Background <p>With rare exception, Canadian jurisprudence rejects the use of random, unannounced workplace alcohol and drug testing for <i>all</i> employees, as an implied right of management, even in safety-sensitive settings. Instead, reasonable cause for individualized testing must first be established. That is, testing may be justifiable in the presence of an acknowledged problem, e.g. a worker with a substance use disorder, within the context of a rehabilitation plan, or post-incident. Currently, there exists no Canadian standards for monitoring and accountability in safety-sensitive workers with a history of substance use disorders returning to safety-sensitive work following substance use disorder (addiction) treatment.</p> Methods <p>This review provides recommendations for such monitoring and accountability in safety-sensitive workers.</p> Results <p>Key considerations are offered for safe and effective monitoring in an occupational setting, including roles and responsibilities, duration of monitoring, detection techniques, monitoring of other substances, testing matrices, management of non-adherence and relapse/return to use, and ethical concerns.</p> Conclusions <p>This paper discusses essentials of monitoring and their rationale in a context intended to inform a range of stakeholders tasked with formulating and/or implementing monitoring and accountability in the Canadian occupational context to ensure safe and durable work.</p>