastname: Ranalletta
authors.forename: S
authors.initials: S
authors.lastname: Simonazzi
authors.forename: C
authors.initials: C
authors.lastname: Stanzani
mesh_terms: D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D004647:Employee Discipline; D004651:Employment / Q000592:standards; D006293:Health Promotion; D006801:Humans; D007318:Inservice Training; D007558:Italy; D016272:Occupational Health / Q000331:legislation & jurisprudence; D009786:Occupational Health Services / Q000458:organization & administration; D016134:Organizational Policy; D011363:Professional Impairment / Q000331:legislation & jurisprudence; D017751:Safety Management / Q000379:methods / Q000592:standards; D015813:Substance Abuse Detection / Q000331:legislation & jurisprudence / Q000592:standards; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D014938:Work Capacity Evaluation