Tox Tuesday: Workplace drug testing

Drugs4_blogFor the second consecutive year, data is showing that the percentage of American workers testing positive for illicit drugs—including marijuana, cocaine and methamphetamines—is on the rise and has increased from 4.3% in 2013 to 4.7% in 2014.

The data, complied by Quest Diagnostics, took into account 6.6 million urine drug tests and 1.1 million oral fluid and hair tests performed by U.S. laboratories in the year-long period. According to the report, 2013 was the first year since 2003 in which the overall positivity rate for urine drug testing increased in the general U.S. workforce.

“American workers are increasingly testing positive for workforce drug use across almost all workforce categories and drug test specimen types. In the past, we have noted increases in prescription drug positivity rates, but now it seems illicit drug use may be on the rise, according to our data,” Dr. Barry Sample, said in Quest Diagnostics’ report. “These findings are especially concerning because they suggest that the recent focus on illicit marijuana use may be too narrow, and that other dangerous drugs are potentially making a comeback.”

Marijuana, for example, was found to be the most commonly detected illicit drug in the study, which has long held the top spot in other workplace drug testing studies as well. As stated in the article, Quest researchers also analyzed urine drug test data for the U.S. workforce from two states with recreational marijuana-use laws—Colorado and Washington. In these states, the marijuana positivity rate increased roughly parallel to the national average.

“We were surprised that marijuana positivity increased at about the same rate in Colorado and Washington as the rest of the United States in 2014, particularly given the sharp increases in the marijuana positivity rate in both of these states in the prior year,” Dr. Sample said in the article. “It’s unclear if this data suggests a leveling off in marijuana use in these particular states or if some other factor is at work.

“We also find it notable that the national marijuana positivity rate increased as much as it did in 2014 and question if this means that people are more accepting and therefore more likely to use marijuana recreationally or for therapeutic purposes than in the past even in states where marijuana’s use is not clearly sanctioned by state laws,” he added.

As for cocaine, analysis showed a steady increase in workplace positivity in all sample types collected, reversing a prolonged period of decline. Methamphetamine (including prescription drugs) and heroin positivity rates also trended upward, showing an increase across both urine and oral fluid drug testing methods.

“Our data mirrors research from the National Drug Intelligence Center which also shows that heroin use has increased markedly in recent years. While overall prevalence is low, the escalation in the detection of the 6-AM metabolite indicates heroin use may be growing,” Dr. Sample said in the article. “With the high costs associated with prescription opiates, some drug users may be turning to comparatively cheaper alternatives like heroin.”

While there are limitations to the data reported, including the selection of the testing population, which is reflective only of results from employers that perform drug testing, those involved in the study say these results should grab the attention of employers and policymakers to take notice of the risks these drugs have in terms of productivity, health and safety in the workplace.

“Many of these substances are clearly associated with impaired physical and cognitive functions… Public and private employers might want to consider revisiting existing substance abuse policies to ensure that they are taking the necessary precautions to protect their workplace, employees and businesses,” Robert DuPont, MD, former Director of the National Institute on Drug Abuse (NIDA), said in the article.

SAMSHA seeks to add oral fluid and hair testing to mandatory guidelines

In addition to these findings, new proposals regarding workplace drug testing have been introduced by the United States Substance Abuse and Mental Health Services Administration (SAMHSA) — the branch of the U.S Department of Health and Human Services responsible for regulating workplace drug testing.

The group is proposing to establish scientific and technical guidelines for the inclusion of oral fluid drug testing and hair testing in the Mandatory Guidelines for Federal Workplace Drug Testing Programs. As of now, the requirements are only related to urine testing. While both proposals are still in the “comment period,” they  aim to improve standards and make certain the best available technology for ensuring the reliability and accuracy of drug tests is being used.

As described in the proposal, oral fluid is the physiological fluid that can be collected from the oral cavity of the mouth and is comprised primarily of saliva produced by the submandibular, sublingual, and parotid glands. Drugs enter oral fluid primarily by diffusion from blood and from active drug use by oral, transmucosal, smoked, inhaled, and insufflated routes.

Oral cavity tissues have a rich blood supply and while the movement of drugs from blood (plasma) to oral fluid depends upon certain properties of the drug, oral fluid drug concentrations are closely related to that of blood. The report also states that drug transfer from blood to oral fluid is a rapid process and drugs can be detected in two to five minutes following an intravenous injection of heroin or cocaine, for example.

As outlined in the proposal, agencies choosing to use oral fluid in their drug testing program may see many benefits including a reduction in time of the collection process; an observed collection method leading to reductions in rejected, invalid, substituted, and adulterated specimens; and an effective tool in post-accident testing identifying the parent or active drug.

Implementation of oral fluid testing could also improve productivity at the workplace as administrative data indicates it takes, on average, approximately four hours from the start of the notification of the drug test, to the actual time the employee reports back to work. Also, since oral fluid collection does not have the same privacy concerns as urine collection, onsite collections are likely to reduce the time an employee is away from the worksite.

In addition, the article states that oral fluid and urine test results have been shown to be substantially similar in terms of results, and oral fluid tests come with some inherent advantages as a drug testing method. For example, oral fluid collection can lessen the risk of specimen substitution and adulteration and unlike direct observed urine tests, the collector does not need to be the same gender as the donor.

As with the proposed addition of oral fluid testing, SAMHSA is also currently soliciting comments about using hair samples for drug testing in the work place as well. Questions including what are the acceptable body locations from which to collect hair, how much hair is needed, what hair treatments (i.e., shampoo, conditioning, perm, relaxers, coloring, bleaching, straightening, hair transplant) influence drug concentrations, and several more are all a part of the request for information document.

As with oral fluid testing, hair testing eliminates some of the privacy concerns that come with urine testing and could be added to the mandatory guidelines for federal employee drug testing if decided upon by SAMHSA. The deadline to comment on the proposal for oral fluid concludes on July 14, 2015, while the period to comment on hair testing ends on July 29. From there, final guidelines will be issued and federal agencies can decide how to test based on the decided guidelines.

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