A New Challenge for Drug-Free Workplace Programs

Current drug testing programs, following the lead of federal programs, do not identify most nonmedical prescription and synthetic drug use.

• By Robert L. DuPont, David M. Martin, Gregory E. Skipper
• Feb 01, 2012

Drug testing has evolved into a high-technology industry in the United States, one that has produced dramatic advances that allow easier and more accurate, sensitive, and specific testing. There are many settings in which the identification of drug use is important to enhance public health and safety, including the transportation industry, law enforcement, health care, the military, the nuclear power industry, and many other "safety-sensitive" industries.

Workplace drug testing also has expanded to non-safety sensitive industries, such as retail and commercial workplaces, to reduce theft, accidents, and lost productivity. Drug testing is vital for identification, treatment, and monitoring of those with addictions.

Drug testing became common in the workplace with the implementation of federal drug test requirements of the late 1980s. Although these regulations applied only to federally mandated drug and alcohol testing, they were widely used as a model for unregulated workplace programs. They focused on testing for five illegal drugs of abuse in urine: opiates/heroin, cocaine, marijuana, PCP, and amphetamines. While these federal regulations have been useful, it is past time to update workplace drug testing in the face of rapidly changing drug epidemic and rapidly evolving testing technology.

Today, many of the most commonly abused drugs are not included in federally mandated -- and many other -- drug testing programs. Prescription drug abuse is the fastest-growing drug problem in the United States. It will continue to spread internationally, as will abuse of synthetic drugs. Current drug testing programs, following the lead of federal programs, do not identify most nonmedical prescription and synthetic drug use, leaving many illegal drug users undetected and a safety threat to themselves, to the workplace, and to the public.

The Epidemic of Nonmedical Prescription Drug Use
Nonmedical prescription drug use is the defining drug problem of the 21st Century. As Gil Kerlikowske, director of the White House Office of National Drug Control Policy (ONDCP), recently said, "Prescription drug abuse is a silent epidemic that is stealing thousands of lives and tearing apart communities and families across America."

The death toll from overdoses of prescription opiates has more than tripled in the past decade. Thomas Frieden, M.D., MPH, director of the Centers for Disease Control and Prevention, recently stated that "overdoses involving prescription painkillers are at epidemic levels and now kill more Americans than heroin and cocaine combined."

Consider the following:

• In 2009, for the first time, drug overdose deaths in the United States (37,485) surpassed the number of highway crash fatalities (33,808).
• In 2008, there were more than 36,000 drug overdose deaths, equal to the number of suicides (36,035) and more than the number of homicides (17,826) in that year.
• Of all overdose deaths in 2008, 20,044 (55 percent) involved prescription drugs. Of the prescription overdose deaths, 14,800 (73.8 percent) involved opiates.
• In 2010, hydrocodone (Vicodin™, an opiate drug used to treat pain) was the most widely prescribed prescription drug in the United States.
• Sales of opiate prescription drugs quadrupled between 1999 and 2010.
• Every day, there are 5,500 first-time nonmedical users of prescription pain medicines in the United States. Every year since 2005, as many or more Americans first used prescription medicines nonmedically as first used marijuana.

These facts demonstrate a major shift in drug use in the United States and the need to update workplace drug testing programs to maintain their effectiveness.

Emergence of Synthetic Drug Use
New synthetic drugs are also known as "designer drugs" because they are "designed" to evade drug testing programs and drug laws. They are increasingly popular. In this category are synthetic marijuana, also known as spice or K2, and "bath salts." Spice and K2 are labeled as herbal incense to disguise their intended uses.

The American Association of Poison Control Centers (AAPCC) reported that in 2010, the nation's poison control centers received 2,915 calls related to synthetic marijuana and 303 calls related to bath salts. As of November 2011, the totals for calls in 2011 had increased to 6,348 for synthetic marijuana and 5,853 for bath salts. These dramatic, short-term increases in poison control assistance requests demonstrate the increases in exposures to synthetic drugs.

The Drug Enforcement Administration (DEA) recently took emergency action to schedule chemicals found in these types of products.

Identifying Drug Policy Goals for the Workplace
Drug testing programs must adapt to changing patterns of nonmedical drug use and must now focus on the prescription and synthetic drugs entering our society, including our workplaces.

The ultimate goal of workplace substance abuse prevention is to find cost-effective strategies that are compatible with our laws and values to reduce the problems caused by alcohol and drug abuse. Because most substance abusers are employed, the workplace must take the lead pushing back against illegal drug use. The widespread use of "medical marijuana" in some states and an increasing tolerance for nonmedical or "recreational" drug use in American culture threaten further large increases in drug abuse in the workplace in the coming decade.

A closer look at the current strategies for detection of nonmedical drug use and intervention strategies reveals that significant improvements are needed now to address specifically the increasing threat of nonmedical prescription and synthetic drug use.

Workplace Drug Testing: Inadequacy of Older Drug Test Panels
The federal drug-free workplace programs today follow the standards established in the 1980s. They are outdated due to their focus on urine screening alone, their limited testing panel, and the manner in which prescription drugs are managed. The National Institute on Drug Abuse specified testing of urine for the "NIDA-5": (cannabinoids [marijuana], cocaine, amphetamines/methamphetamines, opiates, and PCP). Recently, methylenedioxymethamphetamine (MDMA, or "Ecstasy") was added to the standard panel.

Even with the addition of the "rave drug" MDMA, the standard six-drug panel does not test for the emerging problem of nonmedical prescription and synthetic drug use. In addition, many non-regulated workplace drug testing programs now use "instant tests" performed on site that do not reliably detect the most commonly abused drugs, either at all or with adequate sensitivity. The types of drugs now being abused include prescription opioids, synthetic drugs, stimulants, sedatives, and over-the-counter drugs such as dextromethorphan, none of which is identified using the standard panel.

Prescriptions for Drugs of Abuse Result in Negative Tests
Not only do the changes in substance abuse present a threat to drug-free workplace programs, but the fact that physician prescriptions increasingly serve as the source of abused drugs also presents an escalating problem for workplace prevention programs.

According to federal guidelines, when a drug test is confirmed to be positive, it must be reviewed by a Medical Review Officer (MRO) before the results are reported to the employer. If the employee has a prescription for a drug that has been detected, the MRO reports a negative test result. In other words, a valid prescription results in a "passed" drug test, despite the fact that the drug may have been taken for nonmedical purposes or may have caused significant impairment.

In order to protect tested employees and fellow workers, action is required if an employee with a valid prescription is determined to be impaired by the use of prescribed medicines. In this situation, it is wise to obtain an evaluation of the employee's use of prescribed medicines by an expert in addiction medicine.

Conclusions
It costs more money to conduct frequent random tests than it does to do infrequent, scheduled tests. It costs more money to test for 20 drugs than it does for five drugs. It costs more money to go beyond urine and use new technologies.

The goals of workplace drug testing are, first, the prevention and, second, the detection of nonmedical drug use. The far larger workplace costs related to nonmedical drug use are not the costs of testing; they are the cost of the failure to identify recent illegal drug use, resulting in higher safety and health costs from increased accident rates and productivity losses.

The drug testing industry has a unique opportunity to lead in the development of smarter drug testing for the 21st Century workplace. This means going beyond the outdated six-drug panel by adding the most commonly abused prescription and synthetic drugs as routine targets for testing. It also means routinely using varying matrices, such as oral fluid, hair, nails, breath, and sweat, in addition to urine. Costs can be reduced by varying testing panels (not testing for every drug with each test) and varying matrices.

These changes, which define the future of drug testing in the United States, will rapidly spread internationally once they are widely used in the United States. The Institute for Behavior and Health, Inc. (IBH), the Drug & Alcohol Testing Industry Association (DATIA), and other organizations are promoting this movement to build on the successes of the past to lead the nation and the world into the smarter, better future of drug testing for the workplace.

This article originally appeared in the February 2012 issue of Occupational Health & Safety.