Testing Programs in Occupational Settings

There are two types of workplace testing: regulated and nonregulated. Regulated testing refers to programs conducted under the Federal Testing Guidelines and includes industries working with the Department of Transportation (DOT), Federal employees, and companies with Federal contracts over $25,000 per year. Nonregulated programs are typically private sector employers who are not federally required to have a DFW program but voluntarily choose to drug-test employees. These programs are not required to have an MRO and are not federally regulated.

Drug testing in the workplace has seen dramatic growth since 1988. Former President Ronald Reagan proclaimed the need for a drug-free workplace in America during his years in office. This initiative resulted in the Drug-Free Workplace (DFW) Act signed into law in November 1988. This legislation (HR-5210-124 Section 5152) laid the groundwork for the existing regulations (49-CFR-40) for virtually all of the drug-testing policies and protocols currently enforced in the workplace today. Interestingly, the DFW legislation was a significant extension of the preexisting "catastrophe-driven" testing, in which testing was only done after a catastrophic event, such as a serious work-related accident. This new policy offered a proactive deterrent philosophy.

Each DFW program is mandated to include five elements: (1) a formal written policy, (2) an Employee Assistance Program, (3) formal training for supervisors, (4) formal employee education, and (5) a drug-testing protocol. Five participants are involved with every DFW drug test: (1) the employer, (2) the donor/employee, (3) the specimen collection site, (4) the laboratory analyzing the sample, and (5) the MRO. The employer is responsible for informing the employee in writing of the Drug-Testing Policy, including all policies and procedures of the test, circumstances warranting testing in addition to preemployment testing, and consequences of a positive test. Employees must sign a form acknowledging that they are aware of the program and the existence of an Employee Assistance Program, and participate in a DFW educational presentation. They must also sign an informed consent document, agreeing to be tested under the circumstances described in the policy handbook. The collec tion site must also conform to specifications described in the policy handbook. The laboratory used must be certified by the Department of Health and Human Services (DHHS). There are over 80 certified laboratories throughout the United States. An up-to-date list is published regularly in the Federal Register. The laboratory is responsible for verifying appropriate chain of custody of the sample (Universal Chain of Custody forms became effective in January, 1995) and conducting a valid and reliable analysis of the specimen. The laboratory must report any breach in protocol it discovers, including any suspicion of tampering with the sample.

The MRO plays a unique and important role in the drug-testing process. Positive tests are reported to the MRO, who then evaluates the facts in the test. For example, if a worker was taking a prescribed stimulant for a medical condition with appropriate preauthorized permission, the MRO can reverse a positive test. The MRO is an "independent agent" in the testing process and is responsible for investigating all positive tests before reporting to the employer.

The five substances routinely tested for include marijuana, cocaine, amphetamines, opiates, and PCP. Other drugs, such as alcohol, may be added to the panel if suspected by the employer from objective evidence (i.e., slurred speech, alcohol on the breath). Keeping with the "Rule of Fives," there are five situations in which drug testing is conducted: (1) preemployment, (2) random, (3) postaccident, (4) probable cause, and (5) return to work/follow-up. The employer may request testing for additional substances in the case of postaccident, reasonable suspicion, and return-to-work situations. In order to undergo this additional testing, the employee must be notified via an official Employee Drug Policy document. Recognizing the high prevalence of alcohol abuse, ethanol testing was mandated in a 1994 amendment. There are separate regulations for alcohol testing, including not requiring MRO participation.

The program is designed always to give the employee the benefit of the doubt, and the benefit of the MRO's advocacy. In workplace testing, the safety of the public, as well as the individual, is at stake. Impaired judgment and hand-eye coordination resulting from intoxication have potentially devastating consequences for professional drivers, pilots, and operators of heavy equipment. Virtually every job performance, with the possible exception of rock stars, will be adversely affected by drug use at the workplace. The highest rates of current and past-year drug use were reported in construction workers, food preparation workers, waiters, and waitresses. Excessive alcohol consumption was observed in these groups, as well as auto mechanics, vehicle repairmen, light truck drivers, and laborers (Hoffman, Brittingham, & Larison, 1996). NIDA (1989) has estimated that if every employee/worker between the ages of 18 and 40 years old were drug tested randomly on any given day, between 14 and 25% would test positive. The cost to society is staggering, not to mention the impact on the user's life. Schwab and Syne (1997) estimates workplace drug use costs between $60 and 100 billion a year in lost and diminished productivity.

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