Chapter 6
Drug Testing

Summary

Tests to detect drug use can be conducted using various biological specimens. Testing for alcohol is typically conducted by obtaining a breath, blood or saliva sample. However, when a person is being monitored following treatment for alcoholism, and abstinence is expected, urine may be tested. Testing for drugs other than alcohol is typically conducted using urine samples although some employers use hair samples. Employers regulated by federal testing programs are required to use urine samples only for testing of drugs. Department of Transportation regulations require breath testing for alcohol.
Most employers test applicants and employees in one or more of the following situations:

• During an annual physical;
• Before promotions or transfers;
• Before being placed in--or routinely while in--positions involv- ing money, security, or safety;
• After accidents;
• For past users;
• Following treatment;
• When referred by management through just cause or reason- able suspicion;
• On a random basis.

Details

The only methodology for drug testing approved by the U.S. Department of Health and Human Services is urinalysis.

Urinalysis involves screening urine for the presence of drug metabolites in a relatively simple and inexpensive procedure. Samples with positive results are then subjected to a highly accurate but more expensive confirmation procedure known as gas chromatography/mass spectrometry (GC/MS). No adverse personnel action should ever be taken before completing the two-step procedure.

Most employers look for a vendor to handle drug testing requirements. In determining how to go about drug testing and what facility to use, consider the following:

• The laboratory should provide guidance in the development of collection procedures to assure that samples are properly ob- tained and not falsified;

• The vendor should provide all materials for collecting samples as well as specific written instructions for doing so. These may include containers, chain-of-custody and report forms, evidence tape, prepaid tamper-proof mailers and labels. The contract price should include these items as well as courier service. Separate financial arrangements may be needed if a urine collection vendor is required in addition to the laboratory services. If a separate collection vendor is used it should be a facility that specializes in specimen collection for the purpose of workplace drug testing.

• Containers should not contain preservatives that might alter the drugs or metabolites being sought. Containers should also include a built-in temperature strip that is capable of measuring the temperature of the urine sample. This is useful in detecting sample substitutions or other attempts at cheating the test.

• The laboratory and its personnel must comply with state licensing and certification requirements.

• A clear, up-to-date laboratory methods procedure manual must be included. Most reputable laboratories follow the procedural guidelines approved by the U.S. Department of Health and Human Services.

• Tests must be performed only by technicians trained and experienced in the specific drug test procedures.

• The laboratory must furnish an analytical plan to assure that a positive test is followed by a GC/MS confirmatory test and that no results are transmitted to the company based solely on a screening result. In other words, all positives should automatically be submitted for GC/MS confirmation and quantitation.

• The limits of sensitivity and specificity for each test procedure should be defined. Most employers, including non-regulated employers, follow the cutoff levels established by the testing program of the U.S. Department of Transportation. Any change from the laboratory’s normal thresholds for detection should be agreed upon in writing.

• The technical and administrative procedures used should differentiate legitimate therapeutic drug use from illicit drug use. In other words, legal medications used by the employee for legitimate medical reasons should be ruled out before a positive is declared. Many employers use the services of a physician known as a Medical Review Officer (MRO) to determine whether legal medications are involved. Employers regulated by the Department of Transportation are required to use an MRO.

• The laboratory should be able to identify any of the normally abused illegal drugs or their metabolites and to offer several “panels” or combination of tests as a cost- effective option to general testing.

• Once the specimen has arrived at the laboratory via approved courier, a confirmed written test result should be delivered within two to three days. Employer actions should never be based upon a verbal test result. Procedures should be established to maintain confidentiality both at the laboratory and in the company, and refrigerated storage of positive samples should be offered by the laboratory.

• Expert testimony in the form of written records and personal appearances concerning results, methodology and opinions should be available with timely notification.

• Laboratory personnel, technical and managerial, should be subject to a program of drug testing.

In conducting drug testing, employers must balance legal liabilities due to lawsuits (brought by unhired applicants and employees who refuse to take the test or who are discharged or disciplined for positive test results) against the well-being of customers, clients, fellow employees, and members of the general public who may be injured or affected by a drug-using employee. Settlements in the former category are usually in the low thousands of dollars, while those in the latter are often in the millions.

Courts are holding more and more companies responsible for mistakes made by poorly trained personnel operating without well-conceived guidelines. As courts have declared, there is enormous liability when a company does nothing or does the wrong thing in the face of the clear evidence of drug and/or alcohol abuse throughout the workplaces of our country.

Many states have drug testing laws that determine what an employer can and cannot do. It is important that employers determine what laws, if any, exist in the states where they conduct business to ensure that the testing rules and procedures established are in compliance with state regulations.