Drug Testing

(drug testing - types of tests - urine) "Urine drug tests, which are the least expensive and most frequently used form of drug test, can generally detect marijuana use within the past week; cocaine, heroin and other “hard” drugs used within the past two days; and alcohol use within the past several hours (though alcohol is not often included in drug screens). Drug tests cannot measure frequency of use, nor do they indicate the severity of impairment or whether an individual has a substance use disorder that requires treatment. In addition, without medical review and confirmation testing on initial positive results, ²⁰ urine screens also cannot distinguish between the illicit use of street drugs and the legitimate use of certain prescription and over-the-counter drugs. For instance, a drug test cannot distinguish between prescribed Tylenol with codeine and illicit opiates. Improper testing procedures and mishandling of samples can also produce inaccurate results."

(drug testing - Fourth Amendment) "The Fourth Amendment protects the “right of the people” to be free from “unreasonable searches and seizures” by the government.¹¹ This constitutional stricture applies to all governmental action, federal, state, and local, by its own force or through the Due Process Clause of the Fourteenth Amendment.¹² Governmental conduct generally will be found to constitute a “search” for Fourth Amendment purposes where it infringes “an expectation of privacy that society is prepared to consider reasonable....”¹³ The Supreme Court, on a number of occasions, has held that government-administered drug tests are searches under the Fourth Amendment.¹⁴"

Editor's Note: Here is the 4th Amendment to the U.S. Constitution:

"The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized."

(drug testing - types of tests - community urinalysis) "Some scientists have recently turned to the sewer to develop a more accurate estimate of drug use. They examine tiny samples of raw sewage for the presence of illicit drugs and their metabolites in a science known as sewer epidemiology.⁴ These samples are essentially a diluted urine test collected from an entire community,⁵ making them akin to a “community urinalysis.”⁶ The basic science is simple: nearly every drug ingested into the body is eventually excreted and finds its way into the sewer system, allowing scientists to profile a community’s drug use based on objective data."

(drug testing - types of tests - hair) "Testing of hair rather than urine is often promoted because it is less invasive and can detect drug use over longer time periods. Hair tests cannot detect very recent drug use but do detect use that has occurred between (approximately) 10 and 90 days prior to the test (depending on the length of the hair). In addition to being more expensive than urine testing, however, hair testing raises several important concerns. As compared with urine drug tests, hair testing may more frequently result in positive results because of external (i.e. passive) exposure to drugs or chemicals. Hair treatments, such as coloring or straightening, can also affect the results of hair tests, making it more difficult to detect drug use. In addition, hair testing is not used in some Federal criminal justice proceedings because there is some evidence that naturally dark hair (e.g. that of African Americans and Asians) is more likely to test positive than lighter hair, leading to concerns of racial bias in the effects of testing programs."

(drug testing - psychological tests) "There is no psychological test that can reliably screen for substance abuse. The MAC-R Index on the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) detects only addiction potential, not current use. If someone has been addicted in the past but is currently living a sober lifestyle, that person is still likely to test positive for addiction potential as this is more a personality style instead of a measure of current status (Friedman, Lewak, Nichols, & Webb, 2001). The idea behind the Substance Abuse Subtle Screening Inventory (SASSI) (Miller, 1994) is a good one. Essentially, it is an attempt to identify substance abuse through a self-report of symptoms that are associated with substance abuse without directly asking the central question. The Michigan Alcohol Screening Test (MAST) (Selzer, 197 1) is considerably less subtle, asking questions more directly. NCS also has an Alcohol Use Inventory (Horn, Wanberg, & Foster, 1987) that it markets."

(drug testing - hemp foods) "The results of this study indicate that even extended ingestion of currently available hemp foods is not likely to produce urine samples which exceed the 50 ppb cutoff in the immunoassay screening test. The occurrence of screening positives at the 20 ppb cutoff is conceivable. However, their confirmation by GC/MS at the 10 or 15 ppb cutoff is highly unlikely."

Drug Testing - Data

(2011 - drug testing - most detected drugs) "American workers continue to use prescription opiates at relatively high levels according to Drug Testing Index™ (DTI) ... Hydrocodone and oxycodones remain the most detected prescription opiates in the U.S. general workforce, with 1.3% and 1.1% positivity rates, respectively, in the first half of 2011. Compared to 2005 levels, oxycodones are 96% higher (0.56% vs. 1.1%) and hydrocodone 47% higher (0.88% vs. 1.3%) in positive prevalence.

"According to Drug Testing Index data from urine drug tests, only marijuana, at 2.0% in the first half of 2011, holds a positivity rate higher than hydrocodone (1.3%) and oxycodones (1.1%)."

(2011 - drug testing - detection from random or post-accident testing) "Random drug testing and post-accident testing detected dramatically more positives for prescription opiates than preemployment drug testing from January 2011 through June 2011 in the U.S. general workforce. Pre-employment screening revealed a 0.85% positivity rate for hydrocodone and a 0.65% positivity rate for oxycodones. However, random drug test positivity was nearly double, at 1.6% and 1.2%, respectively. Post-accident testing for hydrocodone and oxycodones continue to reveal dramatically higher rates of positivity at 3.7% and 1.8%, respectively."

(2008, 2010 and 2011 - drug testing - cost of implementing TANF drug screening program) "Implementing a drug testing policy is costly and not a good use of taxpayer dollars. The U.S. Department of Health and Human Services analyzed the cost of drug tests among 12 states that have a drug screening program, and found that the costs for these policies were anywhere between $92,487 and $20 million. Most notably, however, is that not one of the state estimates for the cost of a drug screening program showed a net savings."

(2010-2011 - drug testing - TANF legislation) "During 2010 and the first half of 2011, legislators in 31 states have proposed 82 bills that would require drug tests of TANF applicants and/or recipients.³¹ There was also one proposal each in the U.S. House of Representatives and Senate."

"The legislative proposals identified differ in the populations that would be subject to drug testing. Of the bills, 50 State bills plus the two congressional bills would require that applicants be tested, 35 State bills would require suspicionless testing of current recipients, and an additional 26 would test current recipients for cause. In addition, while nearly all bills focus on testing adult applicants or recipients, a small minority of State bills would require youth aged 13 or older be tested and proposed legislation in one State would require that all benefit recipients, including children under 12, be tested."

Editor's Note: The source for this quote contains a comprehensive list of 2010 and 2011 federal and state legislative proposals concerning TANF drug testing, along with cost estimates from 12 states.

(2008 - drug testing - reporting disincentives) "Occupational safety and health stakeholders we interviewed and occupational health practitioners we surveyed told us that primary factors affecting the accuracy of injury and illness data include disincentives that affect workers’ decisions to report work-related injuries and illnesses and employers’ decisions to record them. ... Workers’ fear of disciplinary actions may be compounded by policies at some worksites that require workers to undergo mandatory drug testing following incidents resulting in reported injuries or illnesses, regardless of any evidence of drug use. Several labor representatives described mandatory drug testing policies as a disincentive that affects workers’ decisions to report injuries and illnesses, and 67 percent of health practitioners reported they were aware of this practice at the worksites where they treated workers in 2008."

(2008 - drug testing - arrestees) "Illegal drugs are widely used among the arrestee population. Two thirds of all arrestees tested positive for at least one substance in their system at the time of arrest and 15 percent or more in all sites test positive for more than one substance. The most common substances in all but three sites are marijuana, cocaine, opiates and methamphetamine."

(2006 - drug tests - declining positive drug test results) "The 2006 Drug Testing Index showed that positivity for amphetamines (positive test results for amphetamine and methamphetamine as a percent of all tests for the substance) declined 20 percent to hit to a new low level among federally mandated, safety-sensitive workers – 0.28 percent, down from 0.35 percent in 2005. Among the general workforce, positivity for amphetamines declined 12.5 percent – from 0.48 percent in 2005 to 0.42 percent in 2006. In addition, the number of positive tests for marijuana, as a percent of the total number of tests for the drug, was down 6.3 percent among the U.S. general workforce compared to 2005 – to 2.38 percent from 2.54 percent. The 2006 Drug Testing Index summarizes the results of more than nine million workplace drug tests performed by Quest Diagnostics between January and December 2006.

"Overall, the testing data indicated that drug use by employees and applicants fell to the lowest level since Quest Diagnostics began publishing the Drug Testing Index in 1988. Of all urine workplace drug tests performed by Quest Diagnostics during 2006 for the combined U.S. workforce, 3.8 percent had positive results, compared to 4.1 percent in 2005 and 13.6 percent in 1988."

(2003 - drug testing - testing of sheriffs) "Nearly all officers were employed by a sheriff’s office that used criminal record checks (99%), personal interviews (98%), background investigations (98%), and driving record checks (95%) (figure 4). More than 4 in 5 officers were employed by an office that used medical exams (87%), and drug tests (85%). More than two-thirds were employed by one using psychological evaluations (72%) and credit checks (69%). More than half of officers worked in sheriffs' offices using written aptitude tests (58%) and physical agility tests (54%)."

(2000 - drug testing - companies that drug test) The American Management Association in its 2000 survey on workplace surveillance and medical testing found the following percentages of companies which conduct drug tests:

Drug Testing - Impairment

(drug testing vs impairment testing) "Few employers have used impairment testing, and information concerning that experience is very limited and extremely difficult to obtain. The available information, however, indicates that impairment testing is not just a better answer on paper, but in practice as well. Employers who have used impairment testing consistently found that it reduced accidents and was accepted by employees. Moreover, these employers consistently found that it was superior to urine testing in achieving both of these objectives."

(drug testing - impairment by drug) "After drinking [alcohol], the brain works inefficiently, taking longer to receive messages from the eye; processing information becomes more difficult and instructions to the muscles are delayed. Alcohol can slow down reaction time by 10 to 30 per cent. It also reduces ability to perform two or more tasks at the same time.

"Alcohol reduces the ability to see distant objects and night vision can be reduced by 25 per cent. Blurred and double vision can also occur. Ability to perceive what is happening at the roadside is weakened. Loss of peripheral vision could be crucial. Alcohol may also create a sense of overconfidence, with the result that people are prepared to take greater risks."

(drug testing - impairment by drug) "Amphetamines are CNS stimulants and are used both medicinally and as drugs of abuse. Amphetamines are generally taken recreationally and to enhance performance (e.g., truck drivers staying awake). Ecstasy falls within this category, and as a methylated amphetamine derivative it also has hallucinogenic properties. Amphetamines have been associated with crash occurrence and could logically be associated with driving impairment both in the stimulation and withdrawal stages; in the latter case especially as the drug interacts with fatigue."

(drug testing - impairment by drug) "Antidepressants are most commonly in the form of selective serotonin uptake inhibitors (SSRIs), such as fluoxetine (Prozac®) and sertraline (Zoloft®). They can cause impairment, especially in circumstances where extremely high blood concentrations are measured or if they are taken outside of medical need or therapeutic treatment. There is also an additional risk of impairment associated with combined use with alcohol."

(drug testing - impairment by drug) "Barbiturates are still widely prescribed CNS depressants and in some cases as anti-epileptic medications. Because of their depressive effects, barbiturates are associated with delayed reaction times and possibly loss of concentration; both effects likely to affect driving performance."

(drug testing - impairment by drug) "Benzodiazepines include many widely prescribed drugs (e.g., Valium®, Xanax®) to reduce anxiety. These drugs act as CNS depressants, show cross-tolerance to ethanol, and are potentially associated with driver impairment. Different types of benzodiazepines have very short to very long half-lives. For example, the desired/therapeutic effect of lorazepam (Ativan®) is sedation, which would obviously have a detrimental effect on driving a motor vehicle. The most common benzodiazepine is diazepam (Valium®) and/or its metabolites: nordiazepam, oxazepam, and temazepam."

(drug testing - impairment by drug) "Cannabinoids have a variety of effects on humans and can be associated with stimulant, sedative, and hallucinogenic effects. Both the experimental and epidemiologic evidence on cannabinoids’ effects on driving are mixed. When marijuana is found in drivers, however, it is often in conjunction with alcohol, where an impairing effect is more likely. ... A positive metabolite result (THCA) with a negative parent compound (THC) is consistent with less recent use (e.g., in the days before sample was taken). A positive oral fluid for the parent compound is likely to be associated with very recent THC use, the timeframe consistent with potential impairing effects."

(drug testing - impairment by drug) "Cocaine, which can be used as a local anesthetic, is often abused because of its stimulating effects on the central nervous system (CNS). At low doses, cocaine might actually have performance enhancing effects; however, little is known about its effects on human performance at higher levels and in conjunction with alcohol."

(drug testing - impairment by drug) "The observations reported here, combined with past reports, indicate that diphenhydramine clearly impairs driving performance .... This study demonstrates that the firstgeneration antihistamine diphenhydramine may have an even greater impact than does alcohol on the complex task of operating an automobile."

(drug testing - impairment by drug) "Methadone, a narcotic analgesic, is used both medicinally for opiate detoxification and maintenance, and for pain relief. It has also been used as a drug of abuse. It may have differential performance effects in naïve or recreational users versus tolerant therapeutic users ..."

(drug testing - impairment by drug) "Opiates are narcotic analgesics used both medicinally and as drugs of abuse. After an initial rush, opiates act as CNS depressants and certainly could have performance-decreasing effects."

"Painkillers are a class of drugs that may lead to driving impairment. Commonly used painkillers include oxycodone (an opioid). Oxycodone has similar effects to morphine and heroin. If used in combination with other depressants of the CNS, such as alcohol or benzodiazepines, it can cause severe impairment or lead to death. Tramadol, an opiate analgesic, has similar effects to oxycodone."

(drug testing - impairment by drug) "Phencyclidine (PCP) is related to veterinary tranquilizers such as ketamine, that impair motor ability, but it also has hallucinogenic effects and is used as a recreational drug. PCP has serious performance diminishing effects and has been found in impaired-driving cases."

(drug testing - impairment by drug) "Sleep aids such as Ambien® cause drowsiness and may cause dizziness. If consumed with alcohol, there is an increased likelihood of these symptoms. Sleep aids alone or in combination with alcohol could have a detrimental effect on driving ability."

Drug Testing - Law and Policy

(drug testing - law and policy - drug testing by the federal government) "The federal government does not impose rules regulating or prohibiting testing in the private sector and instead gives direct governance to specific agencies for employees under their jurisdictions and to the states. Two federal departments (Department of Transportation and Department of Defense) require random drug testing for contractors and employees holding certain jobs and in certain circumstances (e.g., after an accident). In addition, there is a federal law (the Omnibus Transportation Employee Testing Act, Pub. L. No. 102-143) that requires testing for specific types of transit operators. For private industries, state laws cover drug testing for both job applicants and employees. The details of laws across states vary: Random testing may be explicitly prohibited but may also be required for certain jobs, such as school-bus drivers. Some states also have conditions detailing the confidentiality afforded to test results or the policies and procedures for conducting such tests (ACLU, 2000)."

(drug testing - law & policy - governmental benefits constitutional challenge) "... state or federal laws that require drug tests as a condition of receiving governmental benefits without regard to an individualized suspicion of illicit drug use may be susceptible to constitutional challenge. Drug tests historically have been considered searches for the purposes of the Fourth Amendment. The reasonableness of searches generally requires individualized suspicion, unless the government can show a special need warranting a deviation from the norm."

"The implementation of governmental assistance programs and the receipt of their benefits do not raise similar public safety concerns as those at issue in Skinner and Von Raab. In implementing these programs, the government also does not clearly act as tutor or guardian for minors, as the Court considered important in Earls and Vernonia. Finally, the evidence, at least thus far, in Lebron has failed to show a pervasive drug problem in the subset of the population subjected to suspicionless testing that strengthened the government’s interests in Earls and Vernonia."

(drug testing - law and policy - alcohol) "Although most laws concerning drug testing are at the state level, federal law must be considered when employers do test for ethanol (i.e., alcohol). The Americans with Disabilities Act (ADA) (Pub. L. No. 101-336) protects individuals with disabilities from discrimination in the workplace. Individuals with current alcohol-induced impairments and past alcohol problems are covered under the ADA. Thus, applicants cannot be tested or questioned about alcohol-use disorders until after a job offer has been made, and, even then, the law restricts when and under what conditions employees can be tested for alcohol use and other alcohol-use disorders. Moreover, employment decisions, particularly negative ones, cannot be based on these test results unless the employer can establish impairment caused by alcohol use (Hartwell, Steele, and Rodman, 1998). On the other hand, use of illegal drugs and of prescribed drugs used illegally and the drug-use disorders associated with such use are not covered under the ADA."

(families - law & policy - impact of TANF drug testing on children) "Few proposals [to drug test applicants and recipients of TANF - Temporary Assistance for Needy Families] suggest child well-being improvements as a result of drug testing, though provisions for protective payees for children’s benefits are intended to ensure funds are spent on children’s needs. Proposals that sanction families by definition reduce the income available to the family and may therefore decrease child well‐being. Sanctions and benefit decreases have been shown to increase the risk that children will be hospitalized and face food insecurity.⁴² An Idaho analysis also suggests that children may be harmed unintentionally by drug testing programs because parents may refuse to apply for benefits knowing they will face drug testing or may refuse to complete treatment.⁴³ On the other hand, deterrent effects of drug testing may lead welfare applicants to reduce drug use, with potential positive effects for children."

(drug testing - law and policy - pregnancy and drug testing) "Ferguson v. City of Charleston (2001) is an important case in the family law domain because MUSC’s [Medical University of South Carolina] policy of testing pregnant women for illegal drugs raises issues at the intersection of public health and constitutional law. The public-health aspects concern the very real and significant risks to maternal, fetal, and societal well-being of drug use during pregnancy; in addition, the policy raises constitutional questions about what constitutes a reasonable search and seizure and women’ s privacy right to reproductive autonomy. Ultimately, the case addresses how best to strike the sometimes competing interests between mothers and their unborn children.

"Although the policy was discontinued before the Supreme Court’s ruling and the Court held the policy to be unconstitutional, all the components of the decision—majority, concurring, and dissenting opinions—point to ways in which a similar policy could be designed so as to avoid the constitutional pitfalls encountered by the policy in Ferguson (2001). The petitioners won, but their victory is likely to be short lived. Recent developments in a number of states, combined with ongoing public concern about drug abuse, especially by pregnant women, suggest that despite Ferguson’s outcome, pregnant women should not feel too secure from state intervention when receiving prenatal care. Such interventions are likely to have significant consequences for pregnant women’s legal rights, as well as for their health, their fetuses’ health, and their behavior during pregnancy."

Drug Testing - Research

(drug testing - research - productivity) In a study of high tech industries, researchers found that "drug testing programs do not succeed in improving productivity. Surprisingly, companies adopting drug testing programs are found to exhibit lower levels of productivity than their counterparts that do not... Both pre-employment and random testing of workers are found to be associated with lower levels of productivity."

(drug testing - research - value of drug testing vs managerial process) "While the inquiry team could see a role for employee drug testing within safety-critical areas (although even here they were far from convinced that such drug testing was effective), there was deep scepticism as to the value of such testing more broadly. Indeed, the inquiry team noted that ‘For the most part, it is unclear that anything can be achieved through drug and alcohol testing that could not be done better through other managerial and supervisory processes’"

(drug testing - research - drug use deterrence among TANF recipients) "Some proponents of drug testing for TANF applicants and recipients support the practice because they believe testing will deter and/or detect and remediate substance abuse, which is seen as a barrier to employment. Little evidence is available to evaluate this proposition. ... Florida State University conducted an evaluation of the pilot and found that there was very little difference in employment and earnings between those who tested positive versus those who tested negative and concluded that the cost of the program did not justify the outcomes achieved and the program did not warrant full implementation.^{44, 45} The study’s a review of the research evidence concluded that drug use is not a major barrier to employment for welfare recipients.⁴⁶ The authors of the Florida study caution that a disproportionate emphasis on drug use as a barrier to employment could be ineffective if other major barriers, such as physical and mental health problems, lack of job skills, and lack of transportation, are ignored."

(drug testing - research - drug prevalence in drivers) "Analyses of the oral fluid samples obtained from daytime drivers indicated an overall drug use prevalence of 11 percent, and for nighttime drivers, 14.4 percent (Table 19). This includes illegal, prescription, and over-the-counter drugs combined. This overall difference between day and night is statistically significant (p < .01).

"In examining the prevalence of drugs by class (Table 31), marijuana was identified in 3.9 percent of daytime drivers and 6.1 percent of nighttime drivers. Sedatives were found in 1.6 percent of daytime drivers and in 0.6 percent of nighttime drivers. Conversely, stimulants were found in 1.6 percent of daytime drivers but in 3.2 percent of nighttime drivers."

Editors Note: According to the study, there was no "drug use prevalence" for 89% of daytime drivers and 85.6% of nighttime drivers. The presence of alcohol was not measured in the study. The overall prevalence for monthly illicit drug use in 2007, 8.1%, as determined by the National Survey on Drug Use and Health, falls within prevalence range of 11% to 14% for this study, considering that these two percentages also include prescription and over-the-counter drugs. Note that an estimated 5.9% of Americans were "Monthly" marijuana users in 2007 - this study detected marijuana in 6.1% of nighttime drivers.