Drug Testing in the Workplace ch 5

Historical Context

• 1971: Richard Nixon declared a "war on drugs".

• 1973: Establishment of the Drug Enforcement Administration (DEA).

• 1986: Implementation of Anti-Drug Abuse Act by President Reagan, which included:

  • Mandatory drug testing for positions requiring security clearances.

  • Introduction of NIDA Guidelines for drug testing.

Urine Drug Testing Statistics

• Annual Positivity Rates (Combined U.S. Workforce based on over 3.4 million tests, Jan-Jun 2012):

  • 1988: 13.6%

  • 1989: 12.7%

  • Overall decline to around 3.6% by 2012.

  • Positivity Rates by Testing Category:

    • Federally Mandated Safety-Sensitive Workforce: Consistently low around 1.6%-1.7%.

    • General U.S. Workforce: About 4.1% by 2012.

Historical Incidents Leading to Drug Testing

• Drug testing in the workplace gained traction in the early 1980s due to various drug-related incidents, including:

  • 1983: Len Bias's death from crack cocaine.

  • 1987: Amtrak collision resulting in 14 fatalities, attributed to cannabis use by the engineer.

Campaigns and Regulatory Bodies

• 1982: The "Just say no to drugs" campaign initiated by Reagan.

• Drug testing practices involve adherence to guidelines set by the U.S. Department of Health and Human Services (HHS) regarding:

  • Types of drugs tested.

  • Collection methods for specimens.

  • Qualifications for laboratory personnel.

Legal Developments in Drug Testing

• Various regulations noted in Federal Registers from 1987-2008, establishing mandatory guidelines for drug testing in the workplace.

Forensic Urine Drug Testing Applications

• Routine applications include:

  • Military services.

  • Regulated transportation sectors; random testing mandated.

  • Federal and state agencies, including the justice system.

• Analytical Methods employed:

  • Preliminary Screening: Includes RIA, EMIT, CEDIA, and ELISA.

  • Confirmation: Governed by GC-MS, LC-MS-MS.

NIDA Five Testing Standards

• Tests focus on five main drug categories with specific cutoff levels for positive results:

  • Cocaine: 300 µg/L

  • Amphetamines: 500 µg/L

  • Opiates: 2000 µg/L

  • PCP: 25 µg/L

  • Cannabinoids: 50 µg/L

Other Drug Testing Considerations

• Possibility of testing for various drugs, contingent upon notification regarding prescription medications by employees.

• Forensic toxicologists recognize the need for specific cutoff levels to account for passive inhalation exposure and cross-reactivity in immunoassays.

Poppy Seed Challenge in Drug Testing

• Poppy seeds can cause false positives in opiate testing due to their natural morphine content, with references to research publications.

Evolution of Drug Testing Laboratories

• Initially, no formal certification was required to establish testing labs.

• Challenges included lack of confirmation testing and labs focused primarily on quick profits.

Rationale Behind Testing for LSD

• LSD testing is not commonly performed due to:

  • Low workplace prevalence among users.

  • Analytical challenges involving the parent drug and metabolites.

Standard Testing Procedures

• Immunoassay Tests: Used as presumptive screening.

• Confirmatory Tests: Performed via GC-MS, focusing on achieving accurate ion ratios for identification.

• Hair Testing: Explored for its ability to detect drug use over extended periods, but limited laboratories currently perform these tests.

  • Collection techniques involve cutting hair close to the scalp and ensuring sufficient quantity for analysis.

Analysis of Hair Samples

• Comprehensive processes to obtain and analyze hair samples, emphasizing the potential for detecting drug use for up to six months.

• Specific cutoff values for drugs detected in hair samples outlined, such as for amphetamines, cocaine, and opiates.

Testing of Other Samples

• New sample types include oral fluids and sweat patches, with indications of their use in various scenarios (e.g., heroin metabolites).

Challenges in Urine Drug Testing

• Adulteration Techniques: Awareness of methods used to tamper with samples, including:

  • Changing pH, dilution with diuretics or water, and sample switching.

• Sample Collection Protocols:

  • Procedures to ensure sample integrity, including temperature checks and safeguarding against tampering.

Role of Medical Review Officer (MRO)

• Critical in interpreting test results, confirming positives, and addressing potential adulteration issues.

• Must be independent from the testing lab and workplace to ensure objectivity.

Final Thoughts and Future Considerations

• Current landscape highlights the ongoing evolution and need for stringent practices in workplace drug testing, with a focus on emerging technologies and methodologies.