THE MAGAZINE

High on the Job

By Michael A. Gips

Testing
All workers in safety-sensitive positions are already subject to mandatory drug testing, but most other employees are currently not asked to take drug tests. That is slowly changing, however. Companies are reevaluating their testing programs, says one executive at a large testing laboratory. “In particular, many companies that never tested before are trying to do it,” he says, pointing to a growth in testing since 2000 and a particular spike in the last year. He says the trend is part of a resurgence in background checks, partly precipitated by the events of 9-11. Another spur to increased testing is pressure brought to bear by insurance companies. They are encouraging, and in some cases mandating, that companies set up drug testing programs, says the lab executive. “I’m inundated with small and medium-sized companies needing drug testing,” he says. “Insurers are threatening rates through the roof” if a testing program is not implemented. A few companies are becoming shrewder about maximizing deterrence while minimizing costs, notes Ferraro. These companies collect specimens from all employees, then randomly select samples to test, perhaps one in every ten. The money saved by not testing most of the samples is being invested in training managers in how they can better identify reasonable suspicion of drug use to determine whether there is just cause for ordering a drug test. The results have been encouraging, Ferraro says. Nontraditional methods of drug testing have been increasing as well, for reasons ranging from efficacy to convenience. In fact, “There’s been a revolution in alternative specimens,” says Douglas J. Blaine, Sr., vice president of Penn Services, a Pennsylvania-based testing company.

Urine. “Urine is still the liquid gold standard” for testing, says Blaine. Urinalysis is the method sanctioned by the U.S. Department of Transportation for testing workers in safety-sensitive positions, “because it’s easy to handle and collect, and all the work is done—the standard is there,” he says. According to the executive at the testing lab, urine tests account for more than 90 percent of the 30,000 tests the lab performs nightly. But some companies are adding tests to accompany urinalysis or substituting for urinalysis altogether. One reason is that a whole industry of products to adulterate or substitute for urine specimens has been developed. Other reasons are that urine doesn’t show same-day drug use, which makes it less effective for detecting the presence of drugs in an employee’s system when he or she is tested on reasonable suspicion of drug use or in the immediate aftermath of a workplace accident. (See the sidebar on page 52 for a chart showing the pros and cons using different types of drug testing methods.)

Hair. Drug testing labs report that they are doing more hair testing. One trend is the use of a combination of hair and urine testing for preemployment screening. That’s proving to be a “very powerful” combination since the two complement each other well, says Blaine. Unlike urine, hair can’t be tampered with, as far as experts know. It also can detect the presence of drugs much farther back in time as compared with urine—90 days versus just a few days. Employers, especially casino venues, want to find out, “Did he use drugs this weekend, and did he use [them] two months ago?” says Joseph Reilly, the president of Florida Drug Screening, Inc., and chairman of the Drug and Alcohol Testing Industry Association. But it takes a hair two weeks to grow out, meaning that an analysis of hair can’t be used to detect recent drug use. Also, hair testing is not an effective means of identifying marijuana, which shows up readily in urine. Kraft Foods uses the dual-testing approach, says Ferraro. The result is a lower frequency of positive tests and fewer substance abuse issues at the company, he says. One place where hair testing hasn’t taken root is in Canada, says Butler. That country’s human rights law stipulates that to conduct a drug test, employers need a bona fide reason directly related to an occupational requirement. “If your objective is to eliminate impairment, the test has to be able to do that,” she says. Because hair testing doesn’t identify current use, it cannot be said to be a means of testing for impairment; rather, it is only for detecting historic use.

Oral fluids. “Saliva testing is very exciting right now,” says Talbot, though it’s in its infancy. The Department of Justice (DOJ) is field-testing oral-fluid testing at police departments across the country, he says; the goal is to be able to perform a saliva test for drugs or alcohol on the roadside and have a result available in two minutes. For the corporate world, it offers great potential for post-accident testing. Some companies are starting to use this method, because they can administer it themselves as long as they use a medical review officer. A report funded by the DOJ, titled Evaluation of Saliva/Oral Fluid as an Alternate Drug Testing Specimen, concludes that “oral fluid is a promising specimen for drug testing and has several advantages over other testing specimens.” These include simplicity of collection, the noninvasiveness of the procedure, and ease of processing. But more research is necessary on how to identify whether a sample has been diluted. And for instant tests, the technology has a long way to go, says the testing lab representative.

Pupillometry.Pupilometry is the measurement of the reaction of the pupil to stimuli. It is beginning to be used to test workers for drug impairment. It works like this, according to Blaine: A person looks into a box, and a technician observes how the person’s pupils react to a series of lights. Then a urinalysis is conducted. If the urine test is clean, the reaction of the pupils to the lights is established as a baseline performance of the subject when he or she isn’t under the influence of drugs or alcohol. This “light test” then can be repeated at any time and checked against the baseline to determine impairment. The method is promising, says Blaine, but the hurdles are obvious. For example, establishing a baseline depends on more factors than just the presence or absence of alcohol or drugs in a person’s system. Also, legally prescribed drugs could affect the baseline pupil response. Moreover, a pupil response indicating impairment might reflect fatigue or some other factor, not necessarily the presence of drugs or alcohol.

Blood.As the most highly invasive measure, blood testing is still typically reserved for legal purposes or extreme cases. For example, it might be used to detect drugs in the body of a deceased worker whose family is filing a lawsuit or workers’ compensation claim. It might also be used instead of urinalysis for workers who are on dialysis. But as the basis of a regular testing program, it has too many disadvantages. For one, drugs leave the blood system quickly. In addition, the testing process is invasive and expensive, and it requires that the specimen taker employ certain precautions that are mandated for needle use. The resultant medical waste must be properly handled and incinerated, notes Blaine.

Subverting the Test
Countless products are available, especially over the Internet, to help workers beat drug tests. More than 400 on the market attempt to dilute or adulterate a specimen, according to the Department of Transportation (DOT). Others enable someone to substitute a different specimen. Their existence is no secret, but companies are often blasé about testing for adulterants either because they aren’t familiar with them or because they don’t want to incur the extra cost. Another factor, says Reilly, is that government agencies “haven’t been definitive on what labs have to do” to test for adulteration. That’s changing. In late 2004, the Department of Health and Human Services (HHS) adopted a rule requiring federal agencies to conduct so-called “specimen validity testing” to determine whether urine specimens collected under federal workplace drug testing programs had been adulterated or substituted. In an attempt to follow suit, DOT has issued a Notice of Proposed Rulemaking to make specimen validity testing mandatory. Reluctance to screen for adulterants may also be a reaction to the statistics. Quest Diagnostics’ Drug Testing Index for 2004 indicates that “oxidizing adulterants” accounted for an infinitesimal percentage—0.05 percent—of all tests of the general work force that turned up positive, and findings that a specimen was substituted accounted for only 0.49 percent. For safety-sensitive workers, those rates are 0.42 percent and 2.4 percent, respectively. The just-released figures for the first six months of 2005 show even lower rates—oxidizing adulterants turned up in less than 0.01 percent of the positive tests in the general work force and in 0.09 percent of the positive tests of safety-sensitive workers. Asked why this should be, Quest’s Dr. Barry Sample says one reason might be that the lab tests for “abnormal oxidizing activity,” which is suggestive of adulteration but not a direct test for it. In other words, the tests are imperfect and may be missing occurences. The company has seen an increase in cases where an oxidant has been found, but not in large enough quantities for the lab to conclude that a sample was adulterated. The result is an invalid specimen. Though Quest doesn’t report the number of cases in which low levels of oxidants are identified, Sample says that the number of invalid specimens has risen. That could be a sign that attempts at adulteration are up. Getting an invalid specimen requires a retest, but it successfully buys time for workers.

Policies
A drug testing program is only as effective as its policies. Unfortunately, many corporations have let their workplace substance abuse policies stagnate, says the testing lab executive. He says that of his lab’s large corporate clients hasn’t rewritten its policy, which runs less than a page, in years. The reason? “Substance abuse, once a hot topic at the forefront of the minds of many organizations, has slipped in importance” as other security priorities—like terrorism—have grabbed attention, says Ferraro. Revising policies is important, says Ramos, to keep pace with changing laws and developments. For example, he says, many companies have policies prohibiting use of drugs on company property, but don’t say anything about use of drugs on company time. This could provide a loophole for a worker to get high at home during lunch, for example. Also, Ramos says, some courts have ruled that policies that use the language “under the influence” are referring to alcohol, while “impaired” refers to drug use. Some companies have no policies at all. When companies do have policies, observes Blaine, they often fail to address what will happen to an employee who is found guilty of adulteration. Policies should specifically equate a verified adulterated test with a positive, he says, and prescribe consequences, such as requiring the user to work with the company’s employee assistance program (EAP) or referring the person to law enforcement for prosecution. There are some companies that are strengthening their drug abuse policies. For example, companies with which Ramos has worked have been moving toward harsher sanctions in their policies. When drug abuse is accompanied by theft, more businesses have been willing to prosecute. “Typically an employer wanted to just eliminate the problem and get on with business,” he says. “Now they want to send a message to existing employees and to prosecute theft by dealers; substance abuse is secondary.”

Training. Corporate policies should also mandate that staff and supervisors undergo training so that they will be able to identify signs of substance abuse and will know how and where to report it. “Often an employer puts in a beautiful policy, but then they don’t train people on it down through the levels” of the organization, says Blaine. An insufficiently or untrained low-level supervisor who suspects a worker of drug abuse may run afoul of proper procedures in dealing with the user or conducting a drug test. If the user is terminated on the basis of such a test, an arbitrator will reinstate that person, Blaine says. Management consultant Butler has seen this in Canada. She has had many companies come to her because they recognized that they had to ramp up training for their supervisors to comply with demands of new clients. Ramos’s firm also does this type of work. It performs three levels of training. At the first and second levels, executives and supervisors, respectively, learn to identify behavior and patterns emblematic of drug use or sales. The third level teaches employees about the impact of substance abuse on their work and family life, and it lays out the legal ramifications. This tiered training makes sure the message gets to the whole organization, he says. For his part, Talbot says that he teaches managers and supervisors how to document the signs and symptoms of drug impairment so that they can write a convincing fitness-for-duty report. They can use that report to impel management to order a test on the user. The ultimate question is whether all this activity has actually led to less drug abuse on the job. One indication of progress is that since Quest began reporting the percentage of drug tests that turned up positive, the number has declined markedly, from 13.6 percent in 1988 to 4.5 percent in 2004 to 4.3 percent for the first half of 2005. Ferraro isn't so sure, however. The numbers may simply indicate that employees have gotten very good at beating the tests.

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